men

Stress

The Effects of Stress on Your Body

Stress is the body's reaction to any change that requires an adjustment or response. The body reacts to these changes with physical, mental, and emotional responses.
Stress is a normal part of life. Many events that happen to you and around you -- and many things that you do yourself -- put stress on your body. You can experience stress from your environment, your body, and your thoughts.

How does stress affect health?

The human body is designed to experience stress and react to it. Stress can be positive, keeping us alert and ready to avoid danger. Stress becomes negative when a person faces continuous challenges without relief or relaxation between challenges. As a result, the person becomes overworked, and stress-related tension builds.

Stress that continues without relief can lead to a condition called distress -- a negative stress reaction. Distress can disturb the body's internal balance or equilibrium -- leading to physical symptoms including headaches, upset stomach, elevated blood pressure, chest pain, and problems sleeping. Research suggests that stress also can bring on or worsen certain symptoms or diseases.

Stress also becomes harmful when people use alcohol, tobacco, or drugs to try to relieve their stress. Unfortunately, instead of relieving the stress and returning the body to a relaxed state, these substances tend to keep the body in a stressed state and cause more problems. Consider the following facts:

Forty-three percent of all adults suffer adverse health effects from stress.
Seventy-five to 90% of all doctor's office visits are for stress-related ailments and complaints.
Stress is linked to six of the leading causes of death: heart disease, cancer, lung ailments, accidents, cirrhosis of the liver, and suicide.

The Occupational Safety and Health Administration (OSHA) declared stress a hazard of the workplace. In terms of lost hours due to absenteeism, reduced productivity and workers' compensation benefits, stress costs American industry more than $300 billion annually.
The lifetime prevalence of an emotional disorder is more than 50%, often due to chronic, untreated stress reactions.

Physical Warning Signs

Chronic stress can wear down the body's natural defenses, leading to a variety of physical symptoms, including the following:
Dizziness or a general feeling of "being out of it"
General aches and pains
Grinding teeth, clenched jaw
Headaches
Indigestion
Increase in or loss of appetite
Muscle tension in neck, face or shoulders
Problems sleeping
Racing heart
Cold and sweaty palms
Tiredness, exhaustion
Trembling/shaking
Weight gain or loss
Upset stomach
Sexual difficulties

Tips for Reducing Stress

If you are one of the millions of stressed-out Americans, there's good news. People can learn to manage stress. Start with these tips:
Keep a positive attitude.
Accept that there are events that you cannot control.
Be assertive instead of aggressive. "Assert" your feelings, opinions, or beliefs instead of becoming angry, defensive, or passive.
Learn and practice relaxation techniques..
Exercise regularly. Your body can fight stress better when it is fit.
Eat healthy, well-balanced meals.
Get enough rest and sleep. Your body needs time to recover from stressful events.
Don't rely on alcohol or drugs to reduce stress.
Seek out social support.
Learn to manage your time more effectively.

By Laura Lane
WebMD Feature

Reviewed By Louise Chang, MD

SOURCES: Institute of Medicine Dietary Reference Intakes Tables. Jeffrey Blumberg, PhD, professor of nutrition, Tufts University School of Nutrition, Science and Policy. Lisa Scott, clinical nutritionist, UCSF Mount Zion Medical Center.

Published Feb. 19, 2003.

Medically updated Dec. 13, 2005.

Supplements to Boost Your Health

Many older adults benefit from these five nutritional supplements.

Doctors instruct people 65 years and older to get flu shots, eat a high-fiber diet and do strengthening exercises to stay healthy.

But of all the things older people can do, taking nutritional supplements ranks as one of the easiest, says Jeffrey Blumberg, PhD, professor of nutrition at Tufts University School of Nutrition, Science and Policy.

"It's one thing you can do that's not too hard to do," he says.

That's important, since seniors need to do what they can to protect themselves from heart disease and cancer, the two leading causes of death among people 65 years and older, according to the National Center for Health Statistics.

Nutritional supplements not only help decrease the risk of certain diseases, but they also fill up what's missing in a typical elderly person's diet. It usually doesn't have a sufficient number of calories to cover the essential nutrients, says Blumberg. Older people tend to have a smaller appetite and usually eat only about 1,200 calories of food. Compare that with the 2,000 calories required to follow the food pyramid -- a recommended diet that includes a healthful balance of foods -- and the need for supplements is clear.

Vitamin B-12

The supplement that nutritionists have been promoting most recently is vitamin B-12, which in food depends on stomach acid to be absorbed. However, recent studies have shown that 10% to 30% of people 51 years and older have lower amounts of stomach acid and therefore can't absorb much of the vitamin.

But in supplement form, the vitamin doesn't rely on stomach acid, making supplements a good way to make up for the lack. Otherwise, people who don't get enough of the vitamin can suffer from anemia, other blood-cell disorders, and neurological disorders including memory loss and changes in gait.

Nutritionists recommend that all adults get at least 2.4 micrograms per day of vitamin B-12, which is found mostly in meats. People 51 years of age or older should get most of the vitamin from supplements or fortified cereals.

Folate

The B vitamin folate reduces levels of homocysteine, a molecule that is a risk factor for cardiovascular disease and stroke. Blumberg recommends that elderly people take 400 micrograms per day to supplement the amount of folate they may get from their diet.

Folate is found in dark green, yellow and orange fruits and vegetables, beans, nuts, seeds and fortified grain products such as pasta and flour. Foods with a high concentration of folate include spinach, orange juice, and lentils.

