Patients
Men’s Health and Quality of Life
Urological advice is offered on men’s health issues, prostate and bladder function (including urological cancer screening), sexual function (including erectile dysfunction, loss of libido), changing quality of life with age, and the contribution of lifestyle and diet.
Many men wish to assure better health through attention to lifestyle, exercise and diet, particularly when significant medical concerns have been excluded. It is not well recognized, but these factors play a significant role in urological health. Often, advice on these matters can avert the need for medications and even surgery. Furthermore, appropriate nutritional and vitamin supplements can be beneficial.
Men (and their families) sometimes become very concerned about the possibility of prostate cancer. Screening is promoted through the media and can be requested through a General Practitioner, but it is not offered formally through the NHS refer urological cancer screening. As a result, many men are uncertain about the risks and benefits of screening, and how this might apply to individual circumstances. The wrong decision can lead to a great deal of avoidable anxiety, and even medical interventions before the implications are fully understood.
Problems and difficulties passing water can adversely (and unnecessarily) affect men’s quality of life as they get older, and they may also affect their partners. Refer Inability to pass urine & IPSS Questionnaire. It is usually straightforward to rule out serious disease and complications. Then advice can be offered to improve both symptoms and life quality.
Quality of life in men can also be adversely affected by other more general symptoms that initially may not raise undue concern but can become detrimental in the longer term. Such symptoms include erectile dysfunction and loss of libido leading to relationship difficulties, loss of vigour, drive, and mood changes affecting work performance and quality of life, as well as other physical symptoms that include sweating, aches and pains, dry skin and difficulty sleeping. Often such symptoms are attributed to work stress, relationship difficulties, travel etc. However, they can also be due to declining testosterone levels, so called testosterone-deficiency syndrome. Refer symptom assessment questionnaire - AMS. The various symptoms relate to different degrees of deficiency, and so some symptoms may be more troublesome than others while others are absent. Regardless, many of these symptoms when due to testosterone deficiency respond well to testosterone treatment. Untreated, longer term testosterone deficiency may increase the risk of osteoporosis, cardiovascular and neurological disease. Before treatment can be recommended, general medical and urological conditions must be fully assessed, potential contraindications ruled out, and subsequently while on treatment monitoring will be necessary.
Erectile Dysfunction
Erection problems (erectile dysfunction) become more common with advancing age. Sometimes this is an indication of other undiagnosed diseases, which need to be investigated. Underlying conditions associated with erectile dysfunction include cardiovascular disease, diabetes and metabolic syndrome, prostate disease, and endocrine abnormalities including thyroid disease and testosterone deficiency. Erectile dysfunction can also be caused by various medications. A variety of urological medications are available for the treatment of erectile dysfunction to suit individual needs.
Lifestyle
Lifestyle may contribute to the symptoms and problems associated with prostate disease. It is nevertheless very important to have symptoms properly diagnosed and assessed in case of unexpected complications or other unsuspected urological conditions that may be developing.
Appropriate attention to overall fluid intake as well as specific beverages may significantly improve bladder function. Other factors include daily bathroom habit, pelvic floor exercise, diet, stress and regular exercise. Basic urological investigations will guide specific advice, and in many cases it may be possible to avoid medication or other urological interventions.
Diet and Supplements
Dietary supplements and herbal remedies that are available at shops “over the counter” can help with prostatic disease – particularly benign disease – reducing symptoms, and underlying this they may sometimes favourably influence disease processes in the prostate for prostate health. Specific supplements must be appropriately selected and used at the correct dose, and it is still important to take appropriate medical advice.
Diet is an important factor in the development of prostate cancer, and there is a lot of research going on to identify the particular dietary factors that are protective, as well as those that may increase risk. There has been a lot of interest in lycopene (derived from tomato), pomegranate, vitamins A, C and E, and Selenium. Other factors include cruciferous vegetables (broccoli, cabbage etc), soy, fruits, omega fish oils, zinc, milk thistle, amongst many others. Some may reduce the growth of prostate cancer in its very early stages.
