Un corretto stile di vita, tramite una alimentazione equilibrata, praticare attività fisica ed avere buone abitudini sessuali permettono di mantenere la prostata in salute.

Caldo e prostata: perché in estate i sintomi possono peggiorare

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Con l’arrivo dell’estate, alcuni uomini riferiscono un peggioramento dei disturbi urinari: maggiore frequenza, urgenza, risvegli notturni per urinare o sensazione di svuotamento incompleto.

È naturale chiedersi se il caldo possa “fare male alla prostata”. La risposta più corretta, dal punto di vista scientifico, è questa: il caldo non è una causa diretta dimostrata di patologie prostatiche, ma può creare condizioni che rendono più evidenti o più fastidiosi i sintomi urinari, soprattutto negli uomini che hanno già benign prostatic hyperplasia (BPH), prostatitis or Lower Urinary Tract Symptoms (LUTS).

I LUTS maschili, infatti, non dipendono solo dalla dimensione della prostata. Possono essere legati all’ostruzione causata dall’ipertrofia prostatica benigna, ma anche alla funzione della vescica, alla frequenza minzionale, all’assunzione di liquidi, alle abitudini alimentari e ad altri fattori comportamentali. Per questo, durante l’estate, cambiamenti apparentemente semplici, bere meno, sudare di più, assumere più alcol o caffeina, modificare la dieta o trattenere più a lungo l’urina, possono avere un impatto concreto sulla percezione dei sintomi. [urologyclinics.com], [nature.com]

Il ruolo chiave dell’idratazione

Uno dei fattori più importanti è l’idratazione. Con temperature elevate, l’organismo perde più liquidi attraverso la sudorazione. Se questi liquidi non vengono reintegrati in modo adeguato, il volume urinario può ridursi e le urine possono diventare più concentrate. Dal punto di vista fisiologico, un buon flusso urinario contribuisce alla normale “pulizia” delle vie urinarie, mentre una riduzione della diuresi può favorire ristagno e maggiore concentrazione di sostanze potenzialmente irritanti. [europeanurology.com], [jamanetwork.com]

Questo non significa che la disidratazione causi direttamente problemi alla prostata. Più correttamente, può contribuire a un peggioramento dei sintomi urinari in chi è già predisposto. Una revisione sistematica ha mostrato che un aumento dell’assunzione di liquidi può ridurre il rischio di infezioni urinarie ricorrenti in soggetti predisposti, confermando l’importanza dell’idratazione per la salute del tratto urinario. [jamanetwork.com]

È però importante evitare un messaggio troppo semplicistico. Bere di più non significa necessariamente bere “molto e tutto insieme”. Studi sui LUTS maschili indicano che la quantità e la distribuzione dei liquidi possono influenzare in modo diverso i sintomi: una maggiore assunzione di acqua può associarsi a migliori sintomi di svuotamento, ma anche a maggiore frequenza o urgenza in alcuni soggetti. Per questo le linee guida raccomandano un approccio personalizzato, ad esempio riducendo l’assunzione di liquidi nelle ore serali se il problema principale è la nicturia. [guidelinecentral.com] [nature.com], [wjmh.org]

Caldo e infezioni urinarie

Un altro aspetto riguarda le infezioni delle vie urinarie. Studi epidemiologici hanno evidenziato che le temperature più alte sono associate a un aumento dell’incidenza di infezioni urinarie, con un incremento osservato soprattutto nei mesi più caldi. In uno studio pubblicato sul Journal of Urology, temperature medie settimanali tra 25°C e 30°C sono state associate a un aumento del 20–30% del rischio di infezioni urinarie rispetto a periodi più freddi. [guidelinecentral.com]

Questa evidenza riguarda principalmente le infezioni urinarie in generale, e in particolare popolazioni femminili, quindi non va interpretata come prova diretta che il caldo provochi prostatite negli uomini. Tuttavia, negli uomini alcune infezioni urinarie possono coinvolgere anche la prostata e manifestarsi come prostatite batterica, soprattutto quando sono presenti fattori favorenti come ristagno urinario, ostruzione o svuotamento incompleto. [link.springer.com], [jamda.com]

In altre parole, è più corretto dire che il caldo può aumentare il rischio di condizioni che favoriscono disturbi urinari o infezioni, e che in alcuni uomini queste infezioni possono interessare anche la prostata. Non è invece corretto affermare in modo diretto che “il caldo causa prostatite”.

