Step-by-step lifestyle changes that can improve urologic health in men, part I: What do I tell my patients?
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Body Mass Index↗
Biomedical subjects
Mark A Moyad
Publications and source records attributed to Mark A Moyad.
Step-by-step lifestyle changes that can improve urologic health in men, part II: What do I tell my patients?
Explore the source record for details and available documents.
Alcohol Drinking↗
Cholesterol, cholesterol lowering agents/statins, and urologic disease: part I - knowing your numbers.
Educating patients on the basic cardiovascular disease (CVD) risk markers such as cholesterol can be difficult in any medical setting, but especially in urology where patients are being evaluated for non-cardiovascular conditions. Primary reasons for discussing cholesterol or cardiac risk factors and assessment in urology include (a) the primary cause of death of men and women in the United States and most countries around the world is CVD; (b) the primary or secondary cause of death from the largest cancer prevention trials (high or average risk) is CVD; (c) the primary or secondary cause of death in men with prostate cancer is CVD; (d) there may be a correlation in some of the mechanisms that contribute to CVD and mechanisms that contribute to numerous urologic conditions, such as benign prostatic hyperplasia, bladder cancer, erectile dysfunction, female sexual dysfunction, kidney cancer, and prostate cancer; and (e) one of the better methods to monitor the success of lifestyle changes for the patient in urology is to monitor these CVD markers, as is the case in some lifestyle studies of men with prostate cancer.
Cholesterol↗
Cholesterol, cholesterol lowering agents/statins, and urologic disease: part II--do you know your Framingham Risk Score?
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Adult↗
Statins, especially atorvastatin, may improve survival following brachytherapy for clinically localized prostate cancer.
This is the largest and longest clinical study to date to examine statin usage and overall patient survival following clinically localized prostate cancer. In a retrospective examination of 938 consecutive patients with early-stage prostate cancer treated with brachytherapy, 191 patients were documented to be taking statin medications. The patients taking statin medications had significantly lower prostate-specific antigen values, percent positive biopsies, and prostate volume than those patients not taking statin medications. Statin usage resulted in a nonstatistical improvement in all survival parameters with the results most pronounced for atorvastatin. Improving prostate cancer survival with statins could have important treatment implications and could potentially limit or even improve the role of supplemental therapies. A prospective trial of statin medications in conjunction with definitive local treatment for prostate cancer is recommended.
Aged↗
Cholesterol, cholesterol-lowering agents/statins, and urologic disease: Part III--A rapid review of FDA-approved cholesterol-lowering agents.
There are a variety of agents, dosages, and mechanisms involved in reducing cholesterol. Statins are the most well-known class and three of the six currently available agents have now lost patent protection. Thus, large reductions in price are expected in 2006-2007 across the entire class. The other classes of cholesterol-lowering agents include targeted triglyceride reducers and high-density lipoprotein boosters; two other classes include primarily cholesterol absorption inhibitors. A recent addition to the cholesterol-lowering prescriptions include prescription omega-3 products, which are highly concentrated, have excellent quality control, and are used to reduce abnormally high levels of triglycerides. All of these agents can be used in some restricted combination, or individually to significantly impact the various forms of lipids in the bloodstream. The bottom line is that practitioners have a large diversity of medications available for cholesterol lowering, and this is enormously exciting at a time when these agents have such profound effects in a variety of disciplines.
Anion Exchange Resins↗
Cholesterol, cholesterol-lowering agents/statins, and urologic disease: Part IV--is vitamin E phosphate or another unique type of this vitamin the last chance for these supplements?
Vitamin E, once the highly espoused heart healthy paradigm of the dietary supplement world, has now been touted by many experts to be either heart unhealthy or simply ineffective based on the results of past and recent randomized trials in cardiovascular medicine. Natural and synthetic vitamin E supplements, especially in large dosages, have been the concern. Researchers have embarked on testing a variety of other novel forms of vitamin E, such as vitamin E phosphate and other forms of vitamin E, to determine safety issues as well as the impact on cardiovascular disease (CVD) risk markers and end-points. Until vitamin E demonstrates meaningful changes in some of the accepted markers of CVD prevention, it will be difficult to espouse their use specifically for these and other conditions.
