Men’s Health

HealthDay - TUESDAY, Oct. 30 (HealthDay News) -- Among prostate cancer patients undergoing a high-tech form of radiation therapy, exposure to a higher amount of radiation over a shorter time span poses no added risk for impaired sexual function, new research reveals.

Oral Phosphodiesterase Inhibitors

Treatment must be tailored to the individual. Some men may not desire treatment at all. Others, perhaps like  Mr G, are interested primarily in gathering information about treatment options before initiating therapy.

The oral phosphodiesterase inhibitors — Viagra, Levitra, and Cialis — represent first-line therapy for men with ED. Viagra and Levitra have similar pharmacokinetic properties, with peak serum concentrations at approximately 1 hour and a half-life of 4 to 5 hours. Cialis has a considerably longer half-life of approximately 18 hours, with evidence that erectile function continues to be enhanced for at least 36 hours. Although to date no head-to-head clinical trial results between these drugs have been published, their overall clinical efficacy appears to be fairly similar, with minor differences in results likely due to variations in the patient populations studied. For example, in a double-blind randomized study of 532 men, successful intercourse was achieved in 69% of men receiving 100 mg of Viagra compared with 22% of men receiving placebo. In a study of 348 men using Cialis (20 mg), 59% successfully reported intercourse at 36 hours, compared with 28% in the placebo group. And in a multicenter, double-blind, placebo-controlled trial, 69% of men receiving Levitra (20 mg) successfully reported completing intercourse, compared with 22% receiving placebo.

Approximately half of men with diabetes mellitus or more advanced coronary and peripheral vascular disease report benefit. A success rate of roughly 30% has been noted following radical prostatectomy. An attempt at treatment with oral agents is warranted only if the nerves have been spared, and even then, success is unlikely unless at least partial return of erections has occurred.

Patient education is critical for optimal response to Viagra. This includes informing the patient to take the medication on an empty stomach and to time sexual activity so that it occurs within 1 to 6 hours, as well as explaining that sexual activity of some sort is necessary to obtain a positive effect. If an initial starting dose of 50 mg is ineffective, I recommend increasing the dosage immediately to 100 mg: nothing is gained by repeated attempts at a subtherapeutic dose. Similar instructions should be provided for Levitra. However, instructions regarding the timing of intercourse may be considerably liberalized for Cialis due to its prolonged duration of effect, although peak concentration occurs somewhat later, at 2 hours.

Limitations. Many men who fill prescriptions for Viagra never refill them, and many others, like Mr G, receive a prescription but never fill it. Reasons for this include ambivalence about taking a medication for sex, cost, concerns regarding risk, and negative partner attitudes regarding sex or the medication. Many men and their partners believe that sexual activity should be natural and spontaneous, and they object to the planning required for successful use of oral medications. Still others may hope that their own sexual abilities will return with time or with resolution of personal problems.

Risks. The phosphodiesterase inhibitors have undergone extensive clinical study and have a fairly benign safety profile when taken as directed. The single important contraindication is the use of any nitrates, either on a chronic or intermittent basis, due to the potential for significant hypotension. Viagra also should not be taken within 4 hours of -adrenergic blockers, and Levitra should not be used at all with them. The most common adverse effects are headache (15%), flushing (10%), nasal/sinus congestion (8%), dyspepsia (7%), and transient color vision changes (3%). Mr G should be reassured that priapism is extremely rare and treatable, and that he may safely take Viagra in combination with his antihypertensive medications, atenolol and hydrochlorothiazide.

Cardiovascular Effects. The relationship of PDE 5 inhibitors and cardiovascular health has been extensively studied. Daily administration of Cialis (20 mg) for 26 weeks in healthy men or patients with mild ED resulted in blood pressure changes similar to those observed after placebo administration. Viagra studies have revealed a minor reduction in systolic and diastolic pressures of 2 to 8 mm Hg without appreciable change in heart rate.