L’impatto sui sintomi urinari (LUTS)

Quando si parla di sintomi come getto debole, urgenza, nicturia o sensazione di svuotamento incompleto, spesso si pensa immediatamente alla prostata. In realtà, i LUTS sono il risultato di un’interazione complessa tra prostata, vescica e sistema urinario. Possono derivare da un’ostruzione al deflusso urinario dovuta all’ipertrofia prostatica benigna, ma anche da una vescica iperattiva o da alterazioni funzionali non direttamente legate alla dimensione prostatica. [urologyclinics.com], [nature.com]

È proprio questa complessità a spiegare perché l’estate possa rappresentare un periodo critico per alcuni uomini. Non perché la prostata “si infiammi con il caldo” in modo automatico, ma perché cambiano le condizioni intorno al sistema urinario: idratazione, concentrazione delle urine, abitudini alimentari, consumo di bevande irritanti, attività fisica, viaggi e routine quotidiana.

Caldo, infiammazione e prostatite

La prostata è un organo sensibile ai processi infiammatori e infettivi.

La prostatite, che può essere batterica o non batterica, è spesso associata a sintomi urinari e dolore pelvico, e in molti casi deriva da infezioni ascendenti delle vie urinarie. [jamanetwork.com]

Fattori che favoriscono infezioni e ristagno urinario, come:

  • disidratazione
  • ridotta frequenza minzionale
  • ostruzione urinaria (tipica dell’IPB)

sono riconosciuti come elementi che aumentano il rischio di infiammazione prostatica. [nature.com]

In un contesto estivo, questi fattori tendono a combinarsi, creando condizioni favorevoli a una riacutizzazione dei sintomi.

Non solo temperatura: lo stile di vita estivo

Durante l’estate può aumentare il consumo di bevande alcoliche, caffè freddo, tè, bibite zuccherate o gassate. Alcol e caffeina possono avere effetto diuretico e irritante sulla vescica, contribuendo ad aumentare frequenza, urgenza e nicturia in alcuni soggetti. Le linee guida europee sui LUTS maschili includono infatti tra le modifiche comportamentali la moderazione di caffeina e alcol, soprattutto nei pazienti che riferiscono sintomi di riempimento o disturbi notturni. [nature.com], [wjmh.org]

Anche il momento in cui si beve conta. Bere grandi quantità di liquidi la sera, magari dopo una giornata calda, può aumentare la probabilità di doversi alzare durante la notte per urinare. Per questo le strategie consigliate non puntano a ridurre indiscriminatamente l’acqua, ma a distribuirla meglio durante la giornata, evitando eccessi nelle ore serali nei pazienti con nicturia. [nature.com], [wjmh.org]

Cosa fare in pratica

Per chi soffre di sintomi urinari o problemi prostatici, alcuni accorgimenti possono aiutare a ridurre il rischio di peggioramento:

  • mantenere un’idratazione regolare durante la giornata, evitando sia la disidratazione sia grandi quantità di liquidi concentrate in poche ore; [jamanetwork.com], [nature.com]
  • limitare alcol e caffeina se si nota un aumento di urgenza, frequenza o nicturia; [nature.com], [wjmh.org]
  • non trattenere troppo a lungo l’urina, perché il regolare svuotamento vescicale contribuisce alla fisiologica difesa delle vie urinarie; [europeanurology.com], [jamda.com]
  • prestare attenzione a sintomi nuovi o persistenti, come bruciore, febbre, dolore pelvico importante, sangue nelle urine o difficoltà marcata a urinare, che richiedono valutazione medica. [link.springer.com], [urologyclinics.com]

Questi suggerimenti non sostituiscono il parere del medico, ma possono aiutare a gestire meglio i disturbi urinari nei mesi caldi.

Il caldo non deve essere considerato una causa diretta di malattie della prostata. Tuttavia, può contribuire al peggioramento dei sintomi urinari attraverso meccanismi indiretti: maggiore perdita di liquidi, urine più concentrate, variazioni nell’assunzione di acqua, aumento del consumo di alcol o caffeina e possibile incremento del rischio di infezioni urinarie. [guidelinecentral.com], [jamanetwork.com], [nature.com]

Il messaggio chiave è quindi semplice: in estate la prostata non diventa necessariamente “più malata”, ma il sistema urinario può diventare più vulnerabile agli effetti di disidratazione, abitudini scorrette e infezioni. Per chi ha già LUTS, ipertrofia prostatica benigna o una storia di prostatite, prestare attenzione a questi fattori può fare la differenza nella qualità della vita quotidiana. [urologyclinics.com], [link.springer.com], [nature.com]

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A prostate stimulator for urinary symptoms

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The use of a prostate stimulator or massager for therapeutic purposes has attracted growing interest, both in the urological field and among patients seeking alternative solutions to improve prostate-related symptoms.

Common goals of these devices include relief of pelvic discomfort, improved urinary flow, and support for sexual function.

The reason for prostate massage

The prostate massage, which can be done manually (with the finger) or through external devices, aims to empty the prostatic ducts of stagnant secretions, promoting the reduction of congestion and inflammation.

Since the beginning of the twentieth century, this practice has found application in the management of prostatitis and benign prostatic hyperplasia (BPH), but the arrival of antibiotics and anti-inflammatories has reduced its traditional medical use (source1, source2).

