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PSA testing got a major lift from an endorsement by the American Cancer Society which has a history of overselling the value of early detection and advising the public to seek tests before their safety and efficacy has been established. Medical organizations like the American College of Physicians and the U.S. Preventive Services Task Force that carefully search the scientific evidence before making screening recommendations have refused to endorse the PSA test. By the time the American Cancer Society tempered its endorsement in 1997, the test had already worked its way into standard medical practice, and one survey showed that half the men over age 65 reported having had a PSA. Not many men, even if fully informed, can walk away from a cancer diagnosis and choose the watchful waiting option that should be offered. Worse, some men dont even know theyve had a PSA. It is often thrown in with usual blood work during a routine physical.
But in recent years, several studies have also shown that this type of shock-wave therapy appears to have a healthy effect on blood vessels.
A system for inserting a pellet of alprostadil into the urethra is marketed as Muse. The system uses a prefilled applicator to deliver the pellet about an inch deep into the urethra. An erection will begin within 8 to 10 minutes and may last 30 to 60 minutes. The most common side effects are aching in the penis, testicles, and area between the penis and rectum; warmth or burning sensation in the urethra; redness from increased blood flow to the penis; and minor urethral bleeding or spotting.
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Vardenafil is generally well tolerated with only mild side effects. These side effects include headache, flushing, nasal congestion, dyspepsia, body aches, dizziness, nausea, and increased blood levels of the muscle enzyme creatine kinase.
Address correspondence to Anthony J. Viera, LT, MC, USNR, Family Practice Department, PSC 490, Box 9097, U.S. Naval Hospital, Guam, FPO AP 96538-1600. Reprints are not available from the authors.
Men who might not otherwise be diagnosed with something potentially fatal may become aware of the problem when they go to the doctor seeking a prescription.
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In the past, erection problems were thought to be "all in the man's mind." Men often were given unhelpful advice such as "don't worry" or "just relax and it will take care of itself." Today, doctors believe that when the problem is not temporary or does not go away on its own, physical factors are often the cause.
Radical cystectomy (for bladder cancer) and prostatectomy (for prostate cancer) require cutting or removing nerves that control penile blood flow. These nerves do not control sensation in the penis and are not responsible for orgasms; only erection is affected by these procedures.
Results of recent surveys indicate that, on average, 15% of the male population has suffered from erectile dysfunction. As a strong indicator of its age-related increase, more than 50% of men over the age of 60 have varying degrees of erectile dysfunction (ED). So it may not be surprising that it is estimated that ED affects approximately 31 million men in the United States, and as a whole, there may be as many as 300 million men around the world suffering with ED. (1)
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