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Science Daily — A new study analyzing men with localized prostate cancer shows that the specialty of the physician they see can influence the type of therapy they ultimately receive. The study, co-led by a urologist and a radiation oncologist at Memorial Sloan-Kettering Cancer Center, found that patients aged 65 to 69 years old who consult a urologist are more likely to undergo surgery to remove the prostate, while those who consult a radiation oncologist and a urologist, regardless of age, usually receive radiation therapy.

“These practice patterns are no surprise but are notable because specialists who treat prostate cancer tend to favor the treatment they themselves deliver, despite the fact that no one has shown one treatment for early stage prostate cancer to be better than another,” said Thomas L. Jang, MD, MPH, a physician in the Department of Urology, at Memorial Sloan-Kettering and co-lead author of the study. “It is very important for patients to receive an unbiased, balanced erectile dysfunction remedy on the full range of treatments.”

The study, presented at the annual meeting of the American Society of Clinical Condition dysfunction erectile more treatment, reviewed the records of 85,088 men aged 65 and older who were diagnosed with prostate cancer between 1994 and 2002 using erectile dysfunction home remedy from the SEER (Surveillance, Epidemiology, and End Results) Medicare-linked database to determine the type of specialist they saw and the therapy they received. The treatments included radical herbal remedy for erectile dysfunction (surgery to remove the prostate), radiation therapy, primary androgen deprivation (hormone) therapy, and expectant management (watchful waiting).

Among the men in the study, 50 percent were seen exclusively by a urologist; 44 percent by both a radiation oncologist and urologist; 3 percent by both a medical oncologist and urologist; and 3 percent by all three specialists. A high correlation was observed between the specialist patients saw and the treatment they received. This was especially true in the younger men aged 65 to 69 year old where 70 percent of men who saw only a urologist had a radical prostatectomy. However, if men in this group saw a radiation oncologist and a urologist, 78 percent had radiation therapy. If the men saw a medical oncologist and urologist, 53 percent had a prostatectomy and an almost equivalent number had either radiation therapy (17 percent), expectant management (16 percent), or primary androgen deprivation therapy (14 percent).

“Because outcomes for men are similar whether they have surgery or radiation therapy, there are often other factors that a patient considers when deciding their most optimal treatment,” said Justin Bekelman, MD, a physician in the Department of Radiation Oncology at Memorial Sloan-Kettering and co-lead author of the study. “When speaking with physicians who have particular expertise in prostate cancer — be they urologists, radiation oncologists, or medical oncologists — men should seek a balanced perspective on the risks and benefits of all available therapeutic options.”

“The treatments for early stage prostate cancer have different side effects, different recovery profiles, and involve a different commitment of time,” said Deb Schrag, MD, a medical oncologist and health services researcher in Memorial Sloan-Kettering Cancer Center’s Department of Epidemiology and Biostatistics and the study’s senior author. “It is imperative that men be advised about the details of all options so that they can make an informed decision that is right for them.”

In 2007, the American Cancer Society predicts that 218,890 men will be diagnosed with prostate cancer. The 5-year relative survival rate for men with localized prostate cancer is nearly 100 percent. Treatment side effects vary. The most common are urinary incontinence and erectile dysfunction for prostatectomy; diarrhea and erectile dysfunction for radiation therapy; loss of libido, hot flashes and breast tenderness for hormone therapy. There are no physical side effects associated with watchful waiting.

Drs. Peter T. Scardino, Michael J. Zelefsky, Colin B. Begg, Peter B. Bach, Elena B. Elkin, Ethan M. Basch, and Yihai Liu of Memorial Sloan-Kettering erectile dysfunction impotence medication in this study. It was funded, in part, by grants from the National Institutes of Health and the National Cancer Institute.

Note: This story has been adapted from material provided by Memorial Sloan-Kettering Cancer Center.

Science Daily — STANFORD — Urologists at Stanford are evaluating a new surgical tool that can help spare men from becoming impotent after surgery for localized prostate cancer.

The new tool aids surgeons in pinpointing the microscopic nerves around the prostate that control sexual function, so that they can avoid damaging these nerves during prostate removal, said James Brooks, MD, an assistant professor of urology who is dysfunction erectile help
in a national, multi-center study of the device.

“It’s a useful tool to help us locate those nerves and decrease the side effects of the operation. I think it has great potential for decreasing impotence after radical prostatectomy prostate removal,” said Brooks, who practices with the Stanford Urology Clinic, part of UCSF Stanford Health Care.

The device, approved one year ago by the Food and Drug Administration, works by delivering a low-level electrical stimulus to the nerves around the prostate and then measuring the erection response. Through this process, the device helps produce a map of these critical nerves, which are invisible to the naked eye, so that doctors can navigate around them during surgery.