Vitamin E

Research studies show conflicting evidence that vitamin E reduces the risk of heart disease, cancer, and other conditions. Vitamin E is found in fatty foods such as nuts and oils.

People 14 years and older should take 15 mg per day, according to the Food and Nutrition Board, the organization that determines "RDAs."

Calcium and Vitamin D

Finally, elderly people need to keep their bones strong by supplementing their diet with calcium and vitamin D. The pair work hand in hand to prevent bones from thinning, which can lead to devastating fractures.

Many older people lack enough calcium in their diets because they can't digest dairy foods, the primary source for calcium, says Lisa Scott, a clinical nutritionist at UCSF Mount Zion Medical Center who works with elderly patients. And meeting the daily requirement of 1,200 milligrams of calcium through other foods, such as broccoli, simply doesn't happen.

For patients who don't eat any dairy products or calcium-fortified orange juice, she recommends they get the full 1,200 milligrams from supplements. Supplements made from calcium carbonate or calcium citrate are best.

With the sun's help, the skin produces the body's main source of vitamin D. But as skin ages, its ability to produce vitamin D decreases. At the same time, elderly people tend to stay out of the sun, making a deficiency all the more probable. The Food and Nutrition Board recommends that people 51 years or older receive 10 to 15 micrograms of vitamin D each day. Taking supplements is a good way to meet the daily requirement.

Still, however convenient supplements may be, they shouldn't take the place of eating a well-balanced diet, Blumberg says.

"It's important to recognize that dietary supplements are not dietary substitutes," he says. Taking supplements is "just another healthy thing you can do for yourself."

Prostate Cancer

What Is the Prostate?

The prostate is a muscular, walnut-sized gland that surrounds part of the urethra, the tube that transports urine and sperm out of the body. A gland is a group of cells that secretes chemicals that act on or control the activity of other cells or organs.

The prostate is part of the male reproductive system. Its main job is to make seminal fluid, the milky substance that transports sperm.

Sperm is produced in the testicles, which also make the male hormone testosterone. Testosterone stimulates the growth and function of the prostate during puberty, and also makes prostatic fluid for semen.

During sexual climax (orgasm), the muscles of the prostate contract to push semen through the urethra and out the penis. The urethra also carries urine, a waste product made by the kidneys and stored in the bladder. When the penis is erect during sexual intercourse, the flow of urine is blocked from the urethra, allowing only semen to be ejaculated at orgasm.

Where Is the Prostate Located?

The prostate is located directly beneath the bladder and in front of the rectum. Because the upper portion of the urethra passes through the prostate, the passage of urine or semen through the urethra can be obstructed if the gland becomes enlarged.

What Is Prostate Cancer?

Prostate cancer is the most common cancer, excluding skin cancers, in American men. It is a malignant tumor of the prostate. In most men, the cancer grows very slowly. In fact, many men with the disease will never know they have the condition. Early prostate cancer is confined to the prostate gland itself. The majority of patients with this type of cancer can live for years with no problems.

Prostate cancer is characterized by both "grade" and "stage." The grade is given to indicate how quickly a cancer is growing -- the higher the grade, the more likely it is that the cancer will grow and spread rapidly.The size and extent of the tumor determine its stage.

What Causes Prostate Cancer?

As with many cancers, the cause of prostate cancer is unknown. But doctors do know it is more common in African American men and men with a family history of the disease. The male sex hormone testosterone also contributes to its growth. Read more about risk factors.

How Many Men Have Prostate Cancer?

More than 230,000 men in the U.S. will be diagnosed with prostate cancer this year, and more than 30,000 will die of the disease. Overall, about one man in six will be diagnosed with prostate cancer during his lifetime, but only one man in 33 will die of this disease. About 80 percent of men who reach age 80 have prostate cancer.

What Is the Outlook?

While the number of men diagnosed with prostate cancer remains high, survival rates are also improving. Ninety-nine percent of men with prostate cancer survive at least five years after their diagnosis, 92% survive at least 10 years, and 61% survive longer than 15 years.

Because prostate cancer is a slow-growing disease, many men with this disease will die from other causes before they die from prostate cancer. Evidence also indicates that many patients detect their prostate cancer at an earlier stage because of annual screening.

Types of Prostate Cancer

There are three types of prostate disease:

Benign prostatic hyperplasia
Prostatitis
Prostate cancer

Although these diseases have different causes, they have similar symptoms. This is why it's important to be checked for prostate cancer as part of your yearly physical examination. You should also see a urologist (a doctor who specializes in diseases of the urinary tract and the male reproductive system) if you have symptoms of any of the following diseases.

Benign Prostatic Hyperplasia

Often called BPH, benign prostatic hyperplasia is a noncancerous enlargement of the prostate gland. It is very common. About half of men younger than age 50 and 80% of men older than age 60 have BPH.

Symptoms of BPH include:

Difficulty urinating
An urge to urinate even when the bladder is empty
Frequent urination, especially at night
A weak or intermittent stream of urine and a sense of incomplete emptying when urinating

Prostatitis

Prostatitis is an inflammation of the prostate. This can be caused by a bacterial infection. Men of all ages can get prostatitis, and it can occur any size prostate (enlarged or not).

Symptoms of prostatitis include:

Difficulty urinating
Frequent urination, especially at night
Pain or burning during urination
Chills and fever along with urinating problems

Prostate Cancer

Prostate cancer, in its early stages, may not cause any symptoms. But as it progresses, symptoms often appear.

