By Adam Dougherty, MPH

Great news for individuals suffering from prostate cancer and men’s health advocates everywhere, as this week the FDA-approved a new treatment for men with the advanced stage of the disease. The vaccine, called Provenge, is not a traditional preventive cancer vaccine (such as those for cervical cancer), but rather boosts the patient’s immune system to combat the already-diagnosed disease. The immunotherapy is derived from the patient’s own white blood cells, where antibodies are tailored to attack the tumor cells.

The drug is more effective and has fewer side effects than chemotherapy, the common course of action for these cancer patients. According to the National Cancer Institute, about 27,000 men died from the disease in 2009. The drug will soon be available to about 2,000 patients at 50 centers that were previously designated as Provenge clinical trial sites, with increased capacity over the next year. The vaccine is the first product approved by Dendreon Company, which hopes to use the same technique in the future for other diseases like bladder cancer.

As the second most common cancer in men with nearly 192,000 diagnoses in 2009, early detection and appropriate treatment are paramount in the fight against the disease (see our March 22, 2010 post by Ramon Llamas for a commentary on the recent developments in PSA screening). We will continue to monitor and promote advances in research and development, in order to sustain a national dialogue aimed at improving the wellbeing of men and their families.

For Provenge’s press release, click here to read the PDF.

What’s your thoughts about the new FDA-approved treatment for men?

By Luke Manley

I don’t know about you, but my phone has a Starbucks/Coffee Bean locator that I use at least a dozen times more often than my phone itself and in our increasingly sleepless and workaholic society I suspect most of you are right there with me.  Caffeine can easily be considered our most common go-to drug of choice and for those of us who don’t go overboard it has been shown to have a number of positive physical and mental effects.  However, most of us don’t think about caffeine in terms of our sexual health. Yet it appears that while it might be great for that little mental boost, in high quantities it may not be exactly a pick-me-up for other equally important areas.

A recent Danish study, published in the American Journal of Epidemiology, has shown that there seems to be a correlation between high caffeine intake and reduced sperm concentration and overall count.  However, devoted coffee drinkers rejoice!  It appears that your source of caffeine may be the more important consideration, as the biggest culprit is our other ubiquitous supply of caffeine: soda.  While the Danish study did observe the negative effect on sperm with high levels of caffeine in general, the results were only statistically significant in men reporting excessive levels of soda intake.  Unfortunately, with nearly 20% of adult men in the U.S. reportedly consuming soda more than 3 times weekly, many could easily be reaching that level.  The actual numbers (sperm/milliliter semen) may be somewhat meaningless, but using my significant biostatistical prowess with simple division, the change amounts to a 30% reduction in total sperm for men who drank more than 34 ounces of soda per day or 14 bottles per week.  Additionally, soda consumption was shown to cause this decrease in semen volume, sperm concentration, and sperm with normal appearance.

Perhaps unsurprisingly, and certainly relevant, there was also a correlation between those men reporting excessively high levels of soda consumption and additional unhealthy lifestyle behaviors.  These men also tended to eat foods high in saturated fats and have less healthy diets overall, and they drank and smoked more.  This of course brings us to the larger issue and one in which I am particularly passionate.  While the authors did their best to control for such possible confounders, their study is more important as a comment on lifestyle.  It is safe to assume that the blame for inadequate sperm cannot be solely placed on soda.  Similarly, your low-performing swimmers cannot be blamed on burgers, or beer, or even cigarettes.  In the end it is the accumulation of our overall personal lifestyle choices that is the culprit.  I’ve always felt that one of the hallmarks of a real man is taking responsibility for your actions.  So in this age of fierce partisan rhetoric and regardless of your beliefs on government being involved in your health care, personal responsibility is something around which we should all be able to rally.  Oh, and for goodness sakes stop drinking soda.

“Personal responsibility extends to lifestyle; that in order to have a healthier America, a more productive America, we need to make some basic changes in what we eat, how much we exercise…”

– Democrat & HHS Secretary Kathleen Sebelius

“Placing responsibility squarely where it belongs, on the shoulders of the patient, will encourage individuals to make healthy lifestyle choices…”

– Conservatives for Patients’ Rights TV ad

Sources

Jensen TK, et al. Caffeine intake and semen quality in a population of 2,554 young Danish men. Am J Epidemiol. 2010 Apr 15;171(8):883-91.

Joelving, F. Is cola bad for sperm? Reuters Health. March 29, 2010. http://www.nlm.nih.gov/medlineplus/news/fullstory_96992.html

By Luke Manley

I wanted to draw your attention to an article published in the February 8^th issue of Newsweek magazine that highlights recently released research that solidly confirms the nearly imperceptible difference between the effectiveness of medications and placebos for the treatment of mild, moderate, and even severe depression.  Drawing primarily from a met-analysis published in the January issue of the Journal of the American Medical Association (JAMA), the article explains how it was discovered that after analyzing just published research it was shown that patients taking a placebo improved 75% as often as those taking the actual medication.  However, only sixty-percent of clinical trials performed on the main drugs for the treatment of depression have ever been published.  After using the Freedom of Information Act to gain access to the remaining 40% of unpublished studies, this number rose to 82%.  In addition, when combining both the published and unpublished trials, researchers found that over half showed “the drug alleviated depression no better than a placebo”.  Further, in the trials that did show an improvement with those taking the actual medication, it successfully reduced severity of depression by only 1.8 points on the 54-point scale.  The final conclusion of the meta-analysis was that the true effect of antidepressants was “nonexistent to negligible” in 87% of people.  The only statistically significant drug benefit was in individuals with very severe, chronic symptoms.  Just in case there was any doubt remaining, researchers exposed that even the very basis of the effectiveness of antidepressants is based only on a single study from the 1950s.  This study showed that a drug called Iproniazid increased serotonin and norepinephrine levels in the brain and seemed to help a number of people with depressive symptoms.  Therefore it was decided that it was an imbalance in these two chemicals that must be the cause of depression.  Yet a new drug sold in Europe has been shown to be as effective as most current antidepressants and actually lowers levels of serotonin.  One of the authors of the ineffectiveness studies puts it plainly, “If depression can be equally affected by drugs that increase serotonin and by drugs that decrease it, it’s hard to imagine how the benefits can be due to their chemical activity.”