Cardiovascular Diseases↗
Statins, especially atorvastatin, may favorably influence clinical presentation and biochemical progression-free survival after brachytherapy for clinically localized prostate cancer.
OBJECTIVES: To conduct a preliminary investigation on statin use and its impact on clinical presentation and biochemical progression-free survival after brachytherapy. METHODS: A total of 512 consecutive patients were treated with permanent brachytherapy for clinical Stage T1c-T3aNxM0 prostate cancer at least 3 years before analysis. Biochemical progression-free survival was defined by a prostate-specific antigen (PSA) level of 0.4 ng/mL or less after nadir. The median follow-up was 5.3 years. The clinical, treatment, and dosimetric parameters evaluated included use of any and specific statins, age, body mass index, PSA level, Gleason score, percentage of positive biopsies, perineural invasion, prostate volume, planning volume, dosimetric quality, supplemental external beam radiotherapy, tobacco use, hypertension, and diabetes. RESULTS: The actuarial 8-year biochemical progression-free survival rate for the entire group was 94.6%. On forward conditional Cox regression analysis, the pretreatment PSA level and percentage of positive biopsies were statistically significant predictors of biochemical outcome. However, a significantly lower pretreatment PSA level, percentage of positive biopsy cores, and PSA density and earlier clinical stage were found in the statin group. Almost every clinical presentation parameter comparison at least favored statin users. When stratified by any or specific statin use, 97.0% of patients taking statins compared with 94.3% not taking statins and 97.8% of patients taking atorvastatin compared with 94.7% taking other statins were free of biochemical progression. CONCLUSIONS: The results of this brachytherapy investigation with the longest reported follow-up period to date suggest that statins, especially atorvastatin, may improve most clinical presentations with a nonsignificant improvement in 8-year biochemical progression-free survival.
Aged↗
Heart healthy equals prostate healthy equals statins: the next cancer chemoprevention trial. Part I.
PURPOSE OF REVIEW: Several important observations should be kept in mind by cancer researchers: cardiovascular disease (CVD) is the number one cause of death; CVD is the number one cause of death in the largest cancer chemoprevention trials; CVD is the number one or two cause of death in prostate cancer patients; and some of the mechanisms that increase the risk of CVD may also increase the risk or progression of prostate cancer. RECENT FINDINGS: Screening studies suggest a high prevalence of dyslipidemia in men with and without prostate cancer. Numerous recent lifestyle interventions that reduce cholesterol have also been found to have a potential impact on reducing the risk of prostate cancer. Recent studies of statins and other heart healthy agents have found a secondary potential for exhibiting a reduced risk or progression of prostate cancer. SUMMARY: Laboratory and clinical data over the past several decades continue to support the use of a heart healthy agent in the nest cancer chemoprevention trial. The potential for an agent to simultaneously reduce the risk of the primary and secondary cause of death suggests that statins and other heart healthy agents are the ideal next interventions to be utilized in the next major cancer chemoprevention trial. If successful, this agent would most likely represent a dramatic impact on the history of cancer chemoprevention, and if not successful the potential secondary impact would again be a landmark finding in cancer chemoprevention; so the time is more than ripe for such a unique trial.
Anticarcinogenic Agents↗
Heart healthy equals prostate healthy equals statins: the next cancer chemoprevention trial. Part II.
PURPOSE OF REVIEW: Specific ongoing observations from diverse medical studies do not serve to belittle the impact of prostate or other cancers, but the overall impact of cardiovascular disease (CVD) in individuals at high-risk or in individuals that have been diagnosed with common cancers needs to be addressed by future research. CVD has been the number one cause of death in men and women since the year 1990. Serum cholesterol levels are some of the most accurate long-term predictors of all-cause mortality. CVD has been the number one cause of death in the largest dietary supplement cancer chemoprevention trials. RECENT FINDINGS: The potential for utilizing a cancer chemoprevention agent that may simultaneously reduce the risk of CVD and cancer is not only attractive, but several agents are available immediately that may demonstrate this unique impact. For example, recently statin drugs, low-dose aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs), and even fish oil supplements may be utilized in the next major cancer chemoprevention trial. SUMMARY: Heart healthy agents and interventions seem to also exhibit the ability to be prostate healthy. In addition, their low cost and potential to reduce all-cause mortality may also ensure good compliance. Statins and other heart healthy agents should be considered to be the next most ideal interventions to be utilized in the next major chemoprevention trial, especially now because several popular past dietary supplements and drugs have demonstrated the potential for notable side effects and an inability to impact the risk of CVD.