Symptoms of prostate cancer include:

A need to urinate frequently, especially at night
Difficulty starting urination
Inability to urinate
Weak or interrupted flow of urine (dribbling)
Painful or burning urination
Painful ejaculation
Blood in urine or semen
Frequent pain or stiffness in the back, hips, or upper thighs

Enlarged Prostate

Benign (noncancerous) enlargement of the prostate, known as benign prostatic hyperplasia (BPH for short) is the most common prostate problem in men. Almost all men will develop some enlargement of the prostate as they age.

When Does Prostate Enlargement Happen?

Overall, the number of men with BPH increases progressively with age. By age 60, 50% of men will have some signs of BPH. By age 85, 90% of men will have signs of the condition. About half of these men will develop symptoms that require treatment.

Does BPH Increase Your Risk of Developing Prostate Cancer?

Based on research to date, the answer is no. However, BPH and prostate cancer have similar symptoms, and a man who has BPH may have undetected cancer at the same time.

To help detect prostate cancer in its early stages, the American Urological Association and the American Cancer Society advise annual screening for men ages 50 to 70. They also say that men who are at high risk, such as African American men and men with a family history of prostate cancer, begin screening at about age 40. Tests used to screen for prostate cancer include the a blood test for a substance called prostate-specific antigen (PSA)and the digital rectal exam (DRE).

What Are the Symptoms of BPH?

Since the prostate gland surrounds the urethra, the tube that carries urine out of the body, it is easy to see that enlargement of the prostate can lead to blockage of the tube. You may develop:

Slowness or dribbling of your urinary stream
Hesitancy or difficulty starting to urinate
Frequent urination
Feeling of urgency or sudden need to urinate
Need to get up at night to urinate

As symptoms progress, you may develop:

Bladder stones
Bladder infection
Blood in your urine
Damage to your kidneys from back pressure caused by retaining large amounts of extra urine in the bladder
Sudden blockage of the urinary tube, making urination impossible

How Is BPH Diagnosed?

After evaluating your medical history and giving you a complete physical, your doctor will perform a digital rectal examination.

Because the prostate gland is in front of the rectum, the doctor can feel much of the gland. This enables him or her to estimate the size of the prostate and to detect any hard areas that could be cancer.

Several studies may be done to help diagnose your condition:

A seven-question survey to evaluate your symptoms
A flow study to measure how slow the urinary stream is compared with normal flow
A study to detect how much urine is left in the bladder after urination is done

How Is BPH Treated?

Patients with mild symptoms may not require treatment other than watching to make sure their condition doesn't worsen. This approach is sometimes called "watchful waiting" or surveillance. A number of treatment options are available if your symptoms are severe.

Treatments for BPH Include:

Medication. Proscar was one of the first drugs used to treat BPH. It works by inhibiting the production of the hormone dihydrotestosterone (DHT), which affects the growth of the prostate gland. Proscar appears to be most helpful for men with larger prostates. More common are drugs to relax the muscle in the prostate to reduce the tension on the urine tube. These include Hytrin, Cardura, and Flomax. Side effects include light-headedness and weakness.
Surgery. A number of surgery types can remove the prostate tissue blocking the flow of urine. The most common is called transurethral resection of the prostate, or TURP. It involves removing the tissue blocking the urethra (urine tube) with a special instrument. Although TURP is effective, side effects may include bleeding, infection, impotence (inability to maintain an erection suitable for sex), and incontinence (inability to control the flow of urine). Another, less complicated procedure is transurethral incision of the prostate (TUIP). Instead of removing tissue, as with TURP, this approach involves widening the urethra by making several small cuts in the bladder neck (area where the urethra and bladder join), as well as in the prostate gland itself. This relieves some of the pressure on the urethra and improves urine flow.
Minimally Invasive Treatments. Newer treatments can effectively reduce the size of the prostate and relieve urinary obstruction, but are less invasive and damaging to healthy tissue than surgery. In general, less invasive procedures require less time in the hospital, result in fewer side effects, are less costly, and allow for quicker recovery. Side effects may be urinary frequency and irritation while the prostate is healing. However, many of these techniques are new. Little is known about the long-term effectiveness and complications of these procedures.

Minimally invasive treatments include:

Transurethral Microwave Thermotherapy (TUMT). Microwave energy delivers temperatures above 45 degrees C (113 F) to the prostate by way of an antenna positioned in the prostate using a special catheter (tube). Another catheter is used to circulate coolant around the urethra, which helps keep you reasonably comfortable throughout the procedure. The entire procedure is computer-controlled, based on temperature recordings obtained in the urethra and rectum. This technique is performed in your doctor's office and takes approximately 90 minutes. Patients are generally given medicine to prevent pain and relieve anxiety. The most common complaints during the treatment are an urge to urinate and a burning sensation in the penis. There are two programs: "standard treatment" or "high-energy" treatment. High-energy treatment delivers more energy to the prostate, which generally provides better results and improved flow, but patients are likely to have more side effects in the recovery period.
Interstitial Laser Coagulation. ILC uses a specially designed laser fiber to deliver heat to the interior of the prostate. The laser fiber is inserted into the prostate using instruments placed in the urethra. The procedure is usually done in the operating room, under anesthesia to numb the pain but not put you to sleep. This technique allows the surgeon to view the prostate directly and to treat specific areas of enlargement.
Transurethral Needle Ablation (TUNA): This technique uses low-level radiofrequency energy delivered through two needles to ablate, or burn away, an area of the enlarged prostate.
Balloon Dilation. A catheter with a balloon at the tip is inserted through the urethra. The balloon is inflated, which stretches the urethra where it has become narrowed by the enlarged prostate.
Transurethral Electrovaporization. This technique uses electrical energy applied through an electrode to rapidly heat prostate tissue, turning the tissue cells into steam. This allows the doctor to vaporize an area of the enlarged tissue and relieve urinary obstruction.
Intraurethral Stents. Stents (wire devices shaped like springs or coils) are placed within the prostate channel (where the urethra runs through the gland) to help keep the channel from tightening around the urethra.

