WebMD Live Events Transcript
From benign enlargement to cancer, prostate problems will affect the majority of men at some point in their lives. WebMD's Sheldon Marks, MD, dscussed the latest diagnostic tools and treatment options on July 7, 2005.
The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.
Welcome to WebMD Live, Dr. Marks. Thank you for joining us today.
It's my pleasure to be here. Thank you for having me.
For the vast majority of men, probably yes. If we live long enough, men will sooner or later have some problems. For most men it will not be serious, but you just never know. The biggest problem is that some of those symptoms are very nonspecific and can actually be a warning sign of more serious problems.
The first thing and the best thing, if men could do it, would be to select different parents. Since we can't do that, then we have to look at some lesser options.
I think an intelligent diet, avoiding high-fat beef and high-fat dairy has been shown to be beneficial, a diet high in antioxidant fruits and vegetables which are basically colorful fruits and vegetables, the less cooked the better -- these have been shown to be very helpful. There are some supplements such as pygeum africanum and saw palmetto that have been shown to have some benefits. And staying in close contact with your regular physician to be sure if a problem develops you identify it and treat it early rather than waiting until it develops into a more serious problem later on.
The official recommendation is that most men, starting at age 50, should have an annual prostate exam -- a digital rectal exam that takes just a few seconds. That should be done in combination with the PSA (prostate-specific antigen) blood test.
If the man is in a high-risk category -- if he's African-American or has a family history of prostate cancer, then those tests should probably begin starting at age 40 and continue on an annual basis.
During the past few weeks I have not been able to get a firm erection. I saw my doctor on Tuesday and asked if the meds he had me on might be the problem. The meds he has me on are for leg pain -- clonazepam and amitryptiline. He told me to stop taking the amitryptiline for a while and see what happens. What do you think of this?
|"Some men have no symptoms, some men have all the symptoms, but they can be quite bothersome and can actually in certain situations become significant, causing serious problems."|
Any time I have any patient of any age who presents with erection problems, what I try to explain to them is that the erection problem is not the concern. It is usually the symptom of something far mere serious that's going on. It may be hormonal or it might be blood vessel damage of the kind that causes heart attacks. Quite often it is from medications but we have to be careful that we don't assume it's the medication and miss this opportunity to find something else.
So yes, it's reasonable to start changing the medicines around to find out if one is causing the problem. Often they do, but it's also important to be aware that there could be something else and to just get a baseline workup that usually includes evaluating the liver, the kidney function as well as thyroid function, probably a testosterone and estrogen level, and in addition to that, probably some form of evaluation of the blood vessels in the body, especially the coronary arteries that provide the blood and nutrition to the heart muscle.
I do think that it's reasonable to go ahead and alter the medications one at a time with the doctor's advice and guidance to see if perhaps one medicine is responsible and that way if you can find the culprit then they can oftentimes come up with other medications to treat the problems and yet allow you to have normal erections.
Sometimes though, the problems need to be treated with those medicines and that's where the use of Viagra, Levitra or Cialis becomes very helpful.
I am 66 and have gone through radiation treatment for prostate cancer. It took care of the problem and my PSA is back to normal. I know I can get a full erection because I wake up very early in the mornings with one. But I don't need it then. I need it at night so my wife and I can have sex.
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This is very common after radiation. The very benefits of radiation -- the damage to cells -- also damages the delicate cells within the nerves and the blood supply and that can lead to erection problems.
In this particular situation, with this added history, I would think that again, the new medications -- Cialis, Levitra and Viagra -- are an excellent option and almost always provide outstanding results to men in this scenario.
The biggest problem is that as men get older, in the face of normal testosterone levels which is part of what men have, the prostate grows. As it grows it squeezes on the urethra and that causes some degree of blockage in the majority of men as they age. This can result in a variety of symptoms. Some men have no symptoms, some men have all the symptoms, but they can be quite bothersome and can actually in certain situations become significant, causing serious problems.
