News from Johns Hopkins on Urinary Incontinence, Kegel Exercises and Familial Prostate Cancer.

Urinary incontinence is a major complication of radical prostatectomy.  According to the November 9th Johns Hopkins Health Alerts (Prostate Disorders), incidence of serious incontinence from surgery at medical centers of excellence is low, around 3% whereas from overall national patient survey data, urinary incontinence is dramatically higher, around 50-60%.  For a clear description of the physiology of urinary incontinence, see the full Hopkins Health Alert.  An earlier issue of the Johns Hopkins Health Alerts (August 24th) described the Kegel exercises which strengthen pelvic floor muscles involved in urination.  These exercises are often prescribed before prostate surgery.

Studies performed on hereditary forms of prostate cancer at Johns Hopkins and the National Cancer Institute have shown that men with one close relative, such as a father or brother, with prostate cancer have a two-fold increase in the risk of developing the disease. If two close relatives are affected, there may be as much as a five-fold increase.  Although a great deal of research has been directed toward the roles of diet and dietary supplements in prostate cancer risk, the results have been inconclusive in terms of hard data.  There is a general consensus that a reduction in the consumption of red meat is associated with lower prostate cancer rates, but the reason is not known.  Cruciferous vegetables, such as broccoli, cabbage, and brussels sprouts, and leafy greens, such as kale and collards, contain compounds that seem to reduce prostate cancer risk.  A compound called lycopene, found in tomatoes and best absorbed from cooked tomatoes (as in sauce), is also thought to be helpful.  For a while, selenium and vitamin E were believed to have a significant effect on the risk of developing prostate cancer, but a large multi-institutional trial failed to show any benefit.  Regardless of diet, prostate health should be monitored at least once a year with a PSA and digital rectal examination. And it is not just the absolute value of the PSA that is important, but also the rate of rise from one year to the next. If the PSA goes up more than 0.5 ng/mL/year, regardless of the absolute value, there is a greater risk that prostate cancer may be developing. Under those circumstances, biopsy should be considered, assuming that there are no other special considerations related to overall health or personal preferences.

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