A JAMA THEME ISSUE
Edited by Phil B. Fontanarosa, MD, MBA, and Helene M. Cole, MD
Men with overactive bladder and other lower urinary tract symptoms are often treated with an antimuscarinic agent or an α-adrenergic receptor antagonist; however, monotherapy is not always effective. In a randomized 12-week trial, Kaplan and colleagues investigated the efficacy and safety of tolterodine extended release (an antimuscarinic), tamsulosin (an α-adrenergic receptor antagonist), both drugs, or placebo in men with overactive bladder and benign prostatic hypertrophy. The authors found that men who received combination therapy were significantly more likely to report treatment benefit than men receiving either monotherapy or placebo. All active treatments were well tolerated and the incidence of acute urinary retention was low.
The optimal management of patients with advanced prostate cancer detected at radical prostatectomy is not known. Thompson and colleagues assessed metastasis-free survival of men with advanced prostate cancer who were randomly assigned to either receive external beam radiotherapy to the prostatic fossa or usual care with observation. During a median follow-up time of nearly 15 years, the authors found that compared with usual care, adjuvant radiotherapy did not improve metastasis-free survival or overall survival but was associated with reduced risk of biochemical relapse and disease recurrence.
Prostate cancer screening by prostate-specific antigen (PSA) level is not recommended for men with limited life expectancies; however, few data exist on actual screening practices. Walter and colleaguesArticle analyzed data from 597 642 male veterans aged 70 years and older who received care at Veterans Affairs facilities during 2002 and 2003. The authors found little evidence that PSA screening rates declined with advancing age and worsening health status. Among men aged 85 years and older, 34% in the best health and 36% in worst health had a PSA test performed. In an editorial, AlbertsenArticle discusses key issues to consider before ordering a PSA test.
In a prospective cohort study of Japanese American men, Willcox and colleagues assessed whether certain biological, lifestyle, and sociodemographic risk factors present in midlife are associated with overall survival and exceptional survival to age 85 years free of 6 major chronic diseases and physical and cognitive impairment. The authors found that high grip strength and the absence of overweight, hyperglycemia, hypertension, smoking, and excessive alcohol consumption in middle-age were associated with both overall and exceptional survival in this cohort men of Japanese ancestry.
Testosterone replacement therapy (TRT) is often prescribed to ameliorate the effects of age-related declines in testosterone, but the effects of TRT on prostate tissue are not clear. Marks and colleagues assessed prostate tissue androgen levels, histology, and cellular functions in men with late-onset hypogonadism, who were randomly assigned to testosterone or placebo injections. The authors found that 6 months of TRT normalized serum androgen levels but was not associated with significant changes from baseline in prostate tissue androgen levels or other prostate-related outcomes.
Researchers are working to identify genetic, anatomical, and functional differences in the male vs the female brain and to determine how such differences play out in disease risk and response to drugs.
Addressing the unique primary health care needs of men who have sex with men (MSM).
Potential influences of fatherhood on health.
Clinical implications of the male biological clock.
Evidence and opportunities for improving men's health are discussed by this issue's editors.
Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.
For your patients: Information about prostate cancer.
This Week in JAMA . JAMA. 2006;296(19):2289. doi:10.1001/jama.296.19.2289