Benefits on urinary symptoms

A retrospective study of 115 men with lower urinary tract symptoms (LUTS), whether related to BPH or chronic prostatitis, showed significant improvement in NIH-CPSI scores, an index used to assess pain, urinary symptoms, and quality of life.

In patients with BPH, the mean score decreased from 11.6 to 6.6, and in those with prostatitis from 16.7 to 11.5. In one case report, ten massage sessions combined with antibiotics reduced the prostate volume, measured by ultrasound, by 52% (from 63 to 30g), accompanied by a marked improvement in symptoms (source).

Studi più datati indicano che, associando massaggio, antibiotici e alpha blokers, si può ottenere una risoluzione della ritenzione urinaria e un miglior flusso di urina.

Relief from pain and prostatitis

Some work suggests that massage may reduce pelvic pain and improve bacterial clearance when combined with antibiotics (source). However, the quality of the evidence is low (small samples, lack of controls).

International guidelines (EAU, AUA) do not recommend prostate massage as standard therapy for CP/CPPS, precisely because of the lack of solid evidence (source).

Aspects of sexual function and ejaculation

Some patients report improved sexual function after prostate massage, although the evidence is still limited and often anecdotal. There are no robust clinical studies demonstrating a significant or lasting effect.source).

Risks and precautions

While generally well tolerated, massage can cause rectal discomfort or pain, especially if used incorrectly. Some people experience irritation or bleeding.

It is essential that the procedure be performed with the utmost care, preferably under the supervision or advice of a doctor, especially in the presence of complex prostate pathologies.

Prostate massage may represent an interesting non-pharmacological option for the relief of LUTS, pelvic pain and ejaculatory problems, with a wide margin of tolerability.

However, the quality of the evidence varies: many studies are retrospective, single-case, or small RCTs. Only more robust research, such as randomized controlled trials, could definitively establish prostate massage as standard clinical practice.

In conclusion, this form of stimulation offers real potential benefits, especially when integrated with conventional therapies (drugs, physiotherapy).

However, an informed, personalized, and safe approach remains important, given the potential risks and the need for further scientific confirmation.

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10 tips for prostate health

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“Doctor, what can I do to prevent the prostate cancer?”.
This is one of the most common questions that doctors hear from men concerned about the health of the prostate.

Unfortunately, there is nothing that can guarantee that one will not develop a disease with certainty. There is always a probability of risk, but it can be reduced with a few simple lifestyle measures.

Adopt a healthy eating pattern

Instead of focusing on specific foods, dieticians, doctors and researchers advertise a general pattern of healthy eating, and healthy eating is easier than you might think.

In a nutshell, here is what the experts recommend:

  1. Eat at least five portions of fruit and vegetables every day. Choose those with bright, intense colours.
  2. Choose wholemeal bread instead of white bread and choose wholemeal pasta and cereals.
  3. Limit consumption of red meat, including beef, pork, lamb and goat, and processed meats, such as bologna and frankfurters. Fish, poultry, beans and eggs are healthier sources of protein.
  4. Choose healthy fats, such as olive oil, dried fruits (almonds, walnuts) and avocados. Limit saturated fats from dairy products and other animal products. Avoid partially hydrogenated fats (trans fats), which are found in many fast food and packaged foods.
  5. Limit sugary drinks, such as soft drinks and many fruit juices.
  6. Reduce salt. Choose low-sodium foods by reading and comparing food labels. Limit the use of canned, processed and frozen foods.
  7. Watch portion sizes. Eat slowly and stop eating when you are full.

Stay active and keep your prostate healthy

Besides eating a healthy diet, you should stay active. Regular exercise reduces the risk of developing some serious problems, including heart disease, stroke, and some cancers. And although relatively few studies have directly evaluated the impact of exercise on prostate health, those that have been done have concluded that exercise is beneficial. For example:

  • Based on the study questionnaires Health Professionals Follow-up Study, sponsored by Harvard University, compiled from over 30,000 men showed an inverse relationship between physical activity and symptoms of benign prostatic hyperplasia (BPH). Simply put, men who were more physically active were less likely to suffer from BPH. Physical activity of low to moderate intensity, such as walking regularly at a moderate pace, also produced benefits.
  • From the same study, a correlation was observed between erectile dysfunction and exercise. They found that men who ran for at least an hour and a half or did three hours of outdoor sports per week were 20% less likely to have erection problems than those who did not exercise at all. And the greater the amount of physical activity, the lower the risk. Interestingly, regardless of the level of exercise, men who were overweight or obese had a higher risk of erectile dysfunction than men with an ideal body mass index.
  • An Italian study recruited 231 sedentary men with prostatitis chronic and divided them into two exercise programmes for 18 weeks: aerobic exercise, which included fast walking, or non-aerobic exercise, which included leg lifts, abdominal exercises and stretching. Each group exercised three times a week. At the end of the study, men in both groups felt better, but those in the aerobic exercise group experienced significantly less discomfort, anxiety and depression and a better quality of life.