Cardiovascular Diseases↗
Fad diets and obesity--Part IV: Low-carbohydrate vs. low-fat diets.
The first three parts of this series of articles covered the basics of some of the more popular low-carbohydrate diets, and the theories behind them. In the fourth and final part of this series, some of the more popular low-fat and low-calorie diets, such as the Ornish diet and Weight Watchers, are covered briefly. Recently, several clinical trials of longer duration that compared low-carbohydrate versus low-fat diets have been published. These studies demonstrate that some of the low-carbohydrate diets result in reduced weight in the short-term, but their ability to reduce weight long-term any better than low-fat or other diets has been questioned. Most popular or fad diets have some positive messages contained within them and some preliminary positive short-term results, but overall the compliance rates with any fad diet are very poor over the long-term. The decision to go on any diet should be made with a health professional who can monitor the patient closely.
Body Mass Index↗
Abandoning isolated free PSA screenings for more comprehensive cardiovascular and cancer screening and education.
The time is ripe to abandon free PSA screenings and replace them with free comprehensive health screenings. For example, cardiovascular disease (CVD) risk screening (cholesterol, blood pressure) that could also include PSA, weight measurement, and a variety of other tests and educational assessments just make more sense in terms of the larger picture of influencing all-cause morbidity and mortality. Numerous reasons are proffered for this important change. Abandoning this myopic single-disease only approach must be embraced by numerous medical centers and health professionals before this comprehensive approach can be successfully implemented.
Cardiovascular Diseases↗
Prevention and treatment of erectile dysfunction using lifestyle changes and dietary supplements: what works and what is worthless, part I.
Clinicians working in urology should adhere to the same guidelines that are observed in cardiovascular medicine when dealing with a patient with ED. A golden opportunity exists to discuss lifestyle changes with any man with or concerned about ED. Providing heart-healthy recommendations to men with minimal to extensive ED may produce a twofold impact: (1) patients may be able to affect the future extent of their disease, and (2) patients may become healthier overall. Patients following a heart-healthy lifestyle after a diagnosis of ED or to prevent ED should enjoy increased quality or quantity of life. The time is more than ripe for patients to understand that heart health is tantamount to erectile health.
Adult↗
Prevention and treatment of erectile dysfunction using lifestyle changes and dietary supplements: what works and what is worthless, part II.
It seems naïve to believe that some plants or herbs do not contain specific compounds that could benefit patients with ED. Many supplements have not been investigated in a laboratory or clinical research setting before commercial sale, however,which creates a complex situation. If efficacy is or is not demonstrated through adequate research, then the benefit or lack thereof cannot be mentioned on the label. Furthermore, clinicians and the public cannot be made aware of which compounds or supplements are effective because no general standards for sale exist under the current guidelines. Dietary supplements have received a tremendous amount of publicity. The large and growing market for ED treatment seems to have contributed partly to the promotion of numerous supplements and their apparent benefits. Whether these dietary supplements have merit is questionable. Some supplements may produce results opposite to those advertised. Other supplements may be enjoying the benefits of the placebo effect. Because a placebo response of 25% to 50% has been recorded in clinical trials with effective agents, it is understandable that some supplements enjoy financial success despite the limited research espousing their use. If one to two of four individuals or one of three individuals who try a dietary supplement gain some benefit for their ED, the market for these supplements will remain extraordinary. On a larger scale, of 100,000 men who try a supplement, approximately 25,000 to 50,000 will claim some success. The challenge for clinicians is to discuss the placebo response properly and the need for good research before any intervention, especially supplements, can be advocated for general use. Table 2 summarizes some popular ED supplements and general conclusions that can be drawn from clinical investigations. Some dietary supplements may have an active ingredient that benefits patients with certain types of ED. An exciting area of future dietary supplement research is the ability of certain agents to have a synergistic effect with prescription agents for ED, thereby improving response rates in men that have failed approved ED therapy initially, especially with oral agents. Randomized clinical trials are the best method of determining which dietary supplements will become a part of conventional medicine. Therefore, more randomized trials for dietary supplements are needed so that they may have the opportunity to become a part of the mainstream milieu, which means that more funding needs to be made available for ED research. The coming years of research should bring enormous excitement and objectivity to this area of medicine.