By simplifying an otherwise challenging surgical procedure, the new tool ultimately could make caffeine impotence surgeries much more widely available to prostate cancer patients, Brooks said.

“Doctors will be able to figure out where the nerves are, map them out and save them,” he said. “So I think this will be a boon to surgery.”

Men with cancers that have spread beyond the prostate are not candidates for nerve-sparing procedures, he noted.

Brooks is currently the only physician in Northern California who is using the new device, which is being evaluated on a large scale at 21 medical centers across the country. The device, called the CaverMap Surgical Aid, is made by UroMed, a biomedical company in Needham, Mass.

Vital statistics

The prostate is a walnut-sized organ that sits in a nest of blood vessels just below the bladder. Prostate cancer is the most common form of cancer among men, causing some 40,000 deaths each year in the United States. Every year, approximately 150,000 American men are newly diagnosed with the cancer. The incidence of prostate cancer has risen in the last decade, Brooks said.

Surgery is now the treatment of choice for those cancers that have not yet spread beyond the prostate. Studies have shown that men who undergo surgery have a better chance of long-term survival than those treated with other options, such as radiation, Brooks said.

But prostate surgery can also have some devastating consequences, leaving the patient impotent and/or incontinent.

That has been changing with the advent of new technologies and surgical refinements, Brooks said. The field of prostate surgery took a major leap forward in 1982, when Patrick Walsh, MD, a urologic surgeon at Johns Hopkins Medical Center in Baltimore, discovered that the nerves controlling erections do not pass through the prostate, as previously thought, but are instead situated alongside the prostate. By 1984, Walsh had developed a new technique — called nerve-sparing radical prostatectomy — that enabled him to preserve sexual function in a large percentage of his prostate cancer patients.

Brooks worked with Walsh for nine years before coming to Stanford a year ago.

Results vary

While many urologists now use nerve-sparing procedures, the results vary widely depending upon the skill of the surgeon, the age of the patient and other factors, according to published reports. In studies of patients undergoing such procedures, reported rates of success in preserving sexual function have ranged from 11 to 86 percent.

A newly published study from the University of Toronto suggests that doctors may get erectile symptom
good results in nerve preservation through use of the CaverMap Surgical Aid. In the study, described in the October 1998 issue of the GOLD Journal of Urology, the Toronto researchers were able to preserve potency in 16 out of 17 men, or 94 percent of patients whose prostatectomies involved use of the new tool.

At Stanford, Brooks began testing the device in September. Already, he has applied it during surgery on three patients. While Brooks said it’s too soon to tell whether these men have retained erectile function, he noted that tests conducted immediately after the surgery showed that the critical nerves remained intact in each case.

Mapping procedure

The device consists of a white surgical wand with a flexible tip that delivers an electrical stimulus of up to 20 milliamps to the tissue around the prostate. A separate, fluid-filled ring that is placed around the penis can detect even the slightest erectile swelling in response to the stimulus.

The physician typically begins locating the critical nerves by placing the tip of the wand at the end of the prostate, then moving it to the middle and finally to the base of the organ. This effectively produces a map of the key nerves involved in erectile function, Brooks said.

The patient, under general anesthetic, feels nothing, he said.

After the prostate has been removed, the physician can retest the nerves to confirm that they have been spared, Brooks said. Most men take months to regain erectile function after any prostate surgery because of the trauma to the region, he noted.

Use of the nerve-finding device adds about an hour to the standard surgical procedure, for a total of about three hours, Brooks said.

Studies by others have shown that cure rates for localized prostate cancer are the same whether doctors perform a traditional surgery or use the nerve-sparing approach, he said.

Preventive efforts

While participating in the CaverMap clinical trials, Brooks is also conducting basic research on a new approach for preventing prostate cancer. He is studying specific enzymes that defend against cancer-causing toxins, in the hope that these might form the basis for a new drug or dietary agent to prevent the disease. The enzyme research is supported by a $300,000 Doris Duke Clinical Scientist Award, which Brooks received in August.

* * *

UCSF Stanford Health Care is a private, nonprofit organization formed in November 1997 to bring together the erectile dysfunction
services of Stanford University and the University of California-San Francisco.

Note: This story has been adapted from material provided by Stanford University Medical Center.

Science Daily — The kids. The job. The house. The cell phone, blackberry and email. With all the erectile help many women juggle, there is often no time for romance, and in many cases, even less desire. Well over a third (40 – 45%) of adult women experience at least one symptom of sexual penis erection problem
, and few feel they can talk about it.

UCSD researchers are working to change the condition and this way of thinking. “Women who have sexual dysfunction should realize this may be a treatable condition, not just a personal problem,” says Thuy-Tien L. Dam, M.D. of the UCSD Department of Family and Preventive Medicine. “Many women don’t know that other women experience this too, and that it might be a new erectile dysfunction medication disorder called Hypoactive Sexual Desire Disorder or HSDD.”