Saw Palmetto

In addition to these medical and surgical treatments, use of the herb saw palmetto shows some promise as a treatment for BPH. Recent studies find that the extract from saw palmetto berries appears to block the formation of DHT, the hormone responsible for prostate gland growth.

Prostatitis

Prostatitis is often described as an infection of the prostate. It can also be an inflammation with no sign of infection. Just 5% to 10% of cases are caused by bacterial infection. It does not raise the risk of getting prostate cancer.

Prostatitis can affect men of all ages. An estimated 50% of men have prostatitis-like symptoms at some point during their lifetime. In fact, chronic prostatitis (which means it doesn’t go away) is the number-one reason men under the age of 50 visit a urologist. In some cases, chronic prostatitis follows an attack of acute prostatitis. Chronic prostatitis may also be related to other urinary tract infections.

The primary symptom of chronic infectious prostatitis is usually repeated bladder infections. Prostatitis is considered chronic if it lasts more than three months.

Types of prostatitis include:

Acute bacterial prostatitis. A sudden bacterial infection marked by inflammation of the prostate. This is the least common form of prostatitis but the symptoms are usually severe. Patients with this condition have an acute urinary tract infection with increased urinary frequency and urgency, need to urinate a lot at night, and have pain in the pelvis and genital area. They often have fever, chills, nausea, vomiting, and burning when urinating. Acute bacterial prostatitis requires prompt treatment, as the condition can lead to bladder infections, abscesses in the prostate or, in extreme cases, completely blocked urine flow. Left untreated, the condition can cause confusion and low blood pressure, and may be fatal. The condition is usually treated in the hospital with intravenous antibiotics, pain relievers, and fluids.
Chronic bacterial prostatitis. This condition is the result of recurrent urinary tract infections that have entered the prostate gland. The symptoms are similar to acute bacterial prostatitis, but are less severe and can fluctuate in intensity. The diagnosis of this condition is often challenging. It’s often difficult to find the bacteria in the urine. Treatment includes antibiotics for six to 12 weeks and other treatment for pain. Sometimes men are given suppressive low-dose, long-duration antibiotic therapy.
Chronic nonbacterial prostatitis/chronic pelvic pain syndrome. This is the most common form of the disease, accounting for 90% of the cases. The condition is marked by urinary and genital pain for at least three of the past six months. Patients have no bacteria in their urine, but may have other signs of inflammation. The condition can be confused with interstitial cystitis (a chronic infection of the bladder).

What Causes Prostatitis?

How the prostate becomes infected is not clear. The bacteria that cause prostatitis may get into the prostate from the urethra by backward flow of infected urine or stool from the rectum.

At one time, prostatitis was believed to be a sexually transmitted disease, but more recent research suggests that only a small number of cases are passed on through sex.

Certain conditions and medical procedures increase the risk of developing prostatitis. You are at higher risk for getting prostatitis if you:

Recently have had a medical instrument, such as a urinary catheter (a soft, lubricated tube used to drain urine from the bladder) inserted during a medical procedure
Engage in rectal intercourse
Have an abnormal urinary tract
Have had a recent bladder infection
Have an enlarged prostate
Other causes may include autoimmune disease (an abnormal reaction of the body to the prostate tissue).

What Are the Symptoms of Prostatitis?

You may have no symptoms or symptoms so sudden and severe that you seek emergency medical care.

When present, symptoms include:

Frequent urge to urinate
Difficulty urinating
Pain or burning during urination
Chills and fever

Other symptoms may include pain that comes and goes low in the abdomen, around the anus, in the groin, or in the back. In some cases, bacteria can get into the vas deferens (the tube that carries sperm from the testicles to the urethra), causing groin pain or an infection of the epididymis (area near the testicles where sperm mature and are stored).

The prostate may swell, causing a less forceful urine stream. Sometimes blood in the urine and painful ejaculation are other symptoms of prostatitis.

Men may also complain of pelvic pain, pain during ejaculation, and pain with sexual intercourse.

How Is Prostatitis Diagnosed?

If your doctor suspects that you have prostatitis or another prostate problem, he or she may refer you to a urologist (a doctor who specializes in diseases of the urinary tract and the male reproductive system) to confirm the diagnosis.

Patients typically undergo a comprehensive examination, including a digital rectal exam. Then, if the doctor is still not sure what you have, more tests may be done, such as a biopsy, voiding studies, or MRI. Voiding studies involve the collection and analysis of urine to determine which part of the urinary system is infected.

What Is the Treatment for Prostatitis?

Treatments vary among urologists and are tailored to the type of prostatitis you have. Correct diagnosis is crucial treatments vary. It’s important to make sure your symptoms are not caused by urethritis (inflammation of the urethra) or some other condition that may lead to permanent bladder or kidney damage.