Adult↗
Preventing male osteoporosis: prevalence, risks, diagnosis and imaging tests.
There is no universal definition of an osteoporotic fracture. Fractures of the vertebra, hip, and forearm generally are considered osteoporotic fractures. There is an increasing recognition, however, that osteoporosis can lead to fractures at other anatomic sites, including the ribs, humerus, tibia, pelvis, and femur. Excluding these types of fractures could underestimate the total cost and impact of osteoporosis. There are a variety of risk factors for osteoporosis and fracture, but several methods can quantify a patient's risk, and these tools are valuable in guiding clinicians in effective intervention. The author hopes this brief review provides clinicians with an introduction and overview of osteoporosis and its risk factors, screening methods, and procedures. The field of urology is constantly evolving, with a growing need for clinicians to become more knowledgeable about preventive medicine. This and other articles should provide a good foundation for clinicians to alter the increasing prevalence of a medical condition that is one of the most preventable causes of morbidity and mortality in men.
Age Distribution↗
Prostate cancer and coronary heart disease: correlation or coincidence?
A few past clinical and recent case-control studies of statin use, for example, in patients with and without prostate cancer have not demonstrated its potential for reducing or preventing the risk for this disease, and the potential for benefit may have been a confounding coincidence. Data from larger continuing and future studies will be needed to resolve this issue, but the recent data on cholesterol or dyslipidemia and risk increase or reduction with treatment are interesting, especially because of other potential improvements with therapy in nonprostate cancers. In addition, the finding that some available cancer treatments improve some parameters of the lipid profile is fascinating, and some cancer drugs are being used in a specific cardiovascular disease treatment setting to improve outcome. Even if CHD, dyslipidemia, and the treatment of these conditions has no role in preventing prostate cancer or its progression, what has been lost? CVD is still the leading cause of death of men, and a heart-healthy program for the patient concerned about prostate disease would reduce this primary cause of death. Patients would take a step forward in improving all-cause mortality. Recent data from surveys, however, continue to demonstrate that men have an inadequate understanding of cholesterol and heart disease. Crisis creates opportunity, and individuals working in urology have ample reasons not only to discuss the overall benefits of reducing lipid markers, but to improve cholesterol and CHD awareness as much as health professionals working in other fields of medicine. The marriage between general preventive medicine and urology seems to be inevitable, and in the authors' opinion, this merger will provide the foundation for novel research that could affect patients' lives dramatically.
Age Distribution↗
Introduction to risk assessment and serum risk markers for the prevention of coronary heart disease and other potential conditions that impact men's health, part II: what do I tell my patients?
Markers and other potential tests for cardiovascular risk abound, and a more extensive review of these and other markers can be found elsewhere. Cardiovascular health tends to mirror urologic health for several conditions. It is imperative in the urology setting that clinicians discuss the probability of early morbidity and mortality with patients. This should not undermine the importance of prostate cancer and other diseases, but rather place risks in their proper perspective. Patients seem to need this guidance more than ever because life expectancy for most individuals continues to increase, and the potential for comorbidities seems to increase in the average aging patient. It is hoped that this article will prompt new interest in evaluating some risk factors for various urologic conditions. This may move researchers closer to discovering intervention agents that could impact numerous male health conditions favorably. Improving men's health will require a concerted educational and research effort from several health disciplines, a reminder that different medical specialties have much in common, and the role of preventive medicine is to point out similarities as opposed to differences.
Adult↗
Introduction to risk assessment and serum risk markers for the prevention of coronary heart disease and other potential conditions that impact men's health, part I: what do I tell my patients?
This article covers the basic cholesterol profile and a method of assessing the potential risks for CHD for most men. It is hoped that this overview will assist clinicians and patients in raising the awareness of CHD as the leading cause of mortality in men, and help to place the overall risk for mortality into a proper perspective.
Adult↗