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I suppose that if you had to choose a subject with as big a taboo as erectile dysfunction (ED), it would be prostate cancer. Fear, shame and denial dominate because men associate the cancer with two equally shameful conditions: impotence and incontinence. This denial is all the more dangerous because, as the prostate enlarges, sexual performance will become painful as it steadily fades away. Worse, it is accompanied by incontinence, particularly at night. Urination grows painful and it can be difficult to start and stop the flow.

At the outset, I will warn that attempting to self-medicate with Viagra, Cialis or Levitra when your erections are already painful could be very dangerous. Whenever you have pain whether in urination or an erection, this should be a signal to visit a physician immediately.

I will simply state the fact - cancer of the prostate is the most common form of malignant cancer diagnosed in men. To give you an insight into the scale of the problem in the USA, about 317,000 cases were diagnosed in 2006, and about 41,000 men died. But, only about 15% of the new cases were in men aged less than 65 years. It almost never appears in men under the age of 55 years.

So what is the true scale of the risk?

The answer, as always, is slightly complicated. Globally, about 3% of deaths are, in part, attributable to prostate cancer. But elderly men also have other diseases and conditions that will contribute to the risk of dying, so separating out the cause and effect of each contributing factor is problematic. But, looking from the other end of the telescope, there is a 90% success rate from treatment for all cases of cancer diagnosed early through prostatectomy, beam radiation therapy and other therapies. This treatment will not necessarily cure the ED. It may in fact make treatment of erectile dysfunction more difficult in the short term despite the availability of Viagra, Cialis and Levitra.

Diagnosis of the cancer depends on the indicators of age, cultural and racial grouping, and whether prostate cancer runs in your family. It is an unfortunate fact that men from the African American community are 60% more likely to get this cancer and twice as likely to die than equivalent white men of the same age and educational background. Similarly, men with a full-blood relative who have had this cancer are twice as likely to get it themselves. Recent clinical studies into the incidence of prostate cancer also appear to be proving an increase in the risk among men with a diet high in red meat and dairy products as opposed a diet of lean meat and low fat products.

Although the mortality rate for cancer has declined by about 4% over the last decade, it is still greater than it was in the 1970s. At the same time, the diagnosis rate has been steadily increasing. Interestingly, the geographical areas with the highest early detection rates do not have the best survival rates. In other words, the survival rates are not determined by when the cancer is first detected. There may also be a problem because earlier post mortem statements of the cause of death may not have consistently identified prostate cancer even though it was the principal cause of death. The bad news is that men who get an earlier diagnosis simply live with the knowledge longer without any guarantee that the treatment outcome rates are improving.

There are two ways in which the cancer can be detected. One is by rectal examination whether physical or digital. The other is the PSA blood test. These tests are poor indicators in the earliest stages of the disease and only become more reliable as the condition progresses. Unfortunately, screening throws up a significant number of false-positive results. This causes what proves to be unnecessary anxiety and forces men to have biopsies taken which is an additional expense. It is therefore uncertain whether the benefits of a more general screening program outweigh the disadvantages. Nevertheless, the tests do remain useful where the medical history and other indicators suggest a greater risk. Even though the blood test may produce false positives or disclose risks that do not manifest themselves in any tumor for ten or more years, the negative results are a relief to those patients.

The available treatments include:

? surgery to remove some or all of the prostate;

? external beam radiation therapy;

? brachytherapy, i.e. radioactive material sealed in seeds is placed next to a tumor;

? testosterone suppression;

? cryotherapy; and

? waiting to see how the disease progresses.

It will be most important to consider your age and whether you have any other conditions affecting your ability to survive surgery and/or radiation therapy. Counselling is of fundamental importance at this time, particularly because the incidence of ED is higher following surgery. In such cases, the standard remedies of Viagra, Cialis and Levitra will not necessarily help so it may be better to defer surgery in the short term.

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