The most common symptoms are waking up at night frequently to urinate, urinating frequently during the daytime and a sense of urgency to rush into the bathroom. Sometimes with even leaking of urine, called urge incontinence. Some men have lots of dribbling afterwards, sometimes they have to stand a long time and strain to start the stream and strain to finish. For men many the stream can be significantly weaker and instead of strong and steady it can wax and wane, starting and stopping. These are some of the symptoms that men can experience as the prostate enlarges and squeezes on the urethra.
The good news is if they identify these problems early there are very effective nonsurgical treatments that can work to prevent further problems and hopefully keep men out of the hospital and out of needing any surgical intervention.
What are causes of reduced ejaculate volume, consistency and frequency?
This is a very common question and it is asked frequently on the men's health message board on WebMD.
As men age the prostate changes and in a changing hormone environment, the volume of ejaculate can fluctuate and as men get older usually the amount of semen ejaculated decreases. In addition, the ability to generate those volumes goes down on a frequent basis. So young guys can have significant volumes and can have that frequently. As men age it's very normal to have less volume in the semen and it takes longer to build up to that volume. That's again, just normal aging, changes that occur as men get older.
Many times with a big gut and the increased abdominal fat, that increases the estrogen level and that alters the normal balance of hormones and can also reduce the ejaculatory volume.
So how is it treated?
The first question is do we really need to treat that? If a man is trying to father children, the first thing to do is to obtain a series of semen analysis to see if the total picture is still adequate. If there is a problem specifically relating to volume, then the way to do that would be to reduce the ejaculatory frequency to allow the body to build up enough, and also to make sure that the man is well hydrated. Other than that, I think it's just one of those things that men just need to accept, is they are not 18 anymore and there are some changes that go along with that.
That's an excellent question. The biggest problem with prostate cancer is that there really are absolutely no early warning signs. As the prostate develops the cancer they tend to be very small. They grow very slowly and this is the best time to identify it and treat it. But it's also the hardest time to find it because you're not going to usually have symptoms of obstruction, you're not going to be getting up at night, you're not going to be urinating frequently. It's very rare to have blood or any warning signs, which is why organized medicine continues to encourage all men to see their doctor for a prostate exam and PSA annually.
One of the biggest problems that I encounter is that men will go to their doctor and either refuse the prostate exam because of discomfort or embarrassment or the doctor, for reasons I still don't know, will also just not do the prostate exam and this is very, very dangerous because, again, these small little cancers are the easiest to treat and the most likely to provide a normal life span with normal cure if we can find it early. So it's important to see your doctor because there are no warning signs of early prostate cancer.
|"In general, we would start checking at age 40. But, let's say the family history is a close relative who developed prostate cancer at age 42. Then I would probably move that patient's checking up to age 30 or 35."|
How likely is it to have prostate cancer with three PSAs (prostate-specific antigen) at zero to less than one within the last nine months, and a negative bacterial culture on semen after a regimen of Cipro? Semen was blood tinged prior to culture but now is bloody.
First of all, blood in the semen, which is called hematospermia, is not a warning of anything. It may be infection, it may be cancer, but by itself it usually is meaningless. Men develop blood in the semen at varying points throughout their lives and unless it is prolonged and heavy we usually just ignore it. That in itself could be something to be concerned about only if it's a real problem but by itself is usually not a concern.
When the PSA is extremely low, as is described in this question, and consistently low, it's very, very unlikely that there will be a significant prostate cancer developing not only in the next few years but even in that person's life span. If the PSA were higher, one or two or three, and the person was young, then you would start to worry a little bit. Not only is the number itself important, but the trend of that PSA number over time. So if his PSA as he described is less than one on three separate occasions within a nine-month period, then prostate cancer is probably not going to be something he has to deal with.
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The question that comes to mind is, if his PSA is so extremely low, why is it being checked so often? One of the biggest problems that we see in urology is that people give too much power to the PSA test, don't understand it and check it too often. The PSA normally fluctuates from person to person, day to day, and even lab to lab, so it is essential that you give enough time. So even in a patient with prostate cancer, I usually will check no more often than every three or four months. If I have a patient that does not have prostate cancer and that I'm not suspicious about, then I'm usually happy to check it just once a year and if there's reasons to be concerned, maybe twice a year if there's a family history.
