Globally respected urologist, Dr. Rene Sotelo, approaches the difficult conversation about the prominence of penile cancer with sensitivity, professionalism and humor. He says, “We have increased the survival rate for breast and prostate cancer, but the survival rate for penile cancer has decreased. Why are people coming in late for treatment? It’s not because they don’t have access to medical services. It’s because of shame, fear, and ignorance of how severe penile cancer can be.” Dr. Sotelo hopes that by shedding light on this preventable cancer, he can reduce the stigma behind the disease and help his patients advocate for their own care and the care of their friends and family.
SPECIAL FROM Grandparents.com
You’d like to think that at least some areas of our bodies will be spared the indignities of aging, but one day you realize: Mr. Happy gets older, too. “You don’t wake up one morning and realize it is different. It’s a gradual process, but starting around age 40, the changes become more noticeable,” says Madeleine Castellanos, M.D., author of “Penis Problems: A Man’s Guide.” So what does it mean when a penis looks and acts different?
Atherosclerosis, a common problem of aging, restricts blood flow, affecting heart, brain, and penis. With less blood in the area, the penis appears lighter in color, says Dr. Castellanos, who is also a sex therapist with a private practice in New York. This is nothing to worry about as long as you have regular checkups that show that everything else is in working order. Also, just as skin everywhere shows effects of aging, so does the penis skin. It may appear more mottled.
Touchy subject. The truth is the penis will shrink a little as time goes on as a result of decreased blood flow and testosterone. “By the time a guy is in his 60s and 70s, he may lose a centimeter to a centimeter and a half in length,” explains Dr. Castellanos. She adds, if a guy carries belly weight, the penis will appear smaller without it actually being smaller. “The penis starts inside the body. If you have belly fat, it comes down and extends over the base of the penis. The belly covers the base of the penis, making it appear shorter.”
But here’s the big secret: Most women really don’t care about size. In fact, enormous shlongs can be quite painful. “It’s what he does with it and the rest of his body that matters,” says Lou Paget, a certified a certified AASECT sex educator and author of “The Great Lover Playbook.”
Testosterone helps support nervous tissue. When its levels start to drop, there will be an accompanying decrease in sensitivity, making it more difficult to reach orgasm. Also, the erection won’t be as hard. “This is a case of use it or lose it,” says Dr. Castellanos. She explains that guys can protect their penile health by having erections every day. They don’t have to be point of orgasm, but daily erections keep the arteries in shape and bring blood flow to the area. “It’s just like if you don’t go to the gym, your muscles will get thinner and your arteries will close up. The same thing happens with a penis,” she adds.
Decline in urinary function
Urinary problems—issues with being able to “go,” or with being able to hold back flow—have to do with prostate health. It affects 20% of men in their 40s, 50 to 60 percent of men in their 60s, and 80 to 90 percent of men in their 70s and 80s.
Preventive actions, courtesy of Dr. Castellanos:
- Maintain a healthy weight.
- Get on your feet. Sitting all day puts a lot of pressure on the prostate.
- Do moderate exercise several times a week to maintain the tone of the pelvic floor muscles. Jogging or brisk walking will do the trick. The Mayo Clinic also recommends Kegel exercises for men.
- Take zinc and selenium.
- Limit alcohol consumption. Alcohol increases the conversion of testosterone to estrogen and increases inflammation in the area.
- Ejaculate several times a week to flush out the area.
- Erectile dysfunction (ED)
Erectile dysfunction (ED)
ED develops in 5 percent of men at age 40, and up to 15 percent at age 70. It can be the result of a variety of intertwined causes:
- Biology -– illness, medications, poor health habits of the male partner
- Psychological -– anxiety, depression, stress in either partner
- Relationship -– lack of trust and intimacy, or emotional conflict between the couple
- Psychosexual skills -– lovemaking skills of either partner, or the interplay between the two
Because of this complexity, simply popping a pill such as Viagra or Cialis without addressing the underlying cause as a couple will lead to failure, says Dr. Castellanos. “First, go to a physician for a complete checkup to rule out any chronic conditions. If that doesn’t yield any conclusive information, seek the help of a competent sex therapist, who can help you both psychologically and physiologically,” says Dr. Castellanos. You can find recommendations at the American Association of Sex Educators, Counselors and Therapists.