From this evidence we can therefore say that if you want to keep your prostate healthy:

  1. Do physical activity, starting with a low intensity, such as walking regularly at a moderate pace
  2. Try to gradually increase the intensity of your physical activity. But without overdoing it. listen to your body!
  3. Prefer aerobic activities, such as brisk walking or running, to non-aerobic activities, such as leg lifts or sit-ups.

source: https://www.health.harvard.edu/mens-health/10-diet-and-exercise-tips-for-prostate-health

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Bike saddle and prostate problems

Cycling is a sport loved by many, but for those who suffer from problems of the prostate, can become a challenge.

Despite common belief, the use of the bicycle does not appear to be a direct cause of prostate problems. However, when problems are already present, microtraumas caused by prolonged saddle pressure can aggravate the pathology and symptoms.

It is therefore important to choose a suitable saddle and take preventive measures to reduce pressure on the perineal area.

Fortunately, there are specific saddles designed to relieve pressure on the prostate and improve comfort while cycling.

Shilling conformation

Saddles for prostate problems, also known as anti-prostate saddles, are designed to reduce pressure on the perineal area. The main feature of these saddles is the presence of a central hole or one groove which relieves pressure on the prostate and surrounding tissues.

This design helps prevent numbness and pain by improving blood flow in the area.

The use of an anti-prostatic saddle is particularly recommended for:

  • Cyclists who spend many hours in the saddle: Reducing pressure helps prevent long-term problems.
  • Cyclists with uro-genital problemsThese saddles can alleviate symptoms and improve comfort.
  • Cyclists seeking greater comfort: Even without specific problems, an anti-prostatic saddle can improve the pedalling experience.

How it works

The functioning of an anti-prostate saddle is based on a few key principles:

  1. Weight distribution: The design with a central hole or groove distributes the rider's weight evenly, reducing pressure on the prostate.
  2. Shock absorption: Many saddles are equipped with gel or foam padding that absorbs shocks and improves comfort.
  3. Breathable materials: The materials used are often breathable and water-resistant, keeping the seat cool and dry.

Types of Shingles

There are different types of anti-prostatic saddles, each with specific characteristics:

  • Saddles with central hole: Ideal for those seeking a significant reduction in pressure
  • Grooved saddlesThey offer a good compromise between support and pressure reduction
  • Padded saddles: Equipped with gel or foam padding for greater comfort

How to Choose the Optimal Saddle

The choice of the optimal saddle depends on several factors:

  1. Width of ischial bones: Measuring the distance between the ischial bones is crucial for choosing the correct saddle width 
  2. Saddle shape: The shape must adapt to the conformation of the pelvis and the pedalling position
  3. Padding: The amount and type of padding must be chosen according to personal preference and the type of cycling practised
  4. Materials: Opt for breathable and water-resistant materials for greater comfort and durability

Choosing the right saddle can make a big difference for those suffering from prostate problems. With the right shape, use and type, you can significantly improve your comfort and health while cycling. Remember to consider your needs carefully and consult an expert if necessary to find the perfect saddle for you.

For further information: https://www.mdpi.com/2411-5142/8/2/71

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The Benefits of Yoga for Prostate Health

The health of the prostate is an important concern for many men, especially as they get older. Maintaining a healthy prostate can prevent problems such as benign prostatic hyperplasia (BPH) and the prostate cancer. One practice that is gaining more and more attention for its benefits on prostate health is yoga.

Stress Reduction

Stress is a factor that can negatively affect prostate health. Yoga, with its breathing and meditation techniques, helps reduce stress and anxiety. The regular practice of yoga can lower levels of the stress hormone cortisol, thus improving overall well-being and prostate health.

Improving Circulation

Certain yoga postures, such as the bridge posture (Setu Bandhasana) and the fish posture (Matsyasana), can improve blood circulation in the pelvic region. Improved circulation can help keep the prostate healthy and prevent inflammation.

Pelvic Floor Strengthening

Yoga exercises involving the Pelvic floor, such as the butterfly position (Baddha Konasana) and the baby position (Balasana), can strengthen the pelvic muscles. A strong pelvic floor supports the prostate and can help prevent problems such as urinary incontinence.

Promoting Muscle Relaxation

Yoga helps relax the muscles of the body, including those in the pelvic region. Muscle relaxation can relieve the tension and pain associated with conditions such as chronic prostatitis.

Improving Sleep Quality

Quality sleep is essential for general health and the immune system. Yoga can improve the quality of sleep, helping to regulate circadian rhythms and reduce insomnia. Good sleep is crucial for cell regeneration and keeping the prostate healthy.