Treatments can include:

Anti-inflammatory medicines along with warm sitz baths (sitting in two to three inches of warm water). This is the most conservative treatment for chronic prostatitis.
Antibiotic medicine for infectious prostatitis. These medicines are not effective treatments for noninfectious prostatitis. For acute infectious prostatitis, patients usually need to take antibiotic medicine for seven to 14 days. Almost all acute infections can be cured with this treatment.
For chronic infectious prostatitis, antibiotic medicine is taken for a longer period of time, usually six to 12 weeks. About 60% of all cases of chronic infectious prostatitis clear up with this treatment. For cases that don't, taking antibiotics at a low dose for a long time may be recommended to relieve the symptoms.
Pain medications.
Surgical removal of the infected portions of the prostate. A doctor may advise this treatment for severe cases of chronic prostatitis or for men whose swollen prostate is blocking the flow of urine.
Supportive therapies for chronic prostatitis, including stool softeners and prostate massage.

Other treatments for chronic noninfectious prostatitis include the use of the drugs Proscar, Hytrin, and Cardura. These drugs relax the muscles of the prostate and bladder to improve urine flow and decrease symptoms.

Many cases of abacterial (nonbacterial) prostatitis (also considered chronic pelvic pain syndrome) respond to a mix of treatments that include exercise, myofascial trigger point release, progressive relaxation, and counseling.

Prostatitis is a treatable disease. Even if the problem cannot be cured, you can usually get relief from your symptoms by following the recommended treatment. Be sure to follow the full course any prescription you are given, even if you no longer have any symptoms. With infectious prostatitis, for example, the symptoms may disappear before the infection has completely cleared.

What Are the Long-Term Effects of Chronic Prostatitis?

Chronic prostatitis affects men differently, with varying degrees of discomfort or pain.

Prostatitis is not a contagious disease. You can live your life normally and continue sexual relations without passing it on.

Having prostatitis does not increase your risk of developing prostate cancer or any other prostate or kidney disease. But even if your prostatitis is cured, you should continue to have regular examinations to detect prostate cancer.

Stages of Prostate Cancer

What Is Staging?

Once prostate cancer has been diagnosed, more tests are done to find out the size and location of the cancer, and if the cancer has metastasized (spread) beyond the prostate. This process is called staging. Knowing the stage of the cancer is important for planning the right treatment.

Several systems are used to stage prostate cancer. The most common are the ABCD system and the TNM system.

ABCD System

This is the simplest method of staging prostate cancer. It breaks down the cancer into four categories:

Stage A. This is prostate cancer in its earliest stage. Typically, prostate cancer in this stage causes no symptoms. It is located entirely within the prostate gland, but is too small to be detected by a digital rectal exam (DRE). In many cases, Stage A prostate cancer is uncovered by diagnosing and treating another prostate-related problem, such as a benign (noncancerous) tumor, or during a follow-up for an abnormal PSA blood test.
Stage B. In this stage, the tumor (mass of cancer cells) is still confined within the prostate but is now big enough to be detected by DRE or ultrasound imaging
Stage C. This stage indicates that the cancer is more advanced. The cancer has spread beyond the capsule, or outer layer, of the prostate to the immediately surrounding tissue but not to distant organs.
Stage D. The cancer has spread to distant areas of the body, often the lymph nodes or bones.

TNM System

TNM is a system that determines the extent of the cancer by assessing the size of the tumor, seeing if the cancer has spread to the lymph nodes, and evaluating the degree to which the cancer has spread, or metastasized, to other areas of the body.

The TNM system is more specific in how it categorizes prostate cancer. It gauges the severity of the cancer on a rising scale.

T = Tumor size

Stage T1. Similar to Stage A in the ABCD system, Stage T1 prostate cancer is confined to the prostate and is not detectable by DRE or ultrasound.
Stage T2. The tumor is confined to the prostate but is detectable by DRE or ultrasound.
Stage T3. The cancer has spread to tissue surrounding the prostate.
Stage T4. The cancer has spread to organs near the prostate, such as the bladder, but is still within the pelvic region.

N = Nodes (extend of spread to the lymph nodes)

Stage N0: The cancer has not spread to the lymph nodes.
Stage N+: The cancer has spread to the lymph nodes.

M = Metastasis (extent of spread to other parts of the body)

Stage M0: The cancer has not spread to other parts of the body.
Stage M+: The cancer has spread to the bones or to distant parts of the body.

In addition to the stages listed above, cancer is also referred to as recurrent, which means the disease has come back (recurred) after it has been treated. The cancer may recur in the prostate or in another part of the body.

Grading the Prostate Cancer

Like staging, grading levels are also assigned to prostate cancer cases. Grading takes place after a biopsy (removal and examination of tissue) is done. The tissue samples are sent to a laboratory for analysis by a pathologist, a doctor who specializes in diagnosing disease by looking at these samples.

If cancer is present, the pathologist will assign a grade for the cancer. The grade refers to the cancer's appearance and indicates how quickly a cancer is growing. Most pathologists grade cancer according to the Gleason score, which assigns a grade (1 to 5) based on how the cancerous cells look compared to normal prostate cells.

Grade 1. The cancerous tissue looks very much like normal prostate cells.
Grades 2 to 4. Some cells do look like normal prostate cells, others do not. Patterns of cells in these grades vary.
Grade 5. The cells do not look like normal prostate cells. They appear to be scattered haphazardly throughout the prostate.

