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Beyond the Prostate: Don’t Forget About the Rest of Your Body!

Treatment of prostate cancer at any stage can be all-consuming.  But don’t forget about the rest of your body! 

This means you still need to think about screening for other cancers, such as colon cancer and skin cancer.  You still need regular checks for blood cholesterol, liver function, kidney function, and diabetes – the lab work doctors usually order at a routine yearly physical.   You need someone to listen to your heart and check your blood pressure.  If, like many men, you don’t have a family doctor or internist, but only go to the urologist, make sure your urologist is aware of this, and be sure to raise any health concerns at your office visit.

Be Good to Your Heart

Right up there at the top of your health goals should be cardiovascular wellness.  Here’s one big reason why:  “If you have localized prostate cancer and are treated successfully for it, your biggest risk of dying is of a heart attack,” says Edward M. Schaeffer, M.D., Ph.D., chairman of urology at Northwestern University.  He made this point in the upcoming book we co-wrote with Johns Hopkins urologist Patrick Walsh, the 5th edition of Dr. Patrick Walsh’s Guide to Surviving Prostate Cancer.

“Even if you don’t have prostate cancer, heart disease remains the number one cause of death in men,” he continues.  “If you have advanced prostate cancer and are on androgen deprivation therapy (ADT), your risk of a heart attack goes up.  Thus, focus on being heart-healthy!”

What’s good for your heart?  A whole-foods diet and healthy habits.  It’s pretty straightforward:  Eat a diet rich in fruits and vegetables and low in processed foods, fried foods, and sugar.  Choose skinless poultry, fish, and plant-based proteins more than red and processed meats.  If you drink alcohol, do it in moderation – or better yet, not at all.  Aim for some moderate exercise every day.  (Get more tips on nutrition, exercise, and rest in PCF’s guide, The Science of Living Well, Beyond Cancer, available here.)

Testosterone and Your Overall Health

Men with advanced prostate cancer need ADT, which shuts down male hormones, including testosterone.  For these men, “that’s the most important issue right now,” says Schaeffer, “keeping their cancer under control.”

But men who are not on ADT, men who don’t have prostate cancer or men who have been treated successfully for localized prostate cancer are in a different situation.  They do need testosterone for good health.  “Male hormones play a big role in keeping your body healthy,” says Schaeffer.  “Ideally, men should have testosterone levels that are in the normal range.”

This can be a hard concept to grasp, says Johns Hopkins neuro-urologist Arthur Burnett, M.D.   “Ever since (Nobel prize-winning scientist) Charles Huggins made the observation 70 years ago that in advanced prostate cancer, if you shut down the male hormones, that will cause a regression of the disease, there’s been widespread notion that if you have prostate cancer, you need to get the testosterone down.  The reality is, if you are cancer-free, for normal physiology, if you have low testosterone, you should get to a normal testosterone level.” Even in men who have not been treated with ADT, testosterone can be low for other reasons, including age, obesity, and certain chronic medical conditions.

Burnett, with investigators at Harvard, is conducting a trial of supplemental testosterone in men after prostatectomy.  The hypothesis is that restoring low testosterone to the normal range “is safe and efficacious, that it can improve cognitive function and some physical limitations that some men have when their testosterone is low, and that there might be some sexual benefit from getting testosterone back into the normal range.  For men who have radical prostatectomy or radiation therapy for localized disease who happen to be testosterone-deficient, rather than condemn them for the rest of their lives to having too little testosterone, how do you help them achieve maximal health?”  The results of this trial may ultimately help to inform best practices and recommendations to manage testosterone levels safely in these patients.

The key is to keep testosterone in the normal range of between 300 and 800 ng/dL, says Schaeffer.  Among other things, “very low testosterone levels can raise the risk of a heart attack or stroke, decrease muscle mass, weaken bones, impair cognitive function, increase the risk of metabolic disease, frailty and depression.” If you are experiencing symptoms such as fatigue or low sex drive, speak to your urologist or primary care physician.

 “Sexual Health is a Barometer”

Both surgery and radiation therapy for localized prostate cancer can cause temporary or longer-lasting difficulties with erectile function.  But other medical conditions can cause erectile dysfunction (ED), too.  Burnett, a pioneer in the field of men’s sexual health – whose scientific discoveries about the role of nitric oxide in erection led to development of the drug Viagra – has written about this in detail in his book, The Manhood Rx: Every Man’s Guide to Improving Sexual Health and Overall Wellness.

For example:  “Heart disease and ED, the two entities are linked,” he says.  “Erection is a matter of vascular function in the genitalia.  Heart disease affects more than the heart – the entire cardiovascular system.  It can cause cerebral vascular disease, peripheral vascular disease, and penile vascular disease.  Erection is all about blood flow and how it’s regulated.”  In fact, “ED is a marker, not only for heart disease, but for diabetes, metabolic syndrome, some autoimmune diseases, and systemic inflammation (diseases including gout, inflammatory bowel disease, gastritis, and prostatitis).”  Being overweight can affect erectile function, as well; basically, fat cells raise estrogen levels, and reduce testosterone.

There are many ways to treat ED, including drugs such as Viagra and Cialis, penile injections, and surgery to implant a penile prosthesis.  “Sexual health after prostate cancer requires a multifaceted approach that begins with the patient,” says Burnett.  “Healthy living, preserving your best health after prostate cancer – eating a balanced diet, exercising, avoiding smoking and moderating your alcohol intake – can help maximize blood flow to the penis.  You won’t get your 25-year-old penis back, but it may help preserve the function you have.  And more proactively, talk to your urologist.  Seek out interventions.  If you don’t respond to a PDE5 inhibitor (Viagra or similar ED drug), there are nonsurgical interventions, including pumps or penile injection, and surgical intervention, implantation of a penile prosthesis.  Don’t give up!”

Janet Worthington
Janet Farrar Worthington is an award-winning science writer and has written and edited numerous health publications and contributed to several other medical books. In addition to writing on medicine, Janet also writes about her family, her former life on a farm in Virginia, her desire to own more chickens, and whichever dog is eyeing the dinner dish.