Integrating yoga into one's daily routine can offer numerous benefits for prostate health. By reducing stress, improving circulation, strengthening the pelvic floor and promoting muscle relaxation, yoga can be a valuable ally in maintaining a healthy prostate. As always, it is important to consult a doctor before starting any new exercise practice, especially if you have pre-existing conditions.

For further information: https://link.springer.com/article/10.1007/s00520-024-08754-2

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BMI (Body Mass Index) and Prostate Cancer

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Il Body Mass Index (BMI), o indice di massa corporea, è un parametro utilizzato per valutare la composizione corporea di un individuo, calcolato come il rapporto tra il peso in chilogrammi e il quadrato dell’altezza in metri. Questo indice è ampiamente utilizzato per classificare il peso corporeo in categorie come sottopeso, normopeso, sovrappeso e obesità.

Significato del BMI per la Salute

Il BMI è un indicatore utile per identificare potenziali rischi per la salute associati al peso corporeo. Un BMI elevato è spesso correlato a un aumento del rischio di sviluppare malattie croniche come il diabete di tipo 2, le malattie cardiovascolari e alcuni tipi di cancro, incluso il prostate cancer.

BMI e Tumore alla Prostata

Numerosi studi hanno esaminato la relazione tra BMI e il rischio di sviluppare il tumore alla prostata. Ecco alcuni punti chiave:

  1. Rischio di Tumore alla Prostata: L’obesità, definita da un BMI superiore a 25 (30 negli USA), è stata associata a un aumento del rischio di sviluppare forme aggressive di tumore alla prostata. Gli uomini obesi hanno una probabilità maggiore di sviluppare tumori ad alto grado e metastatici rispetto agli uomini con un BMI nella norma.
  2. Progressione della Malattia: Un BMI elevato può influenzare la progressione del tumore alla prostata. Diversi studi hanno dimostrato che gli uomini con un BMI più alto al momento della diagnosi hanno un rischio maggiore di progressione della malattia e di mortalità specifica per il tumore alla prostata.
  3. Influenza del Peso Corporeo: La perdita di peso può avere effetti benefici sulla salute della prostata. Ad esempio, uno studio ha rilevato che gli uomini che hanno perso più di 5 kg tra il 1982 e il 1992 avevano un rischio ridotto di sviluppare tumori alla prostata ad alto grado.

Il BMI è un parametro importante nella valutazione del rischio di tumore alla prostata. Mantenere un BMI nella norma attraverso una dieta equilibrata e l’esercizio fisico può contribuire a ridurre il rischio di sviluppare forme aggressive di tumore alla prostata e migliorare la prognosi per chi è già affetto dalla malattia.

È sempre consigliabile consultare un medico per una valutazione personalizzata e per discutere le migliori strategie di prevenzione e gestione del peso.

Calcolatore BMI

Calcolatore BMI

References:

https://aacrjournals.org/cebp/article/16/1/63/276620/Body-Mass-Index-Weight-Change-and-Risk-of-Prostate

https://csn.cancer.org/discussion/191220/men-who-put-on-pounds-after-prostatectomy-nearly-double-odds-of-recurrence-one-study-finds

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Overcoming erectile dysfunction with prostate disease

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Do you know what erectile dysfunction really is? Not being able to have an erection one night after drinking a few more drinks, or even for a week during a period of intense emotional stress, is not erectile dysfunction.

The inability to get an erection again immediately after an orgasm is not erectile dysfunction either. Almost every man occasionally has trouble getting an erection and most partners understand this.

The erectile dysfunction is the inability to achieve and maintain an erection sufficient for sexual intercourse at least 25% of the time. The penis does not get hard enough, or it gets hard but softens too soon. The problem often develops gradually. One night it may take longer or require more stimulation to achieve an erection. On another occasion, the erection may not be as firm as usual or may end before orgasm. When such difficulties occur regularly, it is time to talk to your doctor.

Erectile dysfunction can have many causes, including certain forms of prostate disease or therapies for the prostate cancer. Fortunately, in many cases, this problem can often be dealt with effectively, for example by taking medication to treat erectile dysfunction.

How an erection occurs

Put quite simply, an erection is a matter of hydraulics. Blood fills the penis, causing it to swell and become firm. But getting to that stage requires an extraordinary orchestration of the body's mechanisms. Blood vessels, nerves, hormones and, of course, the psyche must work together. Problems with any one of these elements can diminish the quality of an erection or prevent it from occurring at all.

Prostate Cancer

Surgery for prostate cancer can sever some of the nerves or arteries necessary for an erection. For men undergoing radical prostatectomy (removal of the prostate gland), estimates of how many men will regain the ability to have an erection vary widely, from 25% to 80%. So-called ’nerve-sparing“ surgical techniques also lead) to erectile dysfunction in up to half or more of all cases. The results depend on variables such as the age of the patient, the skill of the surgeon and the location of the tumour (if a tumour is too close to the nerve bundle, the nerves cannot be spared). Even when the nerves are not permanently compromised, it can take 6 to 18 months for the nerve fibres to recover from the trauma of surgery and restore sexual function.