There’s been a lot of talk lately about andropause – basically, whether it truly exists or not. In theory, it is a significant response to hypogonadism (when the testicles are no longer producing normal levels of testosterone). With andropause, men can have symptoms similar to women in menopause such as fatigue, depression, night sweats, and low sex drive. Dr. Castellanos explains that very few men have true andropause that needs to be treated with testosterone. Since testosterone naturally declines with age and can be affected by many environmental factors, Dr. Castellanos says it’s important to…
- Eat healthy
- Get seven to eight hours of sleep nightly
- Limit alcohol to one drink per day
- Quit smoking
- Keep stress levels under control
“All of these factors provide what is necessary for the body to produce optimal amounts of testosterone. The body is constantly responding to its environment and making adjustments accordingly. If the environment is too stressful (no sleep, bad diet, lots of stress), the body compensates by declining the production of testosterone – and vice versa,” explains Dr. Castellanos.
Even if you don’t have true andropause, these healthy life changes can’t hurt.
Caution: Taking testosterone when it is not really needed impairs the body’s ability to make its own, so testicles and penis will actually shrink.
By Dr. Octavio Almanzor
The testicles represent the principle male sex glands. They are located under the penis in a pouch of skin called the scrotum and their functions are sperm production and secretion of a sex hormone called testosterone, which has to do with the sexual development of man.
Compared with other types of cancer, testicular cancer is relatively uncommon, and represents approximately 2% of all cancers in men. It appears most frequently in males aged 20–35 and is much less common after age 50. Risk factors for developing testicular cancer include undescended testicles at birth, family history of testicular cancer, viral diseases of childhood, such as mumps and even infertility.
Usually, this cancer does not cause symptoms, only the growth of one or both testicles. On suspicion, the doctor performs a thorough physical examination and scrotal ultrasound – which can show the presence and size of a tumor mass in the testicle-. Besides there are certain laboratory blood tests that measure increased presence of certain substances that function as tumor markers for testicular cancer, such as the alpha fetoprotein, lactate dehydrogenase and the determination of the human chorionic hormone gonadotropoina subunit B.
Diagnosis is based on the clinical examination, histopathological findings of tumor cells within the organ. In such a case, further tests will be needed to see if the cancer has spread from the testicle to other parts of the body. Determining the stage of the disease helps plan the entire treatment.
Treatment should be multidisciplinary, where the urologist, medical oncologist and radiation therapist are involved. In general, it depends on the patient’s age, the type of tumor and how advanced it is found to be, although cure rates are calculated as high as 95%, especially in those cases detected early.
The surgery called radical orchiectomy is the removal of the testicle and is often sufficient for the complete cure of the patient. After surgery the patient retains exactly the same potency and the same capacity for parenthood, because he retains the healthy testicle. If the patient wishes, a prosthesis can be inserted in place of the testicle removed by surgery. In cases where the patient has only one testicle, and it is affected by the cancer, surgery will be needed where only the tumor is removed and the remaining healthy testicular tissue is preserved.
If the tumor has spread outside the testicle and depending on the type of tumor it may be necessary to have both chemotherapy and radiotherapy, to be administered by the medical oncologist or radiation oncologist, respectively.
These two treatment modalities can interfere with sperm production, so that the preservation of semen in biobanks is required for these patients.
Chemotherapy is the use of special drugs that destroy cancer remaining in the body after surgery, although it may be the initial treatment if the cancer is in an advanced stage, i.e., where it has spread outside the testicle before the operation. Most drugs have some side effects including nausea, hair loss, fatigue, diarrhea, vomiting, fever and chills.