This particular person -- probably cancer is not going to be a problem. But again, that doesn't eliminate that they can have other problems such as prostate enlargement, infection and so on.
What role does genetics play in prostate cancer?
Prostate cancer has a definite genetic influence for a significant percent of men. We know that men who have a strong family history of prostate cancer with their fathers, grandfathers, brothers, uncles -- they are at increased risk.
There's also concern that men who have cancers in their mothers and grandmothers such as ovarian and breast cancer -- these are also hormone-related cancers -- can also be at risk.
If anybody has any of these hormone-related cancers in their family, whether breast or ovarian on the mother's side or prostate cancer on the father's side, or actually even if the mother's father had prostate cancer -- any of those diseases on either side is reason enough to start checking early and regularly both in the exam and the PSA.
How early is earlier? At what age would you begin?
In general, we would start checking at age 40. But, let's say the family history is a close relative who developed prostate cancer at age 42. Then I would probably move that patient's checking up to age 30 or 35.
But in general, for most people, since most prostate cancers occur later in life, I think age 40 is a reasonable place to start checking the PSA and exam. If there is no family history, then probably age 50.
My husband has metastatic prostate cancer. Our son, who is 44, has BPH (benign prostate hyperplasia) and a PSA of 2.9 from last October's test. In June, my husband and I attended a prostate cancer conference in Washington, D.C. and believe our son, who is at risk, needs to be tested again by a reliable urologist rather than by his internist. He lives in a small Arkansas town. How should he go about finding an outstanding urologist in the town where he resides? Should he go to the state's medical school?
This is a very common question and I think the fact that the writers of this question have gone and done their research tells us that they probably already know many of the answers.
First of all, a PSA in the high twos for a young man is a serious concern to me. We used to call 4.0 the cutoff of concern and for many experts now that's dropped down to 2.5. A young man in his 40s should have a PSA probably below one. So the fact that his PSA is 2.9 is of concern, and I do agree he needs a recheck of the PSA and evaluation by a urologist, most likely with prostate biopsies with transrectal ultrasound.
If there is not a urologist in the community that they feel comfortable with, then they should travel to the next significant city because there will be many urologists there. If they do have questions, then a good excellent resource is always the local medical school university training programs. They always have cutting-edge technology and usually well-read physicians who are able to provide state-of-the art medicine. But, just because the doctor is not at a medical school or medical center doesn't mean that he is bad.
I think the first thing would be just to talk to the local doctors and say, we need a referral and is there somebody in the nearest city who he can see and be evaluated?
I do think it's very important that he be evaluated with repeat PSAs and most likely with biopsies if the PSA is still above one and a half.
Ever since I had the cancer treatments, my prostate has dried up and I have no semen.
That is correct. Obviously if a man has the prostate removed, there will be nothing to come out because the majority of the fluid that does come out during ejaculation is from the prostate and adjacent glands called the seminal vesicles and during the surgery those are removed; so there should be nothing coming out after radiation.
The tissues are killed by the radiation. The goal is to kill the cancer cells and in so doing many of the adjacent normal prostate cells and seminal vesicles do whither up and atrophy. So after radiation, cryotherapy or many of the other conservative treatments, having no or minimal ejaculate is considered the norm.
|"One thing to remember is that anything that happens from the base of the bladder all the way out to the tip of the penis is felt as urethral, penile pain."|
I've heard that following a radical prostatectomy some men find masturbation more pleasurable than intercourse. Is this true and why?
My answer to this would be that it's very individual. I had not heard this before, but it may have to do with the fact that after surgery, there may be a compromise to some of the nerves and there may be a need for more physical stimulation to achieve the same level of satisfaction. So that is something that is totally individual and will depend on the person and their relationships and specifically the treatment and how effective it was and what injury may have occurred at the time.