Radiation treatment (radiotherapy) can also damage erectile tissue. Both external radiation and radiation-emitting seeds implanted in the prostate (brachytherapy) lead to erectile dysfunction in about half of the men receiving these therapies. However, these changes may not occur until two years after treatment.

Erectile dysfunction is sometimes a side effect of certain hormone therapy drugs prescribed for men with cancer that has spread beyond the prostate. Among these hormone-based drugs are leuprolide (Lupron) and goserelin (Zoladex). Others, such as flutamide (Eulexin) and bicalutamide (Casodex) can cause erectile dysfunction to a lesser extent. Prostate cancer itself, in its advanced stages, can also spread to the nerves and arteries necessary for an erection.

Benign prostatic hyperplasia

Men who have thebenign prostatic hyperplasia (BPH), or enlarged prostate, may also experience erectile dysfunction and ejaculatory problems. While BPH itself does not cause these problems, some of the treatments used can. For example, finasteride (Proscar), a testosterone-lowering drug prescribed for BPH, has been linked to erectile dysfunction in 3.7% of men who use it and decreased libido in 3.3%. But alpha blokers such as tamsulosin (Flomax), alfuzosin (Uroxatral), and silodosin (Rapaflo) may improve BPH symptoms with a lower risk of sexual side effects.

Transurethral resection of the prostate, a surgical technique often used when drugs fail, also causes erectile dysfunction in a small percentage of men.

Low testosterone

The levels of testosterone tend to decrease with age. They peak at the beginning of adulthood and then may decrease to 1% per year from about the age of 40. Sometimes a sudden drop occurs due to an injury or illness (such as an infection), chemotherapy or radiotherapy, or certain medications.

The hormone testosterone plays an important role in men's health, but perhaps its most significant role is in fuelling sexual desire. If testosterone levels fall too low, men can experience erectile dysfunction and lacklustre libido.

Prostatitis

The prostatitis is an inflammation of the prostate gland that can be acute (usually caused by a bacterial infection) or chronic (usually not caused by an infectious agent). Symptoms include pain during urination, more frequent urination and possibly discharge from the penis or fever. Severe prostatitis can directly cause erectile dysfunction. In milder forms, the condition may produce painful ejaculation, which can certainly interfere with sexual pleasure and may lead to erectile dysfunction.

What tests to do for erectile dysfunction

The doctor will listen to your heart and also take your blood pressure; both high and low blood pressure can impair blood flow. The doctor will check your pulse at several points: at the wrist, ankle and groin. Slow or low pulse in any of these areas can mean that not enough blood is getting to the tissues of the extremities, including the penis.

In addition, the doctor will examine the testicles, penis and chest. Abnormally small testicles and enlarged breasts are sometimes signs of inadequate testosterone. Spots of scar tissue in the penis suggest Peyronie's disease. The doctor may check the prostate gland for signs of infection or cancer by performing a digital rectal examination.

Your control will probably include tests for the cholesterol (to assess the risk of cardiovascular disease) and triglyceride and blood sugar levels (to check for diabetes). The doctor may also request a urine sample because the presence of red or white blood cells could be a sign of an underlying urological problem.

Now that drugs can successfully treat most men with erectile dysfunction, many routine diagnostic tests are only used when the doctor suspects that the patient has an underlying problem that requires additional treatment.

Hormonal tests

Checking testosterone levels was one of the first tests ordered for men with erectile difficulties, but it was before doctors realised that testosterone deficiency was rarely the source of the problem. Now, hormone tests are performed for men whose medical examinations suggest an endocrine problem and for those who have experienced a loss of sexual desire.

The doctor may also want to check blood levels of prolactin (a pituitary hormone that can block the action of testosterone) or thyroid-stimulating hormone (a good indicator of an overactive or hypoactive thyroid gland).

Blood flow examinations

A duplex colour Doppler ultrasound, an imaging technique, can reveal problems with blood flow through the arteries or veins of the penis, such as venous leakage. A newer version, called a penile doppler, can be performed in a doctor's office. If you have tried erectile dysfunction pills, but have not found them helpful, your doctor can inject prostaglandin, a fatty acid that widens blood vessels, into your penis to see if this causes an erection. If so, there is a good chance that you will respond to one or more of the injectable drugs used to treat erectile dysfunction.

Nocturnal tumescence test

If it is unclear whether your erectile difficulties have a psychological or physical cause, your doctor may suggest a nocturnal penile tumescence test. Psychological factors come into play when you are trying to achieve or maintain an erection. But the psyche does not influence nocturnal erections, which occur involuntarily during sleep. Physical causes influence both types of erections.

