Movember Mustaches

Filed in Articles and Presentations on November 1, 2014

movemberProstate cancer is one of the most common avoidable and over treated cancers. Men are more likely to die of cardiovascular disease than prostate cancer. This year I was so pleased to see in the medical press two articles which re-enforce what I have previously written on this subject. The first article came out in Health Affairs in 2014 called ‘Reconceptualising Health and Health Care: Why our Cancer Care Delivery System is in Crisis’.

I quote, “the biggest misconception is the belief that all cancers should be aggressively treated, even among older, frailer people with low grade disease who are much more likely to die from other causes. We often over treat patients, causing unnecessary costs, unnecessary care fragmentation and unnecessary pain and suffering for patients.” The authors note that the attitude of fear of cancer leads to unnecessary aggressive treatments which are more harmful and compromise other aspects of health than resolving the disease itself.

Prostate cancer is a classic example of this situation. Firstly it is a chronic not an acute disease. Most men when diagnosed are in their sixties with a life expectation of 20 years. Prostate cancer is a very slowing growing cancer and the mass applied use of the PSA measurement is wildly misleading and the aggressive use of biopsy cores can actually stimulate existing cancerous cells. In the UK, unless the PSA is 10 or over, there is a far more relaxed approach enabling men to lead a better quality of life. Biopsies do not automatically take place under this figure. Why? Because it is normal for men of over 70 to have a PSA of upto 7.2. Here in Ontario the figure universally given out is 4.00. As a result there is huge overtreatment and a waste of public monies but no poor urologists.

Once a prostate gland has been removed, even without the harmful therapies of radiation and anti androgen treatments, there is no going back, so a man’s ability to have normal sexual intercourse is gone and he is likely to have urinary incontinence for life. His quality of life is directly affected forever.

During the month of Movember let us remind ourselves that Prostate cancer like most cancers is avoidable and preventable. 70% of it is caused by lifestyle. This means diet, alcohol consumption, lack of exercise, and smoking. In other words all the items mentioned in the European code. In particular, the consumption of alcohol. We need to teach young men the consequences of alcohol and in particular the harms of binge drinking. We now have a very interesting study that shows young men (under 30 years) especially binge drinkers, produce low sperm quality and higher testosterone hormone levels in the body. A ten to fifteen year period of continuous binge drinking will inevitably lead to prostate cancer as well as potentially other diseases such as liver cirrhosis. Adverse effects on semen/testosterone can be seen with as little as 5 beers a week. Heavy beer drinkers and men taking dutasteride (Avodart which also works like finasteride) and who are heavy drinkers have a significantly increased risk of prostate cancer as do men regularly drinking over 10 beers or equivalent in wine/spirits a week. Thankfully the use of cigarettes has declined in North America but it is still far too prevalent amongst the young.

For those who have been given or about to be given anti androgen drugs – think carefully, these drugs will have little long term benefit if the cause of the prostate cancer is not addressed and it will potentially hasten death. Anti Androgen drugs ( Casodex, Androcur) are designed to block the hormones known as androgens which in the body if left unchecked go on to produce testosterone and oestrogen. Oestrogen is the proliferating hormone in prostate disease. Normally the body has a feed back mechanism which reduces oestrogen but in cancer this feed back mechanism has been impaired and hence the high oestrogen levels leading to proliferation of cancer in the bone. Normal bone and the lungs have high levels of oestrogen receptors thus attracting oestrogen and this is the reason why prostate cancer spreads to bone and or the lungs in the first instance.

Cancer is not just dependant on androgens which is one of the reasons why anti androgen drugs have limited effect but also they cause a further condition called osteoporosis or brittle bone disease. By reducing androgens via a synthetic drug normal bone formation is inhibited thus altering the structure of bone and enabling cancer to create tumours. To offset this consequence of the drugs many patients are given bisphosphonate drugs (e.g. Fosamax, Zoledronic acid) but these drugs freeze bone and kill the new red blood cells in the bone marrow ultimately weakening bone further, making it more fragile.

We look forward to spotting funny Movember mustaches!

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