The Aging Male
Practice pointers for you and your patients. Top 10 threats to men's health and a checklist to help keep them healthy at 50 and beyond.

EAU LAUNCHES NEW CLINICAL MALE SEXUAL DYSFUNCTION GUIDELINES FOR 2009
The European Association of Urology (EAU) released updated guidelines on male sexual dysfunction at their 24th Annual Congress held in March in Stockholm. According to the EAU, since the prior guideline that addressed only erectile dysfunction (ED), considerable data and various drugs have become available. The new guideline addresses the efficacy of phosphodiesterase type 5 (PDE5) inhibitors and patients who do not respond to the agent, as well as combination drugs, continuous dosage, and drug preferences. The new guideline also addresses the treatment of premature ejaculation.

The EAU also said that most patients who have had nerve-sparing radical prostatectomy suffer from varying degrees of ED. In many of those patients, PDE5 inhibitors offer improvement. The panel, consisting of an expert group chaired by Eric Wespes, MD, PhD, stressed the need for a professional assessment of all patients presenting with ED, with a psychological evaluation being taken into account. Dr. Wespes is in the Department of Urology at the C.H.U. de Charleroi, Belgium. The EAU stated that self-medication and the recreational use of what in many countries are still prescription medications without taking into account possible side effects, is not advocated.

The guidelines note that it is important that physicians warn patients that sexual intercourse is a vigorous physical activity, which increases heart rate as well as cardiac work, and that physicians should assess the cardiac fitness of patients prior to treating ED.

All EAU guidelines are available on the society Website, www.uroweb.org/professional-resources/guidelines.

OMEGA-3 FATTY ACIDS REDUCE RISK OF ADVANCED PROSTATE CANCER
Omega-3 fatty acids appear protective against advanced prostate cancer, and this effect may be modified by a genetic variant in the COX-2 gene, according to a report in Clinical Cancer Research.

"Previous research has shown protection against prostate cancer, but this is one of the first studies to show protection against advanced prostate cancer and interaction with COX-2," said John S. Witte, PhD, professor of epidemiology and biostatistics at the University of California San Francisco, in a news release from the American Association for Cancer Research.

In this study, researchers performed a case-control analysis of 466 men diagnosed with aggressive prostate cancer and 478 healthy men. Diet was assessed by a food frequency questionnaire and researchers genotyped nine COX-2 single nucleotide polymorphisms.

Researchers divided omega-3 fatty acid intake into four groups based on quartiles of intake. Men who consumed the highest amount of long chain omega-3 fatty acids had a 63% reduced risk of aggressive prostate cancer compared to men with the lowest amount of long chain omega-3 fatty acids, according to the news release.

The researchers then assessed the effect of omega-3 fatty acid among men with the variant rs4647310 in COX-2, a known inflammatory gene. Men with low long chain omega-3 fatty acid intake and this variant had a more than five-fold increased risk of advanced prostate cancer. But men with high intake of omega-3 fatty acids had a substantially reduced risk, even if they carried the COX-2 variant.

"The COX-2 increased risk of disease was essentially reversed by increasing omega-3 fatty acid intake by

0.5 g per day," said Dr. Witte. "If you want to think of the overall inverse association in terms of fish, where omega-3 fatty acids are commonly derived, the strongest effect was seen from eating dark fish such as salmon one or more times per week."

MEN WHO START EXERCISING IN MIDLIFE LIVE LONGER
Increased physical activity in middle age is eventually followed by a reduction in mortality to the same level as seen among men with constantly high physical activity, according to research published in the British Medical Journal. This reduction is comparable with that associated with smoking cessation, wrote Karl Michaelsson, MD, from the Department of Surgical Sciences at Uppsala University, Uppsala, Sweden, and colleagues.

Researchers undertook the study to examine how change in level of physical activity after middle age influences mortality and to compare it with the effect of smoking cessation. Their investigation included a population-based cohort of 2,205 men in Uppsala, aged 50 in 1970 to 1973. They were then re-examined at ages 60, 70, 77, and 82 years.

The absolute mortality rate was 27.1, 23.6, and 18.4 per 1,000 person years in the groups with low, medium, and high physical activity, respectively. The relative rate reduction attributable to high physical activity was 32% for low and 22% for medium physical activity, the team wrote. They also found that men who increased their physical activity level between the ages of 50 and 60 years continued to have a higher mortality rate during the first 5 years of follow-up (adjusted hazard ratio 2.64, 95% confidence interval 1.32 to 5.27, compared with unchanged high physical activity).

"After 10 years of follow-up their increased physical activity was associated with reduced mortality to the level of men with unchanged high physical activity (1.10, 0.87 to 1.38). The reduction in mortality associated with increased physical activity (0.51, 0.26 to 0.97, compared with unchanged low physical activity) was similar to that associated with smoking cessation (0.64, 0.53 to 0.78, compared with continued smoking)," Dr. Michaelsson said.