I've been seeing my urologist for a couple of months now and he says I have prostatitis. He put me on Cipro XR 1,000 milligrams and I think it's finally working. But when I pinch my penis, the tube and back up to the head, I still feel some discomfort. Is there anything you can tell me? This is very depressing. Also, my semen is still a little clumpy, but not like it was.
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Prostatitis is a name applied to a significant number of different problems. Prostatitis can be a bacterial infection of the prostate from any one of dozens of different bacteria, it can be viral and sometimes it's just an inflammatory irritation.
The nice thing about Cipro and other antibiotics in that category is not only do they kill most of the germs that live within the prostatic tissue and fluid, but there's also an anti-inflammatory component.
What we often do with men that have prostatitis is not only do we use a long course of antibiotics, such as Cipro, but we also usually add additional anti-inflammatory medications for the very reason he describes in that sometimes there's continued irritation of the urethra and prostate from the swelling that goes along with the infection. Whether the doctor uses over-the-counter anti- inflammatory medications such as ibuprofen or whether it is prescription medication such as Celebrex, the doctor will have to individualize the treatment for that particular person. Oftentimes these anti-inflammatory medications help significantly.
One thing to remember is that anything that happens from the base of the bladder all the way out to the tip of the penis is felt as urethral, penile pain. So pain in the prostatic urethra is felt out towards the tip. A bladder stone can be felt as pain in the tip, a kidney stone passing can even be felt as pain in the tip of the penis. The fact that he is feeling pain along the urethra suggests that there's probably still some inflammation going on and if he continues to have this he should talk to his doctor to follow up.
In addition, there are medications that are topical anesthetics that will numb the urethral lining and possibly improve his symptoms as well.
I'm 24 years old and about four to six months ago I started getting up once in the middle of the night to urinate. At first it was every so often but now it's happening every night, once a night. I stay away from drinking large amounts of fluid two hours before I go to bed. During the day I go every two or three hours depending on the amount of fluid I intake. Is it normal for me to be going like this? I don't want to continue losing out on sleep.
He is right to be concerned because most 24-year-olds do not wake up once at night to urinate. Even men in their 40s, 50s, and 60s aren't happy if they have to start waking up once at night every night. The fact that he is getting up makes me wonder.
Stopping fluids two hours before bedtime is a good start. If he is drinking a lot of caffeinated drinks such as coffee, tea or cola drinks or having alcohol such as beer or wine -- those stimulate the production of fluid. So even if he stops two hours before bedtime, his body is still producing the fluid, then he goes to bed, the kidneys continue to produce the excess fluid, and then when he hits a critical amount in the bladder, he gets the message he has to go and wakes up to go. I would strongly suggest that he not only look at the timing of the fluids but what it is he is drinking and consider cutting back dramatically on any alcohol or caffeinated beverages starting in the late afternoon as well as cutting back on the volume in late afternoon.
Let's talk a bit about some of the treatment options that a man might have if he does have prostate cancer. Where do you begin?
The first thing we need to know is the particulars of that cancer. Each person that has this cancer is different and each cancer is different. Some are high grade, some are low grade, some are regressive, some are nonaggressive, some are large volume, some are small volume. All of these factors need to be taken into account with the individual characteristics of that particular patient.
We need to know the family history and the longevity in the family. If the parents are still alive in their late 80s, then clearly if he is in his 60s we have a lot of work ahead of us to be sure we keep him alive for his normal expected life span.
We take into account his health. Has he had heart problems? Is he diabetic? Is he a distance runner? All of these factors play into deciding which treatments are best.
At this point, if he can tolerate it, surgery is still the gold standard against which all other treatments are measured. Surgery provides the best long-term cure and disease-free time, but the benefits really don't kick in usually for seven to ten years. Up until that point almost all the treatments are fairly effective. So, if you are young and you have a long life span ahead of you, then for the vast majority, removing the cancer is still the best option.
