Diagnosis and Treatment of Sexual Dysfunctions in Late-Onset Hypogonadism

Testosterone is the principal androgen in the human male. The decline of testosterone with aging was recognized to be associated with a number of symptoms and signs that reduce the quality of life and that may even have severe, debilitating consequences. Clinically, late-onset hypogonadism (LOH) is diagnosed by use of biochemical and clinical measures. Despite published guidelines and recommendations, however, uncertainty surrounds the profile of clinical symptoms as well as the biochemical threshold of diagnosis. Clinicians should be aware of these shortcomings while adhering to the guidelines. Current treatment methods are centered on restoring testosterone to mid to lower levels of young men with natural testosterone replacements. Although recent studies have highlighted possible additional benefits involving improvement of systemic disorders, the goal of treatment is to improve sexual function, while observing for adverse effects in the prostate. Overall, the problem of LOH in debilitating the quality of life and well-being is real, and by following proper guidelines with attentiveness to the results of treatment trials, testosterone replacement therapy presents a safe and effective treatment option

Selenium and prostate cancer: analysis of individual participant data from fifteen prospective studies

Background: Some observational studies suggest that a higher selenium status is associated with a lower risk of prostate cancer, but have been generally too small to provide precise estimates of associations, particularly by disease stage and grade. Methods: Collaborating investigators from 15 prospective studies provided individual-participant records (from predominantly men of white European ancestry) on blood or toenail selenium concentrations and prostate cancer risk. Odds ratios of prostate cancer by selenium concentration were estimated using multivariableadjusted conditional logistic regression. All statistical tests were two-sided. Results: Blood selenium was not associated with the risk of total prostate cancer (multivariable-adjusted-odds ratio [OR] per 80 percentile increase = 1.01; 95% confidence interval (CI) = 0.83 to 1.23, based on 4527 cases and 6021 controls). However, there was heterogeneity by disease aggressiveness (i.e. advanced stage and/or prostate cancer death; Pheterogeneity = 0.01), with high blood selenium associated with a lower risk of aggressive disease (OR = 0.43; 95% CI = 0.21 to 0.87) but not with non-aggressive disease. Nail selenium was inversely associated with total prostate cancer (OR = 0.29; 95% CI = 0.22 to 0.40; Ptrend <0.001 , based on 1970 cases and 2086 controls), including both non-aggressive (OR = 0.33, 95% CI = 0.22 to 0.50) and aggressive disease (OR = 0.18, 95% CI = 0.11 to 0.31; Pheterogeneity = 0.08). Conclusions: Nail, but not blood, selenium concentration is inversely associated with risk of total prostate cancer, possibly because nails are a more reliable marker of long-term selenium exposure. Both blood and nail selenium concentrations are 6 associated with a reduced risk of aggressive disease, which warrants further investigation

Selenium and prostate cancer: analysis of individual participant data from fifteen prospective studies

Background: Some observational studies suggest that a higher selenium status is associated with a lower risk of prostate cancer, but have been generally too small to provide precise estimates of associations, particularly by disease stage and grade. Methods: Collaborating investigators from 15 prospective studies provided individual-participant records (from predominantly men of white European ancestry) on blood or toenail selenium concentrations and prostate cancer risk. Odds ratios of prostate cancer by selenium concentration were estimated using multivariableadjusted conditional logistic regression. All statistical tests were two-sided. Results: Blood selenium was not associated with the risk of total prostate cancer (multivariable-adjusted-odds ratio [OR] per 80 percentile increase = 1.01; 95% confidence interval (CI) = 0.83 to 1.23, based on 4527 cases and 6021 controls). However, there was heterogeneity by disease aggressiveness (i.e. advanced stage and/or prostate cancer death; Pheterogeneity = 0.01), with high blood selenium associated with a lower risk of aggressive disease (OR = 0.43; 95% CI = 0.21 to 0.87) but not with non-aggressive disease. Nail selenium was inversely associated with total prostate cancer (OR = 0.29; 95% CI = 0.22 to 0.40; Ptrend &lt;0.001 , based on 1970 cases and 2086 controls), including both non-aggressive (OR = 0.33, 95% CI = 0.22 to 0.50) and aggressive disease (OR = 0.18, 95% CI = 0.11 to 0.31; Pheterogeneity = 0.08). Conclusions: Nail, but not blood, selenium concentration is inversely associated with risk of total prostate cancer, possibly because nails are a more reliable marker of long-term selenium exposure. Both blood and nail selenium concentrations are 6 associated with a reduced risk of aggressive disease, which warrants further investigation

A meta-analysis of individual participant data reveals an association between circulating levels of IGF-I and prostate cancer risk

The role of insulin-like growth factors (IGFs) in prostate cancer development is not fully understood. To investigate the association between circulating concentrations of IGFs (IGF-I, IGF-II, IGFBP-1, IGFBP-2, IGFBP-3) and prostate cancer risk, we pooled individual participant data from 17 prospective and two cross-sectional studies, including up to 10,554 prostate cancer cases and 13,618 control participants. Conditional logistic regression was used to estimate the odds ratios (ORs) for prostate cancer based on the study-specific fifth of each analyte. Overall, IGF-I, IGF-II, IGFBP-2, and IGFBP-3 concentrations were positively associated with prostate cancer risk (Ptrend all ≤ 0.005), and IGFBP-1 was weakly inversely associated with risk (Ptrend = 0.05). However, heterogeneity between the prospective and cross-sectional studies was evident (Pheterogeneity = 0.03), unless the analyses were restricted to prospective studies (with the exception of IGF-II, Pheterogeneity = 0.02). For prospective studies, the OR for men in the highest versus the lowest fifth of each analyte was 1.29 (95% confidence interval=1.16-1.43) for IGF-I, 0.81 (0.68- 0.96) for IGFBP-1, and 1.25 (1.12-1.40) for IGFBP-3. These associations did not differ significantly by timeto-diagnosis or tumor stage or grade. After mutual adjustment for each of the other analytes, only IGF-I remained associated with risk. Our collaborative study represents the largest pooled analysis of the relationship between prostate cancer risk and circulating concentrations of IGF-I, providing strong evidence that IGF-I is highly likely to be involved in prostate cancer development