William Shatner is doing it.

Hugh Jackman (far left) is doing it.

Are you doing it?

It's time to grab your stuff, boys, and feel around for lumps that don't belong there (note: those two big lumps are your testicles).

Feeling Nuts Challenge for men goes viral

By Sara Cheshire, Special to CNN
Fri October 3, 2014

Men, are you #feelingnuts?

STORY HIGHLIGHTS

• #feelingnuts is raising awareness online of testicular cancer
• Celebrities Hugh Jackman and William Shatner have joined in
• Testicular cancer typically affects young men
• Experts estimate 8,820 cases of testicular cancer will be diagnosed this year in the U.S.

(CNN) -- Now that the Ice Bucket Challenge has made the rounds, a new trend is on the rise: crotch grabbing -- for testicular cancer.

Stars such as Hugh Jackman and William Shatner have already participated in the Feeling Nuts Challenge, which you can follow online with the hashtag #feelingnuts.

Why testicular cancer awareness? Unlike some other cancers, testicular cancer typically affects young men, with an average age of diagnosis 33, according to American Cancer Society. The organization estimates that 8,820 new cases of testicular cancer will be diagnosed this year in the United States.

Fortunately, it is highly treatable if discovered early.

Men who have cryptorchidism, or an undescended testicle, are more at risk, along with those with a family history of the cancer. White males have the highest risk, followed by Latino, Asian-American and black men, according to the ACS.

So if you're joining the Feeling Nuts Challenge, feel for lumps and follow up with a doctor if anything seems amiss.

Statins and Prostate Cancer - Don't Believe What You Read

Every few years, it seems, there is renewed interest in using statins (hydroxy-methyl-glutaryl CoA reductase inhibitors - drugs that lower cholesterol) to treat (or prevent) prostate cancer. WebMD reported on a 2009 study suggesting an almost 2/3 reduction in death rate with the use of statins:

Statins and Prostate Cancer Death

The new study involved 380 men ages 55 to 79 who died from prostate cancer between 1999 and 2001 and who had living spouses who could verify their medical histories. They were compared to 380 married men in the same age group who were still alive.

A total of 63 men who died from prostate cancer had taken statins, as had 109 of the men who were alive.

After taking into account other risk factors for dying from prostate cancer, men taking statins were 63% less likely to die from the disease than men not taking statins.

Stephen Marcella, MD, assistant professor of epidemiology at the University of Medicine and Dentistry of New Jersey in Piscataway, presented the findings at the 2009 Genitourinary Cancers Symposium.

Further analysis showed that high-potency statins like Lipitor, Zocor, and Crestor were linked to a lower risk of dying from prostate cancer even more than weaker statins like Mevacor, Pravachol, and Lescol.

"The high-potency statins were about 2.5 times more effective at preventing prostate cancer death than the weak statins," Marcella says.

"That makes sense," Klein says. "The more potent the drug, the bigger the biologic effect."

That doesn't mean high-potency statins are better than weaker statins, he stresses. "Their primary purpose is for cholesterol lowering and you typically want to use the least aggressive therapy you can to achieve the desired effect," Klein says.

While the studies were not designed to examine how statins might protect against dying from prostate cancer, Klein notes that they are potent anti-inflammatory drugs. "There's a lot of evidence that inflammation contributes to the development of prostate cancer." Alternately, statins may directly kill cancer cells, Klein says.

The anti-inflammatory model of the reduction of cancer severity in those who use statins may be true for some patients. We don't know. But we do that a diet rich vegetables, antioxidants, fruits (especially berries), and anti-inflammatory herbs (curcumin, olive leaf extract, oregano oil), combined with regular exercise and an avoidance of too much red meat (or, more precisely, flame-cooked meat) and too much sugar and other simple carbs, all work in synergism to reduce inflammation, which is the primary driver of cancer growth.

Why use statins when we can get the same benefit (and may others as well) from a proper diet?

In a 2010 paper (Di Stasi, MacLeod, Winters, and Binder-Macleod¹) on how physical therapists can be useful for those taking statins, the authors outline some of the issues with statins and muscle damage:

Approximately 25 million Americans use statins,¹³ and 5% to 18% of these patients report some form of myalgia.¹⁴ Skeletal muscle side effects that are associated with statin use involve muscle cramping, soreness, fatigue, weakness, and, in rare cases, rapid muscle breakdown that can lead to death (ie, rhabdomyolysis).^15,16 Side effects have been associated with all commonly used statins and are dose dependent.^17,18

Other research has suggested the percentage of people who experience side effects (especially in muscle) is not really so tiny. Parker, Capizzi, Grimaldi, Clarkson, et al. (2013²) found that even non-symptomatic patients express increased average creatine kinase, suggesting that statins produce mild muscle injury even among asymptomatic subjects.