The higher the Gleason score, the more likely it is that the cancer will grow and spread rapidly. Pathologists often identify the two most common patterns of cells in the tissue, assign a Gleason grade to each, and add the two grades. The result is a number between two and 10. A Gleason score of less than six indicates a less aggressive cancer. A grade seven and up is considered more aggressive.

Other Test Results

Sometimes, when a pathologist looks at the prostate cells under the microscope, they don't look cancerous, but they're not quite normal, either. These results are often reported as "suspicious." They generally fall into two categories, either atypical or prostatic intraepithelial neoplasia (PIN).

PIN is often divided into low grade and high grade. The importance of low-grade PIN in relation to prostate cancer is still unclear. Many men have it and never develop prostate cancer.

But with atypical findings or high-grade PIN, cancer may already be present somewhere else in the prostate gland. For high-grade PIN, there is a 30% to 50% chance of finding prostate cancer on a later biopsy. For this reason, repeat prostate biopsies are often advised.

Prostate Cancer Specialists

The treatment of prostate cancer often requires the expertise of many medical specialists. Depending on your own case, doctors you may see include:

Urologist. A urologist is specially trained to treat problems affecting the urinary tract (kidneys, ureters, bladder, urethra) and disorders of the male reproductive system. Some urologists, called urologic oncologists, are surgeons who further specialize in treating cancer of the urinary tract and male reproductive organs.
Radiation oncologist. A radiation oncologist specializes in the use of radiation therapy to treat cancer. He or she develops the radiation treatment plan, monitors patients while they are receiving radiation therapy, and treats any side effects from the radiation.
Medical oncologist. A medical oncologist specializes in treating cancer with medical therapies, such as chemotherapy and hormone therapy. Medical oncologists also handle the general medical problems that may arise during the disease.

Other medical specialists that may be involved in your care include:

Oncology Nurses. These are nurses who specialize in caring for patients with cancer.
Dietitians. Dietitians assist in managing nutrition related to cancer and treatment.
Physical Therapists. These health professionals are trained to use rehabilitation treatments to restore function and prevent disability following disease, injury, or loss of a body part.
Occupational Therapists. These therapists work with patients to help them improve the activities of daily living.
Psychologists or counselors. Both professionals help patients and their families cope with cancer and treatment.

Reviewed by the doctors at The Cleveland Clinic Urological Institute.

Edited by Charlotte E. Grayson, MD, WebMD, April 2005.
Portions of this page © The Cleveland Clinic 2000-2005.

Hair Loss

Introduction

The male pattern baldness (MPB) form of androgenetic alopecia (there is also a female pattern baldness) accounts for more than 95% of hair loss in men. By age 35, two-thirds of American men will have some degree of appreciable hair loss and by age 50 approximately 85% of men have significantly thinning hair. About 25% of men who suffer from male pattern baldness begin the painful process before they reach 21.

Contrary to societal belief, most men who suffer from male pattern baldness are extremely unhappy with their situation and would do anything to change it. Hair loss affects every aspect of their life. It affects interpersonal relationships as well as their professional life. It is not uncommon for men to change their career paths because of hair loss.

The American Hair Loss Association recognizes how devastating male pattern baldness can be for men of all ages and has created resources for men to get completely objective answers to their hair loss questions.

We strongly advise against researching your options through the Yellow Pages or commercial websites. Hundreds of products and services are sold to the vulnerable hair loss consumer, but currently only two FDA-approved products have been clinically proven to stop or prevent hair loss. Also, there are only a handful of surgeons performing surgical hair restoration to state-of-the-art standards.

Causes

Androgenetic alopecia or male pattern baldness (MPB) is responsible for the vast majority of hair loss in men. While there are many possible reasons people lose hair, including serious diseases, reaction to certain medications, and, in rare cases, extremely stressful events, most hair loss in men can be blamed on heredity.

What male pattern baldness sufferers inherit are hair follicles with a genetic sensitivity to dihydrotestosterone (DHT). Hair follicles sensitive to DHT begin to miniaturize, shortening the lifespan of each hair follicle affected. Eventually, these affected follicles stop producing cosmetically acceptable hair.

Male pattern baldness is generally characterized with the onset of a receding hairline and thinning crown. Hair in these areas including the temples and mid-anterior scalp appear to be the most sensitive to DHT. This pattern eventually progresses into more apparent baldness throughout the entire top of the scalp, leaving only a rim or "horseshoe" pattern of hair remaining in the more advanced stages of MPB. For some men, even this remaining rim of hair can be affected by DHT.

What Is DHT?

Dihydrotestosterone (DHT) is a derivative or by-product of testosterone. Testosterone converts to DHT with the aid of the enzyme 5-alpha-reductase. While the entire genetic process of MPB is not completely understood, scientists do know that DHT shrinks hair follicles, and that when DHT is suppressed, hair follicles continue to thrive.

Hair follicles that are sensitive to DHT must be exposed to the hormone for a prolonged period of time for the affected follicle to complete the miniaturization process. Today, with proper intervention, this process can be slowed or even stopped if caught early enough.

What male pattern baldness sufferers inherit are hair follicles with a genetic sensitivity to dihydrotestosterone (DHT). Dihydrotestosterone (DHT) is a derivative or by-product of testosterone.

Diagnosis

Typical male pattern baldness is usually diagnosed based on the appearance and pattern of the hair loss, along with a detailed medical history, including questions about the prevalence of hair loss in your family.