Dam, clinical director at UCSD Prevention Studies, is conducting a clinical trial to see whether an investigational drug is safe and effective for women with low sexual desire. HSDD is the most common form of female sexual dysfunction, characterized by decreased sexual thoughts and feelings as well as a loss of desire for sex. About 17% to 55% of women have low levels of sexual interest, depending on age.

“Candidates for the study are women who have desire problems; women who once had a healthy sex-drive who now notice a big difference in desire level, for some unknown reason,” says Dam. “If we can understand the physiologic process of what’s happening, we can tailor the treatment specifically for that.”

Studies have shown that erectile dysfunction in men is sometimes caused by a physiologic problem, such as reduced blood flow. There is a school of thought that perhaps physiologic changes in the female brain may be associated with female sexual dysfunction.

While male erectile dysfunction is widely known, publicly discussed and treated, the U.S. Food and Drug Administration has not approved any investigational drugs for treating similar disorders in women. This study is an important step in the dysfunction help
options to help women regain a satisfactory sex life, and to be able to talk about it, said Dam.

Women who may qualify for this study:

• are premenopausal, 18 years of age and older;
• are using a medically approved form of birth control or are surgically sterile;
• are not nursing or pregnant;
• have experienced a loss of sexual desire for at least 6 months;
• have been in a stable, heterosexual, monogamous relationship for at least 1 year;
• are not taking an antidepressant.

Approximately 30 women will be enrolled at UCSD Prevention Studies. A total of 1,400 women are expected to enroll at 75 sites in the Unites States and Canada. Potential patients please contact the study coordinator at (858) 534-0950.

Note: This story has been adapted from material provided by University Of California - San Diego.

Science Daily — More than eight million men are at risk for erectile dysfunction (ED) induced by Type II (insulin resistant) diabetes. While the exact mechanism(s) involved in diabetes mellitus induced erectile dysfunction (DMED) is not yet understood, a team of researchers has hypothesized that certain proteins may regulate penile vascular tone increasing sensitivity to the action of vasoconstrictor agents. Their findings suggest that protein kinase C (PKC) may contribute to an enhanced vasoconstriction of the penile circulation and reduced erectile response.

Constriction of the penile vasculature prevents erection and is largely mediated by two agents: a-adrenergic agonists or endothelin (ET-1). These agents cause vasoconstriction by activating phospholipase C (PLC) and result in the generation of inositol triphosphate (IP3) and diacylglycerol (DAG). This pathway is believed to recruit PKC in the constrictor response. Researchers have tested the hypothesis that in diabetic-obese Zucker rats, there is a depressed erectile response caused by increased action of the vasoconstrictor pathway involving PKC in a key sensitization process.

A New Study

The authors of a new study entitled “Altered Penile Vascular Reactivity and Erection of the Zucker Rat: A Role for PKC Ca2+ Sensitization,” are Christopher J. Wingard, Delores Young, Katherine Lane and Shadhid Husain, all of the Department of Physiology, the Medical College of Georgia, Augusta, GA. They will present their findings during the upcoming scientific conference, Understanding Renal and Cause and treatment of erectile dysfunction Function Through Physiological Genomics, a meeting of the American Physiological Society (APS) (http://www.the-aps.org), being held October 1-4, 2003 at the Radisson Riverfront Hotel and Convention Center, Augusta, GA.

Methodology

The researchers examined the erectile response (ICP/MAP) to pelvic ganglion stimulation using lean and obese-diabetic Zucker rats. Their methodology included:

Erectile Response Measurements: Lean or obese-diabetic male rats between 15-18 weeks of age were used. The animals were anesthetized and the left carotid artery cannulated to continuously monitor the mean arterial pressure (MAP). The right corpus cavernosum was cannulated to permit continuous monitoring of erectile dysfunction impotence medication pressure (ICP) and the left corpus cavernosum was cannulated to allow for administration of vasoactive compounds. Bipolar electrodes were positioned on the right major pelvic ganglion (MPG) and, during the experiment, stimulatory voltages applied to the MPG ranged from 1 to 6 volts delivered in 5 msec pulses at a frequency of 12 Hz. The duration of stimulation was 1 minute with rest periods of 5 minutes between subsequent stimulations.

Isolated Cavernosal Tissue Force Measurements: Cavernosal strips were bathed in a physiological salt solution and gassed with breathing air. Strips were mounted at lengths that allow maximal force generation during potassium-depolarization. Cumulative dose response curves for the a-adrenergic agonist phenylephrine, (PE) 0.1-10 mM and ET-1 (0.01-10 mM) were preformed. Cumulative dose-response protocols were completed either in the absence (Control) or presence of PKC inhibitor Chelerythrine (10 mM). Tissues were incubated with the inhibitor for 30 minutes prior the completion of the dose-response protocol.