Radiation, external beam therapy, is an excellent second choice. With new techniques of IMRT or intensity modulated radiation therapy, the ability to get much higher doses with much lower side effects is becoming commonplace now. Instead of having several large beams that overlap in the vicinity of the prostate, the radiation therapists are now able to literally paint the prostate with thousands of pencil-size beams which allows you to get a much higher dose to the gland which provides better killing of the cancer, and a much lower dose to surrounding tissues, so fewer side effects.
In addition to that, radioactive seeds are also a very viable treatment option for many. The doctors will place radioactive pellets -- like little rice particles that are radioactive - into the prostate. Each of these releases a significant amount of radiation, specifically to a particular area, and that also kills the cancer cells.
Cryotherapy is another good option for many men where the prostate gland, instead of being destroyed with radiation or removed, is frozen and the cancer cells and all the tissue cells are frozen and effectively die. That is a very good option not only for men in particular grades and stages of cancer but even if they have radiation failure.
In addition to that, if the cancers are more aggressive, we oftentimes use a combination of therapies. We can also add on hormone therapy, which reduces the cancer's ability to grow because these prostate cancers almost always lead the male hormone testosterone to grow.
And lastly, chemotherapy -- which for many years wasn't good for prostate cancer. Now there have been major breakthroughs that show that certain regimens in combination with some of the other treatments mentioned do provide significant benefits in life span and quality of life.
So it's all very individualized. It's essential not to see ten different options as confusion, but just the ability to be fortunate that they have choices. There are so many other cancers out there where if you have cancer A, you get treatment A, and there aren't a lot of choices. With prostate cancer, because it is so varied and because we have so many options, we can provide a number of choices so that each patient can choose the treatment that they feel most comfortable with.
|"It's important for him to not only monitor his PSA levels to make sure the cancer isn't coming back, but also to be monitoring the testosterone levels because that can be a warning sign. If the testosterone comes back and jumps up rapidly and the PSA follows, then we know that he needs to go back on some hormone therapy."|
I'm 68 years old and have had two heart attacks. I'm not sure about undergoing surgery. What do you think about watchful waiting?
Watchful waiting is a reasonable treatment for prostate cancer only if the odds are great you're going to die of something else before the cancer can hurt you. So, even though this writer has had two heart attacks, the question is -- what's his longevity? Some men with heart attacks are walking on thin ice and may not survive very long. Other men have a heart attack and 30 years later are still viable, healthy, happy people. So the specifics of the heart attack need to be addressed with the cardiologist.
The great news is that all these other treatments like the IMRT, radioactive seeds or cryotherapy provide very good treatments with very little risk.
The problem with watchful waiting is that if a man has a significant cancer and does nothing, the cancer will continue to grow. If it grows and becomes a problem, usually it's much harder to treat later on than it would have been early on. So we primarily reserve watchful waiting for small volumes of low-grade cancer in elderly men who are likely to die of something else normally, or in men who have such significant health problems that any of the treatments are a threat to them. So, for the majority of men, we're not too happy with watchful waiting.
Now, the question comes up -- how long can we go with watchful waiting? And the answer is probably if it's a low-grade small cancer, you might be able to go years. Studies have show that you can go out 10, 14 years. The problem is, the majority of men, if they live long enough, will still die of prostate cancer. It may be 14 to 17 years later, but these cancers are still growing and they still, no matter how small or benign they are early on, they move in the wrong direction. They become larger and more aggressive.
So he should talk to his urologist and his cardiologist and ideally have the two doctors talk to determine what treatments are reasonable, if any, and in what time frame.
How does Casodex affect the liver? My husband was on hormone therapy for four months due to a PSA of 0.4 after prostatectomy and after the hormone therapy his ALT (alanine aminotransferase) liver function was elevated at 70. Should we be concerned?
The Casodex is an antiandrogen and what it does is it changes the cancer cell's ability to identify and use the male hormone testosterone to make the changes that stimulate cancers to grow. So it's kind of like putting blinders on the cancer cells. The testosterone is still there. The cancer cell just doesn't see it.