The cardiac effects of Viagra during exercise in men with suspected coronary artery disease was studied in a randomized, double-blind, crossover study of 105 men with ED who underwent supine bicycle echocardiograms 1 hour after taking Viagra or placebo. No negative effect of Viagra was seen with regard to symptoms, exercise duration, or ischemia. Similar safety was noted in a double-blind single-dose crossover study using Levitra (10 mg) or placebo in 41 men with stable exertional angina who underwent exercise tolerance testing. No differences were noted between Levitra and placebo with regard to exercise time or time to first awareness of angina, but Levitra did significantly prolong the time to ischemic threshold.

A persistent concern among men and their partners is that Viagra or its competitors might cause a myocardial infarction, based on early reports of sudden death reported in the lay press. An unquantified number of these anecdotal cases were clearly related to the contraindicated simultaneous use of nitrates. Nevertheless, the data regarding PDE 5 inhibitors and coronary artery disease have been reassuring. Cardiac catheterization for severe coronary artery disease was performed in 14 men before and 45 minutes following administration of Viagra (100 mg), resulting in no negative hemodynamic effects. Moreover, an investigation of reports of Viagra-associated deaths showed no difference from expected death rates, and the rate of cardiac events in England among users of Viagra appeared to be no higher than that of the general population. Nevertheless, it must be recognized that sexual activity itself is associated with a small risk of myocardial infarction, and cardiovascular assessment should be considered prior to treatment of ED in any patient considered at increased risk for a cardiac event.

Since cardiovascular disease often coexists with ED, the Princeton Consensus Panel was convened to review existing data and provide recommendations regarding the treatment of sexual dysfunction in men with heart disease. Those recommendations indicate the need for no additional evaluation prior to treatment for men in a low-risk group, including those with controlled hypertension; mild, stable angina; history of uncomplicated myocardial infarction; and mild valvular disease. A high-risk group was identified in whom treatment of sexual dysfunction should be withheld until further safety data could be accumulated. This group included men with unstable or refractory angina, uncontrolled hypertension, high-grade congestive heart failure, myocardial infarction within the previous 2 weeks, high-risk arrhythmias, obstructive cardiomyopathy, and moderate to severe valvular disease. Men with intermediate risk, eg, those with moderate angina or recent myocardial infarction (<6 weeks), should undergo further cardiac evaluation before restratification into one of the other groups.

Other Treatment Options for ED

Penile injections with vasoactive medications are effective in 70% to 80% of patients, have an onset of action within 10 minutes, and are nearly painless. They represent the most common treatment for men who take nitrates or have had no success with phosphodiesterase inhibitors and are used by approximately 10% of men with ED. Alprostadil is most frequently prescribed but can cause an unpleasant burning sensation in about 20% of men. Papaverine and phentolamine can be used to avoid this problem or used in combination with alprostadil for greater efficacy. In a study of 615 cases of men using penile injection therapy, penile fibrosis was noted in 3%, and 4% of men experienced a prolonged erection, representing 0.3% of injections. Although less than half of men taught to use penile injection therapy continue to use this therapy for more than a few years, satisfaction rates among users are comparable to men who use Viagra as therapy for ED.

iPlan RT treatment planning software is helping to save more than 83 percent in planning time, while achieving greater consistency in radiotherapy treatments for prostate cancer.

Exercise may reduce, and even reverse, bone loss caused by hormone and radiation therapies used in the treatment of localized prostate cancer.

HealthDay - MONDAY, Oct. 29 (HealthDay News) High-dose precision radiation therapy doesn't harm the sexual function of prostate cancer patients, U.S. researchers say.

Prostate cancer and treatment options are in public focus as Israeli PM Olmert reveals that he has prostate cancer, but will stay on the post.

Levitra is a drug that helps men achieve an erection. Cialis is a drug that helps men achieve an erection. Viagra is a drug that helps men achieve an erection. Does anyone else think it's weird that society is constantly using the word "achieve" in this context? Hillary at Everest was an achievement, I really have to be modest here.

Maybe I'm just down to earth, but I've never wanted to tilt my head back, put my hands on my hips and laugh "Look at what I've accomplished!" in reference to my stiffy.

To begin with, it's a bit chauvinistic. Women get wet or become moist. Men achieve an erection? Why thank you. Please hold your applause until the end.