Western Blotting: Equal amounts of proteins were separated on 10% SDS-PAGE and transferred to herbal remedy for erectile dysfunction membranes followed by incubation with anti-PKC and Rho-kinase isoforms or RhoA antibodies for 3 h at 20 C. After washing, the membranes were incubated with secondary antibodies for 1 h at 20 C. For chemiluminescent detection, the membranes were treated with enhanced chemiluminescent (ECL) reagent and subsequently exposed to ECL hyperfilm.

Quantification of Protein of Interest: The densities of the protein bands were determined by scanning with a densitometer. Specific immunoreactive bands were expressed as arbitrary units (AU), which were calculated from the area of peak of selected band scanned by the densitometer. The density values were normalized to the protein content of b-actin and expressed relative to those determined from the lean tissues. Data were analyzed using analysis of variance (ANOVA) with post hoc comparisons; statistical significance was set at P < 0.05.

Results

The researchers observed that:

* erectile response of the obese animals was suppressed by >30 percent at voltages >3;

* maximal contractile response of tissues from obese-diabetic animals was increased by 25% for PE and 35% for ET-1 stimulations. However, there was no significant shift in the sensitivity to these agonists when comparing calculated EC50’s for lean and diabetic-obese tissues;

* PKC inhibitor Chelerythrine inhibited more than 70 percent of the force generated by ET-1 in tissues from the obese-diabetic animals while only blocking 30 percent of the phenylephrine induced force generation;

* obese-diabetic corpus cavernosum showed increased protein expression of PKC isozymes a, d and Rho-kinase b.

Conclusions

These results suggest that PKCs may contribute to a vasoconstriction of the penile circulation, and to reduced erectile response in the diabetic-obese Zucker rat. Future research is aimed at identifying the specific elements in the signaling pathway involving PKC and controlling the constrictive behavior of the penile vasculature. Such findings, by adding to the prostate cancer impotence of how constrictor agonists play a role in DMED, will eventually make a significant contribution to the treatment methods for those who display the hallmarks of obesity-induced hypertension and diabetes.

The American Physiological Society (APS) is one of the world’s most prestigious organizations for physiological scientists. These researchers specialize in understanding the processes and functions by which animals live, and thus ultimately underlie human health and disease. Founded in 1887 the Bethesda, MD-based Society has more than 11,000 members and publishes 3,800 articles in its 14 peer-reviewed journals each year.

Note: This story has been adapted from material provided by American Physiological Society.

Science Daily — A University of Alberta researcher has discovered a potential breakthrough for premature ejaculation–the most common sexual dysfunction in men–with a drug usually used to treat bi-polar or anxiety disorder.

Dr. Pierre Chue, a psychiatry professor at the U of A, has found success in treating premature ejaculation (PE) with the use of gabapentin, better known by the brand name Neurontin. Chue writes about his findings in the September issue of the “Canadian Journal of Psychiatry.”

“This disorder affects almost 40 per cent of males–it is even more common than erectile dysfunction erectile symptom
it is not talked about much and there has been very little research on it,” said Chue.

The essential feature of the disorder is persistent ejaculation with minimal sexual stimulation before or shortly after penetration and before the person wishes it. PE is believed to be a neurobiological phenomenon involving primarily a disturbance of serotonin receptor function. Currently, physicians prescribe medications that are known to influence these erectile dysfunction impotence medication serotonin reuptake inhibitors or SSRIs–that delay ejaculation but these antidepressants also come with negative side-effects..

In his report, Chue cites a case study in which a 40-year-old man diagnosed with PE received minimal effectiveness from different techniques–the use of a condom with topical anesthetic and different antidepressant drugs–aimed to improve the disorder. The drugs resulted in such side effects as restless legs, headaches, decreased libido or accelerated ejaculation. The man “had previously found that alcohol produced alternative treatment for erectile dysfunction ejaculatory delay with no loss of erectile capacity, but clearly this was not a feasible regular option,” says Chue. A trial of gabapentin taken one to two hours before intercourse proved effective. Higher doses prolonged ejaculation even further but also caused drowsiness.

Dr. Chue is not certain how gabapentin works to improve PE but believes it has to do with the drug’s ability to increase aminobutyric acid (GABA), the most important inhibitory dysfunction erectile symptom
in the brain. Since there are currently no specific treatments for PE, the use of gabepentin to prolong ejaculation warrants further study, says Chue, particularly for those men where other therapies are ineffective or poorly tolerated.

Meanwhile, Chue is looking for people to participate in a clinical trial he is running that will use an SSRI-type drug called dapoxetine, to learn its effects on men with PE. This is an SSRI with a very short half-life that has been shown in clinical trials to delay ejaculation without the usual SSRI side effects.

Note: This story has been adapted from material provided by University Of Alberta.