In the case of radiation, electromagnetic waves of high intensity that kill cancer cells and shrink the size of the residual tumors are employed. Side effects of radiation therapy depend mainly on the treatment dose. These commonly include fatigue, skin changes where the treatment is performed, loss of appetite, nausea and diarrhea.
Because testicular cancer is curable when detected early, experts recommend conducting a monthly testicular self-examination after a hot shower – when the scrotum is more relaxed-, for lumps, enlargement or other abnormalities; also, try to identify if there is pain or discomfort when doing the exploration and also a sense of heaviness. It is always important to consult a doctor to determine the cause of any of these symptoms.
Testicular cancer can recur. Monitoring can vary depending on the type of tumor and, in general, patients are examined by an urologist 2 or 3 times per year with scans and blood tests.
Translated by Weldon Woodard
Although not a common disease in our area, it is important to detect since its evolution can be fatal and devastating, not only for health status and patient survival, but also for the quality of life
By Dr. Oscar Darioa Martín Garzón
Of the urologic tumors, penile cancer represents one of the less frequent, with 1 case per 100,000 men in the United States and Europe, with variations by demographic area: 0.7 3 per 100,000 people in India, Brazil 8.3 per 100,000 men; surpassed by Uganda, where it is the most commonly diagnosed cancer. By race, it is more common in Hispanic whites and less common in blacks and non-Hispanic whites.
Risk factors important for the development of penile cancer can be identified clearly and precisely, among which are social and cultural habits, hygiene, and customs associated with religion.
The presence of cancer is rare in communities that practice circumcision in newborns or before puberty (Jews, Muslims and the Ibo of Nigeria). “Early circumcision reduces the risk of penile cancer between 3-5 times, but it should be clear that adult circumcision does not protect against penile cancer,” says the American and European urology guidelines.
The risk factors most clearly identified for this condition are phimosis (the redundant or large foreskin), chronic inflammatory condition of the foreskin or head of the penis (glans) resulting from conditions such Balanopostitits, lichen sclerosus and atrophicus (xerotica balanitis , common in diabetics); sexual history (multiple partners, early age at first intercourse) and patient report of warts (lesions on the penis with a fluffy appearance). All these are associated with a risk of 3-5 times more of penile cancer, in addition to smoking cigarettes, which increases the risk of the disease from 4 to 5 times.
It is Important to point out that because of modesty or fear, men do not immediately consult a specialist and prior to this start nonmedical local treatment, resulting in the progression of the disease and a terrible unfavorable outcome for both the patient and his urologist.
Once the diagnosis is made, the disease is classified according to its severity in order to offer local treatment or to go immediately to surgery with a penectomy (removal of penis) which can be complete or partial depending on the case. After this, the possibility of involvement of the lymph nodes is classified, which is the site where the cancer spreads, mainly to the ganglia in the groin and the pelvis.
Given the possibility of lymph node involvement, a resection should be done immediately to ensure no spread of the disease and improve the patient’s chance of survival.
Nowadays there are two possibilities for surgical treatment, open and minimally invasive (laparoscopy and robotics). A few months ago, in Caracas, specifically in the La Floresta Clinic, the first robotic inguinal lymphadenectomy in Latin America was performed, and the third in the world, by our group, the most experienced and with the most reported cases worldwide, allowing us to discern clearly the advantages of robotics in such operations, among which are better identification and dissection of the anatomy, less scarring, improving the aesthetic factor, important for many patients; also there is less chance of intraoperative and postoperative complications, resulting in a faster return to daily activities. The day after the procedure the patient said “it’s amazing to know how medicine has improved in the world and in Caracas.”
INFOGRAPHIC LEGEND: The working ports are placed for the robot-assisted laparoscopic approach, taking into account the different anatomical structures surrounding the affected area. Then the arms of the robot are connected to the working ports.
Interview with Doctor René Sotelo