Pfeiffer Protocol
The Pfeiffer protocol offers a range of active dietary supplements that may reduce the biological activity of prostate cancer in the appropriate prescribed combination in individual patients. It has been used in combination with and as an alternative to “conventional” treatment of prostate cancer, and for some patients it appears to be beneficial. There is currently insufficient evidence to assess critically the results of this approach. The treatment protocol is available but not in the NHS, and therefore it can be an expensive option. In patients with cancer, careful medical supervision is always recommended to monitor the tumour growth. When considering alternative treatments, it is important to remember that established medical treatments are invariably recommended because there is strong evidence indicating their benefit over and against alternatives and their risks.
Evidence Based Medicine
Many medical and surgical treatments offered in the UK have been assessed by NICE (National Institute for Health and Clinical Excellence). NICE Reports that assess the benefits and risks of specific treatments are available on the internet (www.nice.org.uk). NICE also reports on some treatments that are still considered experimental: this means that there is still insufficient evidence for benefit compared with conventional treatment, but there may be some kind of advantage in some clinical situations. Usually in this situation, there are ongoing trials assessing outcome and risks of the treatment in a large group of patient volunteers. It is important to remember that the risks as well as benefits are largely undefined in relation to proven treatments, and that not all patients are suitable or eligible to enter trials.
Testosterone Deficiency
It is rarely appreciated that Testosterone is required to maintain very diverse functions in many tissues of the body, in both males and females. In males, it is necessary for normal genital development, before birth and at puberty. In adulthood, the maintenance of sexual function is only one aspect of this hormones function, in both men and women. Testosterone has an important role in the function and physiology of brain, bone, muscle, testis, cardiovascular system and metabolism. It is not surprising therefore that deficiency can produce a wide spectrum of symptoms, particularly in men, and these symptoms can be reversed by testosterone treatment.
The most immediate and obvious symptoms of testosterone deficiency include erectile dysfunction, loss of libido, loss of vigor, drive, and mood changes. These may affect work performance, quality of life and relationship difficulties. Other physical symptoms include sweating, aches and pains, dry skin and difficulty sleeping. Often such symptoms are attributed to work stress, relationship difficulties, travel etc. These symptoms can be caused by declining testosterone levels, which occurs in all men as they age, and the symptoms may start to manifest in middle age. In the longer term, testosterone deficiency may contribute to other age-related conditions and diseases, characterized as testosterone deficiency syndrome.
Symptoms acquired as a result of testosterone deficiency usually respond well to appropriate testosterone replacement treatment. The individual symptoms that an individual experiences tends to relate to the different degree of deficiency, with some symptoms being more troublesome than others. Some symptoms may be absent even in the presence of testosterone deficiency or they develop at a later stage if testosterone continues to decline. Untreated, longer term testosterone deficiency may adversely affect quality of life, and increase the risk of osteoporosis, cardiovascular and neurological disease. However, before treatment can be recommended or begun, general medical and urological condition must be fully assessed, potential contraindications ruled out, and during treatment monitoring will be necessary.
Testosterone therapy may increase the growth of prostate cancer, but testosterone is not currently thought to cause of the cancer (nearly all men have testosterone, but only 3% will die from it). Many but not all forms of testosterone treatment impair normal testicular function and fertility (and testosterone has been tested as a contraceptive). While testosterone treatment may be very effective for symptoms, occasionally side effects may develop. These include (but are not limited to) occasional breast swelling, an increase in balding (hair loss), slight testicular shrinkage, and an increase in blood count, though none of these are common with modern treatment monitoring. Since prostate cancer becomes more common with advancing age, careful monitoring is necessary to ensure it is detected and treated early. In men who have had prostate cancer, the effect of testosterone and consequences of deficiency require very careful consideration with a urological specialist.
Testosterone replacement therapy is usually carried out with skin gels, and a variety of gels are now available. These provide the most physiological levels of the hormone and are convenient and generally acceptable to most men. A minority of patients are better suited to an injectable form of testosterone. Hormone implants provide replacement for up to six months, but are least physiological and the symptomatic benefit may be somewhat unsatisfactory along with a greater tendency to side effects.
Medications that improve erectile function can be used combination with testosterone supplementation depending on the underlying diagnosis.