Secondly, before you award me the Congressional Medal of Honor, I have to give credit where it's due. My girlfriend can claim sole authorship of this penile masterpiece. At best, I had the assist. In fact, I'm always impressed by how she gives me an erection ("gives me"...almost like a gift). Throw HER a parade, if anything.

Personally, I don't feel like I've done enough work to say I've achieved something. Maybe it's the fact that I'm 24 and I have a beautiful lady but I'm booking a flight to Boneropolis about every five minutes. Perhaps my take would be different if I were an 87 year old, guzzling handfuls of ED medication. I guess for Grandpa Horndog, a woody is something to write home about, but geez... achieve? Really?

What is Viagra?
Viagra® (sildenafil citrate)  is a breakthrough treatment now available for male Erectile Dysfunction (ED), often called impotence. It comes in the form of a pill which you take prior to engaging in sexual activity.
 Viagra can help many men who have ED get and keep an erection when they become sexually stimulated, either physically or visually.

How does Viagra work?
Normally, when a man is sexually aroused, the arteries in the penis relax and widen, allowing more blood to flow into the penis. As the arteries in the penis expand and harden, the veins that carry blood away from the penis become compressed, trapping the blood in the penis. This leads to enlargement, rigidity and  an erection of the penis.

If the nerves or blood vessels associated with this process aren't working properly, a man may not be able to get an erection. Viagra increases blood flow to the penis, so that when a man is sexually aroused, he can get and keep an erection. When the sexual encounter is over, the erection goes away.

How much dose is necessary for the desired effect?
Viagra is available in three strengths: 25 mg, 50 mg. and 100 mg. Though 50mg is the recommended dose, your initial Viagra dose would be decided by your healthcare professional. It is important to remember that only one dose should be taken per day and should not be increased unless advised by your doctor.

If you take any medicines that are nitrates (nitroglycerin, as chest pain) every day or even once in a while, you have to take Viagra NOT.
Discuss your general state of health with the doctor that you are healthy to engage in a sexual relationship. If chest pain, nausea, or any other discomforts during sex, to seek immediate medical assistance.

Although erections more than 4 may occur rarely with all ED treatments in this drug class, in order to avoid long-term injuries, it is important to seek immediate medical assistance.

If you are over 65 or have serious liver or kidney problems, your doctor may start you at low doses (25 mg) of Viagra. If you are taking protease inhibitors, such as for the treatment of HIV, your doctor may recommend that the 25 mg dose and may limit you to a maximum single dose of 25 mg in 48 hours Viagra.

In rare instances, men taking PDE5 inhibitors (oral erectile dysfunction drugs, including Viagra) reported a sudden decrease or loss of sight. It is not possible to determine whether these events are related directly to these medicines or other factors. If a sudden decrease or loss of sight, to stop the adoption of PDE5 inhibitors, including Viagra, and call a doctor immediately.

Sudden reduction or loss of hearing has been rarely reported in people taking PDE5 inhibitors, including Viagra. It is not possible to determine whether these events are directly related to PDE5 inhibitors, or other factors. If a sudden decrease or loss of hearing, to stop the adoption Viagra and contact a doctor immediately. If you have prostate problems or high blood pressure, for which you take medicines called alpha blockers, your doctor may start you on a lower dose of Viagra.

Be sure to protect yourself and your partner from sexually transmitted diseases.

The most common side effects of Viagra are headache, flushing the front, and upset stomach. Less commonly, bluish vision, blurred vision or sensitivity to light May briefly place.

Look for the complete prescribing Viagra (25 mg, 50-mg, 100-mg) tablets.

Reuters - A strand of revolutionary Ernesto "Che" Guevara's hair and related items are being auctioned on Thursday in Dallas in a sale that is rumoured to have caught the eye of Venezuelan President Hugo Chavez. The collection belongs to Gustavo Villoldo, 71, a former CIA operative who helped hunt Che down in the jungles of Bolivia in 1967 and who claims he cut off the lock before burying the guerrilla fighter with two of his comrades.