Circumcision Linked to Lower Rates of Prostate Cancer

March 12, 2012 — Circumcision prior to first sexual intercourse appears to be associated with a reduction in the relative risk for prostate cancer.In a study published online in Cancer, early circumcision was linked to a 15% reduction in the relative risk for prostate cancer, compared with no circumcision. These findings were observed in both aggressive and less aggressive disease."Although the hypothesis and findings of this study are interesting, it is too early to make recommendations about circumcision for prostate cancer prevention," said Siobhan Sutcliffe, PhD, assistant professor in the division of public health sciences at Washington University School of Medicine, St. Louis, Missouri, who was approached for independent comment.She pointed out that this study is a pooled analysis of 2 observational case–control studies, and compares the proportion of men circumcised before their first sexual intercourse in patients with prostate cancer and in control subjects. "You can draw stronger conclusions from the results of a clinical trial than from a case–control study," she told Medscape Medical News. "This will require many more studies."The researchers, led by Jonathan L. Wright, MD, affiliate investigator in the public health sciences division at the Fred Hutchinson Cancer Research Center, Seattle, Washington, note that epidemiologic and histologic data support the concept of an inflammatory pathway in prostate cancer development. In addition, there is some evidence of an infectious pathway. Sexually transmitted infections (STI) have been implicated in prostate cancer in some but not all studies.Some sexually transmitted organisms have been detected in the prostate, including Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, Treponema pallidum, human papillomavirus (HPV), herpes simplex virus, and human herpes virus type 8. The researchers point out that genes that are involved in infection susceptibility, such as RNASEL (ribonuclease L [2′,5′ -oligoisoadenylate synthetase-dependent]), might also play some part in the development of prostate cancer.In addition, they note that there is research suggesting that circumcised men have a lower risk for STIs, and randomized trials conducted in Africa have shown that circumcision reduces the risk for HIV.Provocative But More Study NeededAnthony Y. Smith, MD, who was not involved in the study, pointed out that it is a "provocative study," but much more data are needed."Because cervical cancer is so tightly linked to HPV, along with ulcer disease, which is also linked to a pathogen, we are more tuned in to the fact that infectious factors may play more of a role," said Dr. Smith, who is professor and chief of the division of urology in Department of Surgery at the University of New Mexico Cancer Center in Albuquerque.However, some research on possible infectious pathways has not held up under scrutiny. "There were studies that looked at the murine leukemia-related virus (XMRV) as a potential infectious pathway for prostate cancer development, but recent research has debunked the hypothesis," said Dr. Smith. "The data could not be reproduced by European investigators; they believe that the samples may have been contaminated. This undermined the evidence for XMRV being a human pathogen."Dr. Smith cautioned that the value of circumcision might be highly dependent on the prevalence of disease in the population. For example, "if the HIV risk is low in the general population, then you are not going to see the effect," he said. "In the African studies, there is high prevalence, so that is why we may be seeing such a strong effect. The flipside is that it may give individuals a false sense of security."Too Many ConfoundersIt is extremely difficult to evaluate the effect of circumcision on a wider geographic scale outside of a controlled clinical trial, he noted. As an example, the prevalence of prostate cancer and STIs is similar in the United States, where circumcision is common, and Western Europe, where it is not."There are just too many confounders," explained Dr. Smith. "There are so many environmental and other variables that we just don't know about that may play a role in prostate cancer.""This was a good case–control study, but it will take a lot more study to see if it pans out," he added. "There is also a great deal of controversy with circumcision, so it is way too early to draw any conclusions."Dr. Sutcliffe agrees. "There are many differences that could exist between the 2 groups that could create or mask an ecologic association, such as differences in the racial distribution of the population, prostate cancer screening practices, sexual practices, sexually transmitted screening practices, the distribution of other known or unknown risk factors for prostate cancer, and so on," she said. "Therefore, it is difficult to interpret ecologic differences or the lack thereof.""There may be many reasons why ecologic observations don't appear to agree with the authors' finding," she added. "That's why more and different types of studies need to be done before a preventive recommendation can be put forward."Study DetailsDr. Wright and colleagues collected data from 1754 patients with prostate cancer (68.8% circumcised) and 1645 control subjects (71.5% circumcised) who participated in 1 of 2 population-based case–control studies of prostate cancer. All participants were residents of King County, Washington. Of the circumcised men, 91% reported that the procedure was done shortly after birth.Overall, they found that men who were circumcised before their first sexual intercourse had a 15% reduction in the relative risk for prostate cancer (95% confidence interval, 0.73 to 0.99), compared with men not circumcised and those circumcised after their first sexual intercourse. Being circumcised after first sexual intercourse was not associated with prostate cancer risk.The effect did not appear to be modified by factors such as age, STI status, history of prostatitis, family history of prostate cancer, education, or income level (P > .4 for all). In addition, the type of STI did not play a role.The researchers note that there was a "suggestion of effect modification by race" (P = .07), but the reduction in risk was observed in both white (odds ratio [OR], 0.87) and black (OR, 0.64) men in stratified analyses.The study was funded by the National Institutes of Health and the Fred Hutchinson Cancer Research Center. The authors have disclosed no relevant financial relationships.

From: Medscape Urology

¿La circuncisión disminuye el riesgo de cáncer de próstata?

La circuncisión es un procedimiento que consiste en la remoción quirúrgica del prepucio, que es la piel que cubre el glande del pene en los hombres al nacer. Este procedimiento tiene muchos beneficios como la disminución del riesgo de balanitis, infecciones de transmisión sexual, infección por VIH; un efecto cosmético, entre otras.