As with all medications, from aspirin all the way up to the most dangerous medicines, there's always potential for side effects. With antiandrogens, one of the risks is that it can injure the liver cells.
A particular level of 70 for some men may be of minimal concern; for others it could be significant. So it's important that the doctors who placed him on the Casodex have monitored the liver function tests over a period of time and discussed this with the primary care physician, and if necessary, a liver specialist, to see if this particular test is at a level of concern and if it's moving in a direction that's not favorable. If it's been 70 on three separate checks, he is doing well with it and the doctors are comfortable watching, then that's totally fine. If it was 28 and then 45 and now at 70 and there's concern -- there are other antiandrogens and other hormonal treatment options that can be used instead of the Casodex.
My husband has been off Lupron and Casodex since May 15 but is still experiencing hot flashes. How long will this continue?
To understand how long it will continue, we need to take a moment and look at how these treatments work. Lupron, Zoladex and Eligard -- all of these medicines are designed to drop the testosterone levels down as if the man had been castrated. It's a chemical castration.
The advantage to these injections is that it's reversible in the majority. What we know, from research, is that the testosterone does not come back immediately upon completion of the medicine. In fact, men who have been on these medicines for years, oftentimes it can take years for the testosterone to return. So the fact that he just stopped it a short time ago, I'm not surprised he is still having hot flashes, which is a common side effect when the testosterone level is low. It may take months or it may be even years before the hot flashes go away. The good news is as the testosterone levels return slowly, the hot flashes will also start to dissipate.
It's important for him to not only monitor his PSA levels to make sure the cancer isn't coming back, but also to be monitoring the testosterone levels because that can be a warning sign. If the testosterone comes back and jumps up rapidly and the PSA follows, then we know that he needs to go back on some hormone therapy.
What is the life expectancy of someone in the fourth stage of prostate cancer?
Well, it's very hard to say because there are so many factors that enter into determining potential life span. I do know that I have had patients that almost 20 years ago had very aggressive prostate cancers and are still alive today. Some of those men still have cancer but it's not significant in their life span. I know of other men that had very small volumes of low-grade cancer and died of that cancer within six months.
The good news is that with current aggressive therapies -- with hormone therapy, with total antigen blockade as we discussed with antiandrogens, and with some of the amazing advances not only in chemotherapy but also vaccine therapy, the life span can be many, many years.
I would say for most patients, five or ten years is not uncommon and it could be even quite longer. Again, it has to be individualized and it can be short depending on the aggressiveness of the cancer, where it's coming from, and the general health and immune status of the patient.
Why would a urologist choose hormonal therapy as opposed to chemotherapy? What goes into the decision-making process as to choosing a therapy?
Each therapy has its pros and cons and we know which therapies are most likely to be effective and which ones have a lesser chance for effectiveness. We also look at the side effect profile.
We have known for many, many years that when we drop the testosterone level to castrate levels, which is less than 20, that the vast majority of prostate cancers stop growing and many will actually shrivel up. This is an extremely effective treatment with the side effects being mostly nuisance side effects, very few really serious side effects. Because of that hormone therapy is usually the primary treatment for advanced disease.
Chemotherapy for many years was not very good for prostate cancer and only recently has been shown to be effective in certain cases. What I like to do is initiate the hormone therapy, be as aggressive as we can with that, and try to include the medical oncologists to talk to us about whether or not they think that adding on chemotherapy will be a benefit. The down side to chemotherapy is it's basically a growth poison; it's designed to kill rapidly growing cells at critical points in the growth cycle. Because of that, there's a potential for significant side effects and a potential for serious damage to the immune system. So chemotherapy is not to be taken lightly.
Because hormone therapy is so effective and chemotherapy is less effective and has more side effects, hormone therapy is usually the No. 1 treatment. Sometimes we add on chemo, sometimes we wait. I think that with current advances, I like to at least involve chemotherapy discussions early on.
|"I think that an annual PSA, an annual exam, a healthy diet and lifestyle choices are the best chances for living a long, healthy life."|
Do you have any recommendations for nutritional supplements or vitamins to use for the prevention of prostate cancer? I've read articles about saw palmetto and soy protein for men.