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Rehabilitation after prostate surgery

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Spesso non è tanto una diagnosi di prostate cancer a spaventare un uomo, quanto la paura delle conseguenze di una terapia.

Dopo un intervento di prostatectomia radicale, per esempio, impotenza e incontinenza urinaria sono effetti collaterali più o meno comuni.

L’incontinenza, però, è nella maggior parte dei casi un problema transitorio che scompare del tutto, grazie anche alla riabilitazione.

L’incontinenza ha un forte impatto negativo sulla qualità della vita dell’uomo che dovendo ricorrere all’utilizzo di assorbenti si vede obbligato a modificare la propria socialità.

La riabilitazione del Pelvic floor è mirata proprio a rafforzare l’azione della vescica, responsabile del contenimento urinario che diventa più difficile per gli uomini a cui la prostata viene asportata chirurgicamente.

La riabilitazione ha l’obiettivo di migliorare i meccanismi che compensano la perdita di attività da parte di quei muscoli che chiudono il canale che porta l’urina dalla vescica verso l’esterno, ovvero dei muscoli pelvici.

Il Fisiatra è lo specialista di riferimento e può programmare il trattamento riabilitativo più adeguato, indirizzando il paziente in un centro specializzato dove imparerà a conoscere questi muscoli e a rafforzarli con esercizi corretti di fisioterapia. Per questo è importante iniziare il prima possibile e che almeno la fase iniziale venga opportunamente seguita.

Questo tipo di esercizi punta a migliorare e rafforzare questa zona, affinché la contrazione del perineo sia in grado di bloccare il passaggio dell’urina.

La ginnastica perineale è consigliata anche agli uomini trattati soltanto con la radiotherapy, ma in questo caso i benefici possono essere minori in ragione di un danno indotto dalle radiazioni al tessuto muscolare: meno sensibile e vascolarizzato. 

La riabilitazione può essere abbinata all’attività sportiva. Vanno benissimo il nuoto o una camminata, all’aperto o sul tapis roulant. Per la corsa sostenuta e le passeggiate in bicicletta, invece, è meglio aspettare un paio di mesi. Vale comunque sempre un consiglio: nel momento in cui l’attività fisica comporta una perdita di urina, non va ripetuta fino a un’avvenuta guarigione.

insights: https://www.pelvicrehabilitation.com/

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Active surveillance for prostate cancer

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The concept of Active Surveillance is increasingly emerging as a viable option for men who decide not to undergo a radical treatment immediate for the prostate cancer, such as surgery or radiotherapy.

Active surveillance is based on the concept that it is certain types of prostate cancer, defined as “low risk”, have a low probability of evolving into an aggressive disease and thus reducing life expectancy.

Over 30% of men with prostate cancer have such slow-growing disease that the side effects of radical treatment far outweigh the benefits.

Of the 10 most common cancers, prostate cancer is the only one in which so many patients have a slow-growing disease that does not warrant immediate aggressive treatment.

But beware: active surveillance is not a “non-treatment”, but rather a strategy to treat you only if and when your prostate cancer actually requires treatment.

It may seem counterintuitive to say that a patient has cancer and the best thing is to sit and wait. But studies show that men with low-risk prostate cancer who have been in active surveillance for 10-15 years after diagnosis have remarkably low rates of disease spread or death from prostate cancer.

In fact, a study by the Johns Hopkins on men in active surveillance found that less than 1% of men developed metastatic disease in 15 years of monitoring. This is extremely important because the treatments used for localised prostate cancer - surgery and radiotherapy - have side effects that can alter a person's quality of life.

The key to successful active surveillance is obviously regular monitoring in order to intervene at an early stage when there are signs of progression.

Who can consider active surveillance?

Patients who may consider active surveillance following a diagnosis of prostate cancer must obviously have localised disease at low risk of progression.

In general, the characteristics of the tumour to be considered a candidate for this type of approach must be :

  • a histological diagnosis with a Gleason score maximum of 6 (indicated as 3+3) or, only for an age over 70, of 7 (indicated as 3+4);
  • Of all the biopsy samples, only 1 or 2 must be positive for prostate cancer;
  • have a value of PSA in the blood equal to or less than 10 ng/ml;
  • have a small tumour that does not exceed the capsule lining the prostate, defined as stage T1c or T2a;

Surveillance or therapy: the choice is always the patient's

Patients with newly diagnosed localised prostate cancer at low risk of progression are provided with information on various types of treatment available to date.

The duly informed patient is invited to discuss this with his or her doctor and persons he or she trusts, and will then be able to choose spontaneously whether to enter the active surveillance programme or to resort to surgical or radiotherapeutic treatment, obviously if appropriate to the specific situation.

Active surveillance in Italy

In Italy, there are some active surveillance protocols in which it is possible to participate.