An experienced dermatologist should examine the scalp under magnification (preferably with a device called a densitometer) to assess the degree of miniaturization of the hair follicles. This assessment is very important for recommending the proper course of treatment.

Some advertised clinics might recommend a costly hair analysis or a scalp biopsy to properly diagnose your hair loss. The only reason to have a hair analysis is to assess the possibility of poison-induced hair loss. A hair analysis may reveal substances such as arsenic or lead; however, hair loss caused by poisoning does not present itself in a typical male pattern.

You should avoid these clinics and seek the advice of a board-certified dermatologist who can properly examine you and help you treat your hair loss.

Treatments

In the past few years, medicine has made tremendous strides in the treatment of men's hair loss. With the advent of 5-alpha-reductace inhibitors such as Propecia and the evolution of surgical hair restoration, living with noticeable hair loss is no longer inevitable. For the first time in the history it is now possible to stop or slow the progression of hair loss and to replace lost hair through surgery with completely natural results.

However, with that said, the vast majority of hair loss treatments being marketed today are still nothing but "snake oils."

You may have seen the ads in the back of men's magazines, you've heard the commercials on the radio, and you've seen the infomercials promoting miracle treatments for hair loss. The bottom line is that most advertised "treatments" do not work for the prevention and treatment of hair loss. If a hair loss treatment is not approved by the FDA or recommended by the American Hair Loss Association, chances are you are wasting your time and money.

Remember that successful treatment of hair loss is greatly dependent on early intervention. It is critical to begin treatment with an effective product as soon as you notice the onset of hair loss.

The following two treatments have been clinically proven to successfully treat hair loss in men to varying degrees.

Finasteride (Proscar, Propecia)

Finasteride is the generic name for the brand name drugs Proscar and Propecia. Finasteride was originally developed by the pharmaceutical company Merck as a drug (Proscar) to treat enlarged prostate glands.

During the trials on men with prostate problems, researchers noted an intriguing side effect: hair growth. Since finasteride had already been approved by the FDA to treat enlarged prostates in men, Merck decided to pursue the possibility of developing finasteride as the first pill to treat male pattern baldness. Minoxidil, a topical liquid solution, was already on the market (see below).

In December 1997, the FDA approved a 1mg dose of finasteride for the treatment of androgenetic alopecia (male pattern baldness) in men. Propecia is the first drug in history to effectively treat male pattern baldness in the majority of men who use it.

How Finasteride Works

Finasteride's hair-raising success is due to its ability to specifically inhibit 5-alpha-reductase, the enzyme that converts testosterone into a more potent androgen dihydrotestosterone (DHT).

Propecia's 1 mg dose of finasteride can effectively lower DHT levels in the scalp by as much as 60% when taken daily. It is DHT that shrinks or miniaturizes the hair follicle, which eventually leads to baldness. This 60% reduction in DHT has proven to stop the progression of hair loss in 86% of men taking the drug during clinical trials. 65% of trial participants had what was considered a substantial increase of hair growth.

At this point, the only truly effective medically proven way to arrest the hair loss process is to lower DHT levels. The American Hair Loss Association recommends finasteride as the first line of attack for all men interested in treating their male pattern baldness.

Minoxidil (Rogaine)

Minoxidil was the first drug approved by the FDA for the treatment of male pattern baldness. For many years, minoxidil, in pill form (brand name Loniten), was widely used to treat high blood pressure. Just like finasteride, researchers discovered a very interesting side effect of the drug. People taking the medication were growing hair in unexpected places, such as on their cheeks and the back of their hands. Some people grew hair on their foreheads.

Some enterprising researchers had the notion that applying minoxidil topically, directly on the head, might grow hair on balding areas. It did, to varying degrees depending on the extent of the hair loss, but at the time it was revolutionary.

While minoxidil has been clinically proven to slow the progression of hair loss and regrow some hair, most experts see it as a relatively marginally effective drug in the fight against hair loss. Since minoxidil has no effect on the hormonal process of hair loss, its positive effects are at best temporary and usually yield somewhat disappointing results.

The American Hair Loss Association still recommends the drug for those who have not responded favorably to finasteride treatment or for those who would like to add another product to their regimen. The AHLA does not recommend minoxidil as the first line of attack for men suffering with male pattern baldness, but does recognize it as an effective treatment for a small percentage of its users.

Reviewed by Paul J. McAndrews, MD, Clinical Instructor of Dermatolagy, USC School of Medicine, July 2005.

Edited by Cynthia Haines, MD, August 2005.

WebMD Medical Reference from the American Hair Loss Association.

Heart Disease

Coronary Artery Disease

Coronary artery disease, also called coronary heart disease, or simply, heart disease, is the No. 1 killer in America, affecting more than 12 million Americans.

What Is Coronary Artery Disease?

Coronary artery disease is atherosclerosis of the coronary arteries. Atherosclerosis is when the arteries become clogged and narrowed, restricting blood flow to the heart. Without adequate blood, the heart becomes starved of oxygen and vital nutrients it needs to work properly.

How Does Coronary Artery Disease Develop?

Your coronary arteries are hollow tubes. Inside, they are smooth and elastic, allowing blood to flow freely.

Before your teen years, fat starts to deposit in the blood vessel walls. As you get older, the fat builds up. This causes injury to your blood vessel walls. In an attempt to heal itself, the cells release chemicals that make the walls sticky.

Then, other substances such as inflammatory cells, proteins and calcium that travel in your bloodstream start sticking to the vessel walls. The fat and other substances combine to form a material called plaque. The plaque builds up and narrows the artery (atherosclerosis).