Strangely enough, the arguments against this study revolves not around the accuracy of the science, which is admitted even by physicians as well as drug proponents, but whether or not it is morally right to overturn the belief of hundreds of millions of people about the effectiveness of their treatment.  It is argued that, even if the improvement truly is fantasy, this belief is necessary for the benefit to continue. Further many fear that exposing the truth might even cause those receiving treatment to abruptly stop taking their medication, which can cause severe withdrawal symptoms such as nausea, vision problems, tremors, and even depression and anxiety.   That is certainly an understandable and noble stance if it is indeed patient well-being and not a financial bottom-line influencing such a stance.  However, this could easily be the most slippery of slopes.  Is it really the moral option to continue to allow millions of people to spend thousands of dollars on drugs that serve no actual benefit?  Who is it that is qualified to determine what is best for each of us?  Physicians?  Pharmaceutical companies?  Do the lobbyists for Prozac have depressed people’s best interests at heart?

Both the news and journal articles focus primarily on the lack of a difference between the effectiveness of pharmaceuticals and placebos and the potential consequences.  However, it does mention documented methods for successful alternatives, such as psychotherapy, which has been shown to be highly effective for all levels of depression, including very severe.  It also makes the case for how the combination of medication and psychotherapy can be even more effective for some people, but warns that this may also be due to the expectation for success.

All this research has important implications for men’s health since men are equally as likely to suffer from depression as women, but are much more likely to successfully commit suicide because of it.  The National Institute of Mental Health estimates that depression affects approximately six million men in the United States and between three and five-percent of men worldwide.  Additionally, a number of sources confirm that worldwide sales of antidepressants are currently over $20 billion.  Therefore any decisions about the distribution and use of these drugs will have profound effects not only on people suffering from depression and the economics that support their treatment, but also the functioning of mental health care systems throughout the world.

References

Begley, S.  The Depressing News About Antidepressants.  29 January 2010.  Newsweek.

Fournier JC, DeRubeis J., Hollon SD; et al. Antidepressant Drug Effects and Depression Severity: A Patient-Level Meta-analysis. JAMA. 2010;303():47-53.

by Brandon Leonard

This past weekend, the Prostate Cancer Research Institute held its annual conference in Los Angeles, hosting over a dozen experts on prostate health and 600 participants.  According to PCRI volunteers, the purpose of the conference is to provide an avenue for those with prostate cancer and their loved ones to get more information about managing the disease.  The theme of this year’s event was “Making a Positive Impact on Quality of Life,” and among the topics discussed were the benefits and pitfalls of interventions such as chemotherapy, radiation, surgery, and hormone therapy.  Understanding effective diet choices and dealing with erectile dysfunction as a consequence of certain treatment options were also highlights of the agenda.  Throughout the weekend, attendees were encouraged to ask specific questions of the speakers. 

It was also evident that this conference is a gathering place for support, where old friends and new ones have come to share their stories with each other – sometimes just to talk to someone who understands, and sometimes to share information that may be useful to another.  Many of these men have joined support groups in their own communities and have been strengthened by the understanding that they do not need to go through this alone.  Indeed, this is one of the big issues that men suffering from prostate cancer – and other health issues – must overcome.  We are not trained to seek help, but to solve problems in isolation.  On the other hand, drawing on the resources, knowledge and care of others – whether they be friends, family, medical professionals or those who simply understand what we are going through – is what gets both men and women through their most difficult health and life challenges.

Not coincidentally, the PCRI conference is held during September, Prostate Cancer Awareness Month.  One of the big messages I heard from those who stopped at the MHN table during this event was that men need to start thinking about their prostate health – and their health in general – at a much earlier age than they do now.  One of our goals in educating men about their health must be to reach them with effective information and support, early and often, so that these messages stay with them as they mature. 

Those present at the event are certainly doing their best to get these messages across.  Since its founding in 1998, PCRI has contributed to a significant increase in the number of doctors involved in prostate cancer research, as well as public education about the disease.  The organization offers a quarterly newsletter with new developments in prostate cancer research, as well as a helpline for patients who need some support finding the right resources.  Their website, which includes a wealth of information about prostate cancer, can be found at http://www.prostate-cancer.org/. 

“Men’s health care showing disparity” – The San Diego Union Tribune

“Center starts program to help men stay healthy” – Washington Square News

“Study: 1 Out of 4 Homeless Are Veterans” – New York Times

“In Tests, AIDS Vaccine Seemed to Increase Risk” – New York Times

“Causes of Death Are Linked to a Person’s Weight” – New York Times