El mes pasado fue publicado un artículo en la revista Cancer, que ha generado mucho debate en la comunidad urológica y medica en general. En éste reporta una asociación entre circuncisión y el riesgo de desarrollar o no cáncer de próstata en el futuro. Se evalúan en dos grupos (casos y
controles) si fueron o no circuncidados, si tuvieron enfermedades de transmisión sexual y la edad de la primera relación sexual. El resultado fue que se muestra una disminución del 15% en el riesgo de tener cáncer de próstata en los hombres que fueron circuncidados antes de la primera relación sexual.

Sin embargo, hay que hacer notar que este articulo solo muestra una asociación, no es una investigación que muestra una causa-efecto, lo que significa que esta asociación puede o no ser válida. Además de presentar otros sesgos y variables que podrían confundir el resultado de la investigación.

Otras hipótesis que señala el artículo es el probable origen infeccioso del cáncer de próstata. Existe evidencia de muchas enfermedades ligadas a infecciones como la hepatitis, el sarcoma de Kaposi, el cáncer de cuello uterino; en el caso del cáncer de próstata esto aun no ha sido
plenamente demostrado.

Por ahora, lo único que puedo decir es que este estudio encontró una asociación interesante,
pero las fallas en el estudio significan que los resultados son muy cuestionables. Nosotros necesitamos más datos antes de que verdaderamente podamos decir que la circuncisión previene el cáncer de próstata. Pero sí la circunsicion es un procedimiento que tiene muchas ventajas para el paciente y deben ser discutidas.

Cualquier consulta pueden llamarme al 981038092 o ubicarme en la Clinica Urozen, donde con gusto absolvere todas sus dudas.

Dr Luciano Nuñez Bragayrac

Medico Urologo

La menopausia masculina, existe?

La "menopausia masculina" o hipogonadismo de inicio tardío (el término médico-LOH-) es una enfermedad que realmente existe, y probablemente es subdiagnosticado por urólogos o médicos de familia.

Normalmente hay una disminución de la testosterona (la hormona masculina) con el aumento de la edad en los hombres, pero esta disminución generalmente no afecta la "función masculina" normal: actividades físicas y sexuales. De hecho, en algún momento esta disminución podría estar por debajo del valor normal sin causar ningún síntoma.

Este problema, según una investigación publicada en The New England Journal of Medicine tiene prevalencia del 2,1% de la población masculina y es más frecuente a partir de la quinta década de la vida. La condición se puede identificar por la presencia de 3 síntomas sexuales (disminución de la frecuenciade la erección por la mañana, disminución de la frecuencia de pensamientos y deseos sexuales y la disfunción eréctil), combinado con una disminución del nivel de testosterona.Otros síntomas no sexuales relacionados con bajos niveles de testosterona (física y psicológica) también pueden estar presentes pero no son necesarios como parte de la
definición. Podemos encontrar: la imposibilidad de participar en actividades vigorosas, como correr o levantar objetos pesados​​, una incapacidad para caminar más de 1 km, y una
inhabilidad de doblarse, arrodillarse, o parada; la tristeza, fatiga y pérdida de energía.

Sin embargo, la LOH podría consecuencias más graves como la baja de hemoglobina en la sangre, aumento de la circunferencia abdominal, resistencia a la insulina, síndrome metabólico, disminución de la mineralización de los huesos y una pobre salud general; todos estos problemas se observaron en un estudio publicado en The Journal of Clinical Endocrinology and Metabolism de la mes pasado.

El diagnóstico se hace basado en los síntomas y signos, algunos análisis de sangre y cuestionarios validos.El reemplazo hormonal es la clave del tratamiento, pero es necesario un seguimiento cercano.

Si usted piensa que tiene esta condición, por favor, no dude en escribirme a lnunez@urozen.com o venir a visitarme en UROZEN.

Dr. Luciano Nuñez Bragayrac

Medico Urologo

Male Menopause, exist?

The “male menopause” or late onset hypogonadism (the medical term-LOH-) is a condition
that actually exists, and probably it is underdiagnosed for many urologist or family doctors.

Normally it is a decrease of testosterone (the male hormone) with the increase of the men age, but this decrease usually does not affect the normal “male function”: sexual and physical activities. In fact sometime this decrease could be below the normal value without causing any symptoms.

This problem according to an investigation published on The New England Journal of Medicine has prevalence of 2.1% of the male population and it is more frequent from the fifth decade of life. The condition can be identified by the presence of 3 sexual symptoms (decreased frequency of morning erection, decreased frequency of sexual thoughts, and erectile dysfunction) combined with a decrease of the level of testosterone. Other nonsexual symptoms related to low testosterone levels (physical and psychological) may also be present but are not required as part of the definition. We can find: inability to engage in vigorous activity, such as running or lifting heavy objects; an inability to walk more than 1 km; and an inability to bend, kneel, or stop; sadness, fatigue, and lossof energy.

But the LOH has more serious consequences like lower hemoglobin on blood, increased abdominal circumference, insulin resistance, metabolic syndrome, decreased bone mineralization and poorer good health, all this problems were seen on an study published on The Journal of Clinical Endocrinology and Metabolism the past month.

The diagnosis is made based on the symptoms and signs, some blood test and validated
questionnaires. Hormonal replacement is the key of the treatment, but it is necessary a close follow up.

If you think you have this condition, please do not hesitance to mail me to lnunez@urozen.com or come and visit me on UROZEN

Luciano Nunez-Bragayrac M.D.

Urologist