Many of the plaque deposits are hard on the outside and soft and mushy on the inside. The hard surface can crack or tear, exposing the soft, fatty inside. When this happens, platelets (disc-shaped particles in the blood that aid clotting) come to the area, and blood clots form around the plaque. This causes the artery to narrow even more.

Over time a narrowed coronary artery may develop new blood vessels that go around the blockage to get blood to the heart. However, during times of increased exertion or stress, the new arteries may not be able to supply enough oxygen-rich blood to the heart muscle.

In other cases, the blood clot may totally block the blood supply to the heart muscle, causing what is called an acute coronary syndrome. This is actually a name given to three serious conditions: unstable angina (an impending heart attack) and two types of heart attacks called non-Q-wave myocardial infarction and Q-wave myocardial infarction.

The length of time that blood flow is blocked and the amount of damage that occurs determines the type of acute coronary syndrome. Some people have symptoms that tell them that they may soon develop an acute coronary syndrome, others may have no symptoms until something happens, and still others have no symptoms of the acute coronary syndrome at all.

What Is Ischemia?

When plaque and fatty matter narrow the inside of an artery to a point where it cannot supply enough oxygen-rich blood to meet your organ's needs, cramping of the muscle occurs. This is called ischemia.

Ischemia of the heart can be compared to a cramp in the leg. When someone exercises for a very long time, the muscles in the legs cramp up because they're starved for oxygen and nutrients. Your heart, also a muscle, needs oxygen and nutrients to keep working. If its blood supply is inadequate to meet the heart muscle's needs, ischemia occurs, and you may feel chest pain or other symptoms.

Ischemia is most likely to occur when the heart demands extra oxygen. This is most common during:

* Exertion (activity)
* Eating
* Excitement
* Exposure to cold

When ischemia lasts less than 10 minutes, there is no permanent damage to your heart. You may be told you have "stable coronary artery disease."

Symptoms

The most common symptom is angina or "angina pectoris." Angina can be described as a discomfort, heaviness, pressure, aching, burning, fullness, squeezing or painful feeling. It can be mistaken for indigestion or heartburn. Angina is usually felt in the chest, but may also be felt in the left shoulder, arms, neck, throat, jaw or back.

Other symptoms that can occur with coronary artery disease include:

* Shortness of breath
* Palpitations (irregular heart beats, skipped beats or a "flip-flop" feeling in your chest)
* A faster heartbeat
* Weakness or dizziness
* Nausea
* Sweating

Learn to recognize your symptoms and the situations that cause them. Call your doctor if you begin to have new symptoms or if they become more frequent or severe.

Ischemia, and even a heart attack, can occur without any warning symptoms. This is called silent ischemia. It can occur among all people with heart disease, though it is more common among people with diabetes.

Diagnosis

Your doctor can tell if you have coronary artery disease by:

* Talking to you about your symptoms, medical history, and risk factors.
* Performing a physical exam.
* Performing diagnostic tests, including an electrocardiogram (ECG or EKG), exercise stress tests, cardiac catheterization and others. These tests help your doctor evaluate the extent of your coronary heart disease, its effect on the function of your heart, and the best form of treatment for you.

Treatment

Treatment for coronary artery disease involves reducing your risk factors, taking medications, and possibly undergoing invasive and/or surgical procedures.

* Reduce your risk factors. This involves making lifestyle changes. If you smoke, you should quit. Your diet will likely need modifying to reduce your cholesterol, keep your blood pressure in check, and keep blood sugar in control if you have diabetes. Low fat, low sodium, low cholesterol foods are recommended. You should also get more exercise to help maintain a healthy weight and reduce stress. But, check with your doctor before starting an exercise program.
* Medications. If making lifestyle changes isn't enough to control your heart disease, medications may be needed to help your heart work more efficiently and receive more oxygen-rich blood. The medications you are on depend on you and your specific heart problem.
* Surgery and other procedures. Procedures to treat coronary artery disease include balloon angioplasty (PTCA), stent placement, rotoblation, atherectomy, and coronary artery bypass surgery. All of these procedures increase blood supply to your heart, but they do not cure coronary heart disease. You will still need to decrease your risk factors to prevent future disease.

Doctors are also studying several innovative ways to treat heart disease. Here are a couple of the more promising ones:

* Transmyocardial laser revascularization, or TMR. This procedure improves blood flow to the heart muscle for people with advanced coronary artery disease. Laser beams are used to make channels through the heart muscle to increase blood flow to dying, but not dead, heart tissue. This technique is used for people with intractable angina who are not candidates for traditional open-heart surgery or transplantation.
* Angiogenesis. This involves giving substances through the vein or directly into the heart that trigger the heart to grow new blood vessels to bypass the clogged ones.
* EECP. There are an increasing number of patients who have persistent angina symptoms, who have exhausted the standard treatments without successful results. Enhanced External Counterpulsation (EECP) may stimulate the openings or formation of collaterals (small branches of blood vessels) to create a natural bypass around narrowed or blocked arteries. EECP is a non-invasive treatment for people who have chronic, stable angina; who are not receiving adequate relief from angina by taking nitrate medications; and who do not qualify for an invasive procedure such as bypass surgery, angioplasty or stenting.

Reviewed by the doctors at The Cleveland Clinic Heart Center.

Edited by Charlotte E. Grayson, MD, June 2004, WebMD.