Topic: Men’s Health

Testosterone to Improve the Diagnosis and Treatment of Prostate Cancer

Testosterone to Improve the Diagnosis and Treatment of Prostate Cancer

by | Nov 2023

Mohit Khera, MD, MBA, MPH, explores how testosterone can help diagnose and treat prostate cancer. He explains that low testosterone is a biomarker for prostate cancer, a predictor of who will progress on active surveillance (AS), and a risk factor for biochemical recurrence after prostatectomy. Further, testosterone therapy can be a treatment for metastatic prostate cancer. 

Dr. Khera argues that while testosterone should not be considered a monotherapy, it can augment treatment. He explains PSA has poor sensitivity and addresses biomarker tests that seek to improve sensitivity and specificity. Dr. Khera asserts the ratio of testosterone to PSA has sensitivity of 82 percent and specificity of 62 percent, with lower costs than biomarker tests. He cites data explaining for men with low testosterone, PSA alone may not be accurate. Dr. Khera cites another study on testosterone as a predictor of upstaging and upgrading in low-risk AS patients. It concludes testosterone should be a selection criterion for inclusion of low-risk prostate cancer patients in AS programs.

Dr. Khera explains lower preoperative testosterone levels increase the risk for prostate cancer recurrence. Dr. Khera turns to treatment options, looking at bipolar androgen therapy (BAT) that includes patients with advanced disease receiving high doses of testosterone which results in a 50 percent reduction in both PSA and metastatic disease. Dr. Khera cites a study on BAT for asymptomatic men with castration-resistant prostate cancer; the BAT was well-tolerated and resulted in high response rates. 

Dr. Khera cites the TRANSFORMER study comparing BAT vs. enzalutamide. Data show no difference in survival; however, patients who switched from BAT to enzalutamide had the highest survival rates. Dr. Khera concludes that testosterone can improve prostate cancer diagnosis and counseling for patients on biochemical recurrence; it comes with significantly less cost and offers greater quality of life.

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The Impact of PDE5 Inhibitors on Major Adverse Cardiac Events

The Impact of PDE5 Inhibitors on Major Adverse Cardiac Events

by | Jul 2023

E. David Crawford sits down with Robert A. Kloner, MD, PhD, and Raymond Rosen, MD, to discuss retrospective evidence of PDE5 inhibitors in preventing major adverse cardiac events (MACE) in men. Crawford, Kloner, and Rosen discuss a retrospective study examining occurrences of MACE in men which demonstrated a significant reduction in MACE in men using PDE5 inhibitors versus those who were not.

They discuss the possibility of over-the-counter (OTC) approval for PDE5 inhibitors, but acknowledge that FDA approval for OTC use of PDE5 inhibitors is not assured. Dr. Rosen discusses the barriers faced by regulatory authorities in approving over-the-counter PDE5 inhibitors. Dr. Kloner discusses pharmacist-mediated prescriptions of PDE5 inhibitors and the patient screening involved. They conclude by touching on the use of PDE5 inhibitors for female patients, and the European OTC PDE5 inhibitor trials which are presently ongoing.

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Challenging Case Discussion Panel: Men’s Health

Challenging Case Discussion Panel: Men’s Health

by | Jul 2023

Martin M. Miner, MD, discusses a challenging case involving testosterone therapy, cardiovascular risk, and prostate cancer. He begins by providing information about a case study patient, highlighting obesity, low testosterone levels, and diminished libido. Dr. Miner then discusses data that find a connection between testosterone therapy and increased cardiovascular risk.

He notes a review of all articles from 1940 to 2014 researching this connection, finding only four studies indicating a connection and uncovering major flaws in their procedures. This leads him to question the link between testosterone therapy and increased cardiovascular risk while also describing the case study patient’s testosterone therapy treatment. Dr. Miner then reviews guidelines from the American Urological Association and the Endocrine Society. He references the case study patient once again, noting the patient’s development of cardiac events and questions whether the patient should return to testosterone therapy.