However, this is not the most serious with statins and prostate cancer. 

Earlier this year, the research surfaces again. This is a lengthy article, and I am including all of it - it comes via the Prostate Cancer Foundation.

Statins and Prostate Cancer

As the science comes together, risk of aggressive disease may be abated with use, but little effect on indolent, early prostate cancers

March 4, 2014 -- Statins are a group of widely prescribed drugs used to lower cholesterol levels in the body. Common statin medications include well-known brands such as Zocar, Lipitor, and Crestor. Statins work by inhibiting an enzyme in our bodies (HMG-CoA reductase) that is used to manufacture cholesterol, and the drugs can also help clear already formed cholesterol from the bloodstream. High cholesterol is a known cause of cardiovascular disease, and it’s well-established that statins reduce the rate of death and illness caused by cardiovascular disease. And while statins can help prevent the risk of heart attack or stroke, some studies have also suggested that statins may have an effect on prostate cancer.

Whether the effect would be beneficial or harmful has been the subject of ongoing studies for some time. When statins first became widely available to the public in the 1980s, concerns erupted that these drugs might spur some cancers. Those fears are now widely dispelled, and this past year, a massive meta-analysis of 135 randomized studies that included over a quarter million study participants, found that statin use did not increase the risk of developing cancer.

Statins and Prostate Cancer

However, whether or not statins had a positive impact on cancer risk remained an open question. Research has suggested that statins can slow cancer cell growth in certain cancer types such as breast, colorectal, and skin cancers, and may lower the risk for the latter two. And some research has also suggested that statins might lower the overall risk for prostate cancer, but because of inconsistent findings, it was clear more research was needed. From such ongoing research, what is emerging is that statins may indeed reduce the risk of death from prostate cancer, but likely have little effect on whether or not a man develops prostate cancer in the first place.

Statins and Advanced Prostate Cancer



Dr. Elizabeth A. Platz of the Johns Hopkins Bloomberg School of Public Health and a Prostate Cancer Foundation-funded researcher.
Dr. Platz and colleagues have twice found that individuals with lower levels of cholesterol (within the normal ranges, not the super low ranges) had a lower risk of developing more aggressive disease, as defined by high Gleason scores. This is yet another reason for men to put aside that plate of fried chicken and head for the salad bar, in order to naturally lower their cholesterol levels.

This January, research out of Canada published in the Journal of Clinical Oncology found that men who used statins after a diagnosis of prostate cancer had a 24% decreased risk of death from the disease compared to men who did not take statins. The longer the men took statins, the greater the protective effect. For example, men who took statins for less than one year post-diagnosis had a 1% lower risk of death from prostate cancer compared to non-users. But men who had taken statins for three or more years post-diagnosis lowered their risk of death from their cancer by 39%.

Interestingly, the study also found that statin use prior to a diagnosis of prostate cancer was even more protective to the men, in terms of both mortality specifically from prostate cancer, or from any other cause. Pre-diagnostic statin use reduced the men’s risk of death from prostate cancer by 45%, and conferred a 34% reduced risk of death from any cause, compared to men not taking statins.

All the men in the study had been newly diagnosed with non-metastatic prostate cancer at the time of their enrollment into the study; men who used statins after their diagnosis were 23% less likely to develop distant metastatic cancer spread during the study period.

This study adds to other recent research showing reduced prostate cancer-specific mortality among men who used statins. Dr. Janet Stanford, of the Fred Hutchinson Cancer Research Center in Seattle and a Prostate Cancer Foundation-funded researcher, and colleagues published a study this past summer in The Prostate demonstrating that men who took statins prior to their diagnosis of prostate cancer experienced an 81% reduced risk of prostate cancer-specific mortality compared to men who did not take statins. At 10 years of follow-up, only 1% of statin users had succumbed to prostate cancer, compared to 5% of non-users. However, that study also found that statin use prior to prostate cancer diagnosis did not affect whether or not prostate cancer recurred or progressed. At the time the study was published, Stanford called for confirmation study to validate her findings, and suggested that such research could pave the way for a large, randomized, placebo-controlled study that will yield the most definitive results on whether or not men with prostate cancer should or should not be prescribed statins to lessen their risk of death from the disease.