This is a common question as to what supplements men can take. Before we get into talking about supplements, I'd like to emphasize that we're going to be talking about just that - supplements. Not something that's designed to replace an intelligent lifestyle and diet, but something designed to supplement and augment an intelligent lifestyle and diet. So it's essential that people not smoke, that they only drink in moderation, they get regular exercise, sleep, a little bit of sunshine every day, and they eat a general well-balanced diet.
The good news is that diets that are proven to be beneficial for the heart, such as a southern Mediterranean diet or a rural Asian diet, have also been shown to be very beneficial in preventing prostate cancer and even in treatment of prostate cancer. So assuming the man is behaving well, he is not abusing his body with chemicals and drugs and he is eating a good balanced diet, high in colorful fruits and vegetables, low in animal fat and dairy fat, then there are indeed some supplements that have shown to be beneficial.
The first one is selenium. The official recommendations of the government tend to be significantly lower than what most experts believe. Most experts are currently recommending 200 micrograms a day of selenium. This is something that in the old days was in the soil absorbed by the plants and we got it through our food. But now with controlling the water and the silt from the soils and with artificial fertilizers, we find that the diet we have tends to be very low in selenium, especially in the Northeast, the South, and the Northwest. If you supplement your diet with one selenium a day, there are many experts that feel strongly that this can dramatically reduce your likelihood of developing not only prostate cancer but colon and lung cancer. Selenium is also suggested to strengthen the heart, boost the immune system, and to slow down the damage from aging. It's shown to be a very powerful and fairly safe supplement when used intelligently. Obviously, high doses can be very toxic as with almost anything that we take so just because one is good does not mean 27 are great.
Another supplement that's been shown to be very good is vitamin E. The problem with vitamin E is that there's potential for side effects with it. Nobody should be taking the supplements without talking to their doctors first. There are some concerns about vitamin E and heart risks. Assuming your doctor gives you clearance, vitamin E, the natural version, the d-alpha, not dl-alpha, may be very beneficial as well.
We usually suggest that men also take a multivitamin with trace minerals as part of their daily regimen. In addition to that, some men like to supplement their diet with a variety of fruit and vegetable extracts such as lycopene which comes from tomatoes or saw palmetto, which really is designed mostly just to shrink the prostate, it doesn't have an impact on cancer. Some men will also use green tea extract or red grape extract.
Again, the ideal form of most of these supplements would be the natural foods and not so much the pills you buy at the store. These, in combination with a healthy lifestyle and a well-balanced southern Mediterranean diet or rural Asian diet, are the most important factors.
What do you see in the future for prostate health?
I think that probably we're going to find that we can detect these cancers significantly earlier in life, and we'll be able to tell which cancers are going to be a threat and which ones aren't. In addition, with the advances in radiation that we have, with the IMRT, with the chemotherapy advances, and most importantly with the vaccine therapies, what we're going to have probably is when a man is diagnosed with a cancer, they are probably going to be some treatment where they will basically stimulate the man's own immune system to identify and kill off all the cancer cells -- hopefully eliminating the need for surgery and radiation and more aggressive treatments with higher side effect profiles.
Doctor, we're almost out of time. Before we wrap things up for the day, do you have any final comments for us?
I would just like to encourage everybody to look at the big picture, to pursue a healthy lifestyle with a healthy diet, and to see their doctor on a regular basis and ask for the exam and the PSA.
There are some out there that say that the PSA has the potential for problems because it doesn't always guarantee that there's cancer and that is right. But I look at it that I'd rather have more information and determine what's relevant and what's not than to not have the information and hope that things are fine.
I think that an annual PSA, an annual exam, a healthy diet and lifestyle choices are the best chances for living a long, healthy life.
Our thanks to Sheldon Marks, MD, for joining us today. Thank you so much, Dr. Marks.
My pleasure. Thank you for having me here.
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