After reviewing additional data on this topic, Dr. Miner concludes that testosterone therapy has at least neutral effects on cardiovascular risk factors, although additional studies are needed. He transitions the discussion back to the case study patient, noting his new development of prostate cancer and reviewing data on testosterone therapy’s effects on prostate cancer. Dr. Miner opens the discussion up to panelists, who discuss testosterone levels, obesity management, and individualized urologic treatment.

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Guidelines and Practical Applications: Artificial Urinary Sphincter

Guidelines and Practical Applications: Artificial Urinary Sphincter

by | Jul 2023

William O. Brant, MD, FACS, FECSM, reviews the 2018 American Urological Association (UAU) guidelines and practical approaches in erectile dysfunction (ED) evaluation, diagnosis, and treatment. He examines methods for evaluation and diagnosis, highlighting the psychological impacts of ED and ED’s connection to cardiovascular disease. Dr. Brant also explores specialized tests and multiple treatment options.

Dr. Brant examines other treatment modalities, such as the vacuum erection device, as a low-cost adjunct treatment. He discusses the intraurethral suppository treatment and warns that up to 30 percent of patients experience urethral pain with this option. Dr. Brant then explains the risks of injection options and surgery. He also analyzes the practicality and commitment inherent in penile prostheses, later transitioning to a discussion on the uncommonly performed arterial reconstruction option.

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Point-Counterpoint: Erectile Dysfunction After Local Therapies: PDE5 Inhibitors and Early Penile Rehab Improves ED Recovery Following Radical Surgery – Con

Point-Counterpoint: Erectile Dysfunction After Local Therapies: PDE5 Inhibitors and Early Penile Rehab Improves ED Recovery Following Radical Surgery – Con

by | Jun 2023

Aditya Bagrodia, MD, FACS, Associate Professor of Urology and Genitourinary Oncology Team Lead at the University of California, San Diego, presents the cons of using PDE5 inhibitors and early penile rehabilitation to treat erectile dysfunction post-radical prostatectomy. In this presentation, Dr. Bagrodia discusses, the known adverse effects of early use of PDE5is in patients, the failure of PDE5is to out-perform placebos, and the strengths and weaknesses of known treatment options for post-operative erectile dysfunction.

This lecture is part of a Point-Counterpoint debate. Its opposing lecture is “Point-Counterpoint: Erectile Dysfunction After Local Therapies: PDE5 Inhibitors and Early Penile Rehab Improves ED Recovery Following Radical Surgery – Pro.

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Vitamin D and Men’s Health

Vitamin D and Men’s Health

by | May 2023

Mark A. Moyad, MD, MPH, the Jenkins/Pokempner Director of Preventive/Complementary and Alternative Medicine (CAM) in the Department of Urology at the University of Michigan Medical Center in Ann Arbor, Michigan, presents on the current status of vitamin D in men’s health. While randomized trials have shown limited benefits in major endpoints, such as preventing cardiovascular disease and cancer, there is a significant signal indicating the potential of vitamin D in autoimmune disease prevention. He discusses exciting findings from the VITAL trial suggesting that a moderate dose of vitamin D may reduce the risk of autoimmune disease. Additionally, individuals with a healthy BMI and those at high risk for bone loss could potentially benefit more from vitamin D supplementation. Dr. Moyad emphasizes the importance of understanding the limitations of vitamin D blood tests and suggests that targeted screening is recommended for specific groups. Overall, he says, fortification and supplementation of vitamin D remain safe and cost-effective strategies for improving men’s health.

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Posterior Urethral Stenosis (PUS) After Prostate Cancer Therapy

Posterior Urethral Stenosis (PUS) After Prostate Cancer Therapy

by | Nov 2022

In this 21-minute video, Brian J. Flynn, MD, Co-Director of Female Pelvic Medicine and Reconstructive Surgery, Reconstructive Urology, and associate professor at the University of Colorado, discusses Posterior Urethral Stenosis (PUS) after prostate cancer therapy and the existing and developing techniques used to address it. He then examines the various treatments used for PUS, such as dilation or transurethral incision (TUI), and considers the advantages and disadvantages of each technique.

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