In an interview with HealthDay News, Dr. Micha‘lsson said, compared with smoking cessation "the reductions in mortality risk were found to be equal. Everyone knows that smoking is hazardous for health and increases mortality risk, but it is not generally known that low physical activity has a similar impact on mortality risk as smoking."

The investigators also noted that whether women might reap the same benefits remains a bit unclear. Dr. Micha‘lsson told HealthDay News he was not aware of a similar study involving older women so, "if you are strict, our results cannot be extrapolated to women. But, I cannot see a biological reason why there should be gender differences in effect."

BUILDING STRONG BONES: RUNNING MAY PROVIDE MORE BENEFITS THAN RESISTANCE TRAINING
Osteoporosis affects more than 200 million people worldwide and is a serious public health concern, according to the National Osteoporosis Foundation. Resistance training often is recommended to increase and prevent loss of bone mineral density (BMD), although previous studies that examined the effects of resistance training in men produced varied results. University of Missouri researchers have found that high-impact activities, such as running, might have a greater positive effect on BMD than resistance training, according to a university news release.

"The results of the study confirm that both resistance training and high-impact endurance activities increase bone mineral density. However, high-impact sports, like running, appear to have a greater beneficial effect," said Pam Hinton, PhD, Associate Professor in the Department of Nutrition and Exercise Physiology in the MU College of Human Environmental Sciences.

According to the researchers reporting in the Journal of Strength and Conditioning Research, the true effects of weight-bearing or resistance exercise are only apparent when controlling for differences in body weight or composition. People who primarily perform non weight-bearing activities will benefit from resistance training that increases lean body mass, Dr. Hinton said. People who engage in activities, such as cycling, swimming, or rowing, should add bone-strengthening activities, such as resistance training or running, to their exercise regimens.

"Exercise programs to increase bone strength should be designed using what is known about how bones respond to exercise," Dr. Hinton said. "Only the skeletal sites that experience increased stress from exercise will become stronger. For example, performing upper body resistance exercises will not increase BMD of the hips. The response of bone to loading is determined by the magnitude of the force, and the rate and direction(s) at which it is applied. Therefore, high-impact, dynamic, multi-directional activities, including structured jump-training (plyometrics), result in greater gains in bone strength. Playing basketball, volleyball, or soccer are also good options."

In the study, the researchers determined the effects of long-term running, cycling, and resistance training on whole-body and regional BMD, taking into account the effects of body weight and composition, in men ages 19 to 45 years. After adjusting for differences in lean body mass, the researchers found that runners had greater spine BMD than cyclists. Lean body mass was positively associated with BMD in both resistance-trained individuals and cyclists but not in runners; therefore, high-impact activity may override the benefits of lean body mass on BMD, Dr. Hinton said.

STUDY LOOKS AT CELECOXIB, ATORVASTATIN TO TREAT PROSTATE CANCER
Celecoxib (Celebrex, Pfizer Inc.) and atorvastatin (Lipitor, Pfizer) are being tested by investigators at The Cancer Institute of New Jersey (CINJ) to see if they hold any promise in slowing or stopping the growth of prostate cancer when combined, according to a news release from CINJ, a center of excellence of UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ.

According to the American Cancer Society, prostate cancer affects one in six men; it is the most frequently diagnosed cancer in men, other than skin cancer, and the second leading cause of cancer death in men. Through a newly opened clinical trial, researchers aim to test the effectiveness of the combined drugs on those with early-stage prostate cancer.

Recent studies have shown that celecoxib and atorvastatin individually have effects on blocking a protein complex known as nuclear factor kappa B (NFkB). NFkB plays a large role in the body's immune system and in many cases can cause tumor cells to grow. By combining these drugs, scientists hope to prevent tumor cells from growing and make them more sensitive to cancer killing drugs.

Susan Goodin, PharmD, FCCP, BCOP, Associate Director of Clinical Trials and Therapeutics at CINJ and Professor of Medicine at UMDNJ-Robert Wood Johnson Medical School, is the lead investigator of the trial. "Understanding the mechanism for tumor activation and growth may allow for targeting more specific tumor pathways for prostate cancer. And by focusing on drugs that already have FDA approval, we can potentially bring targeted therapies to patients faster than if we were testing a brand new compound or drug," she noted in the news release.

Selected patients will undergo various testing before and during treatment, including blood work to detect prostate specific antigen (PSA) levels and computed tomography (CT) or bone scans. For 6 months, participants will take both drugs daily; following that period, patients will have their PSA levels assessed every 3 months for the next 2 years.