In various parts of our country, the study is active PRIAS promoted by the urology society SIURO, while in Piedmont and Valle d'Aosta recruitment is active for the study START.

They are “observational” studies because they do not involve testing drugs or new technologies. They consist exclusively of collecting information on the patient's state of health over time, whichever treatment he or she decides to undergo among the various possible options.

In particular, information is collected on the patient's quality of life, by means of simple questionnaires to be filled in at the start of treatment and then periodically at the usual check-ups, where, in addition to checking PSA values and the objective examination, imaging examinations may be carried out, such as a multiparametric MRI.

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Prostate cancer prevention

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Prevention is always the best way, even for prostate cancer.

There are some tricks, some simple habits that can help safeguard prostate health, preventing, for example, the prostate cancer, even in the presence of certain risk factors, such as the presence in the family of relatives who have dealt with this disease.

Primary prevention

Here are some simple steps to reduce the risk of developing prostate disorders:

  • Diet rich in fibre, antioxidants and omega-3. Whole-grain flours, fresh fruit and vegetables are therefore recommended (especially the less sugar-rich fruits such as apples and pears, orange vegetables, fennel, turnips and cabbage), blue fish, extra virgin olive oil and legumes. A healthy diet protects the function of the prostate and delays the ageing process and the risk of related abnormalities;
  • Foods to be reduced are sausages, fried foods, very fatty cheeses and foods that contain a lot of simple sugars (such as sweets and sugary drinks). These promote inflammatory states, as well as leading to cardiovascular problems and increasing the risk of becoming overweight;
  • Maintaining a healthy weight. We visited as obesity constitutes a risk factor for prostate cancer.
  • Do exercise on a regular basis reduces both the risk of benign prostatic hyperplasia and prostate cancer. 
  • Do sex habitually. Frequent ejaculations maintain good prostate function, improve health of body and mind.

Secondary prevention: controlling the prostate

Maintaining a healthy prostate means having regular check-ups, especially after the age of 50, although it is recommended to visit a urologist as early as the age of 40.

What tests and examinations are recommended for early detection of any abnormalities, dysfunctions or diseases that may affect the prostate?

  • Urinalysis. Urine culture is useful for detecting infections or bleeding;
  • PSA (prostate-specific antigen)is a blood test that detects levels of a protein produced solely by the prostate. Normal levels range from 0.0 to 4.0 ng/ml (nanograms per millilitre of blood), but can increase due to various causes, including tumours, benign prostatic hyperplasia and prostatitis. It is generally recommended to perform it in the presence of symptoms suggesting the presence of one of these diseases. If the value is above 4 ng/mL, or is constantly rising, further tests may be necessary.
  • PSA ratio: ratio of free to total PSA. In the blood, the PSA protein is normally found bound to other substances, not “free” except in minute concentrations. However, in the presence of a malignant tumour, these values fall even further. For this reason, when the PSA test gives “suspicious” results, the doctor may also prescribe the dosage of PSA free (also called free PSA or fPSA). The free PSA/total PSA ratio is used to interpret the data. Normal, i.e. non-pathological, values are around 0.20%. Values different from this percentage may indicate the presence of prostate pathology, for which the doctor will prescribe other tests;
  • Digito-rectal exploration (DRE)The urologist manually checks the condition of the prostate by introducing a finger through the rectum, after lubricating the part. This exploration makes it possible to discover an enlargement, the presence of nodules or prostatitis. It can be annoying, but it is harmless; the greatest discomfort is psychological, which it is good to point out to the doctor so that he can reassure the person.
  • Uroflowmetry. The person must urinate into a device, similar to a toilet, that measures the speed and volume of the urine flow. An ultrasound is usually prescribed after this test;
  • Transrectal prostate ultrasound. A quick and harmless examination to assess the morphology of the prostate and thus detect dilatation or possible neoformations. It is carried out by inserting a probe into the rectum, which is lubricated, that emits ultrasound that can be converted into static or dynamic images. Sometimes a biopsy of the prostate is associated with this examination.

If these examinations give results that lead to the suspicion of prostate cancer, it may be necessary to undergo a prostate biopsy. The operator inserts a tube with a small rectal probe, to explore before the operation; then, through the same tube, he inserts a needle which is used to take small pieces of prostate tissue. These will be analysed to detect any abnormalities in the cells and, if positive, the aggressiveness of the cancer. The procedure, which is very quick, is painless as it is performed under local anaesthesia.

Currently, the PSA test is the mainstay of preliminary examinations to monitor the risk of prostate cancer. However, its low reliability as a single parameter makes it of little use as a screening test.

If you want to know how our innovative urine test for prostate cancer works click HERE.

Read the AIOM guidelines: https://www.aiom.it/linee-guida-aiom-carcinoma-della-prostata-2019/

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