In response to last month’s study in the Journal of Clinical Oncology (JCO), Drs. Lorelei A. Mucci and Meir J. Stampfer from the Harvard School of Public Health and both Prostate Cancer Foundation-funded researchers, penned an editorial on the subject: Mounting Evidence for Prediagnostic Use of Statins in Reducing Risk of Lethal Prostate Cancer. In this article, Mucci and Stampfer point out that much of the inconsistency among studies on statins and prostate cancer “disappears" when the research distinguishes between risk of overall incidence of prostate cancer and risk of advanced or lethal disease. In reviewing the current “mounting" evidence, Mucci and Stampfer pointed to Stanford and colleagues findings of lower risk of death from prostate cancer in statin users, as well as a Danish study showing lower rates of death for statin users, and a Norwegian study finding that risk of lethal prostate cancer also dropped with statin use.

The authors noted that Prostate Cancer Foundation researchers were the first to focus on risk of lethal disease and statin use in a prospective, observational study published in the Journal of the National Cancer Institute (JNCI) , in 2006. (Men at risk for prostate cancer were observed over the course of several years; their use of statins was recorded, as was their incidence of prostate cancer.) That study, with first author Dr. Elizabeth A. Platz of the Johns Hopkins Bloomberg School of Public Health and a PCF-funded researcher, found that men diagnosed with prostate cancer who used statins halved their risk of developing advanced disease during the study period, and lowered their risk of lethal disease (having metastatic disease at time of diagnosis or succumbing to prostate cancer during the study’s follow up period) by 61 percent. Furthermore, the study found that the risk of developing advanced prostate cancer was lower with longer durations of statin use.

Dr. Mucci says that the Canadian study was a particularly good study for a number of reasons. “It is one of the larger studies to date with the ability to study lethal cancer during the follow-up period," says Mucci, referring to the fact that a large number of men in the study developed lethal disease during the study’s follow-up. Because smaller studies may pick up outcomes that happen just by chance rather than due to the effect of the drug, this study allows far greater confidence in the findings that statin use did have a positive effect on risk of dying from prostate cancer. Also, says Mucci, “A really unique feature of this study is that the researchers looked at statin use both before and after diagnosis." That may be important in helping to determine the mechanism of action statins have on prostate cancer. “One can think about statin use after a diagnosis, and that the drug will probably influence tumor cells after they’ve left the prostate, whereas, statin use before diagnosis could influence the tumor itself," says Mucci.

Knowing when and where statins act on prostate cancer can help determine which patients are most likely to benefit, as well as lead to new drug development specific to prostate cancer once the cellular pathways of action are determined.

Dr. Mucci and colleagues are now working out how statins may affect genes and other molecular pathways for better or worse in prostate cancer patients. They will examine prostate tissue samples taken from men who’ve just undergone radical prostatectomy. “We want to determine if there are differences in gene expression between men who use statins and those who don’t," says Mucci. They examine both tumor tissue samples and normal tissue samples taken from the prostate of each man in their study.

Statins and Overall Risk of Prostate Cancer – unlikely to work as chemopreventive agent

While statin use may have an effect on survivability of prostate cancer in some men, the evidence to date does not point to a protective effect from the drug in terms of overall risk of prostate cancer. In the 2006 JNCI study by Platz and colleagues, while risk of lethal disease was lowered among statin users, there was no risk reduction for the overall occurrence of prostate cancer in men who were taking statins.

On the heels of that study, Platz and colleagues decided to further investigate overall risk of prostate cancer and statin use. “Most of overall prostate cancer is early stage disease, and we did not see an association between statin use and prostate cancer overall" says Platz, “and we were worried maybe we might be missing an association because of a particular study bias—detection bias." Men who regularly seek care through their primary-care doctor are more likely to be screened for both high cholesterol and PSA levels. “If a man has high cholesterol he may well be prescribed a statin to lower his cholesterol levels, and if his PSA levels are elevated, his doctor might recommend a biopsy," says Platz. Regular screening can lead to both a high incidence of statin use and prostate biopsy. And because biopsy if quite sensitive to picking up early prostate cancer, this can create a false association between statin use and prostate cancer, says Platz.

“We wanted to study early prostate cancer in a setting where such detection bias is very unlikely to be operating," said Platz.

To that end, her group studied statin use in a group of men enrolled in the Prostate Cancer Prevention Trial, a study that called for annual PSA screening and digital rectal exams for prostate cancer. This eliminated the variability in screening that likely colored other studies. And, because Platz wanted to focus on early cases of prostate cancer, a setting where all men are screened equally also favored early disease detection that gave the researchers a more homogenous group of diagnosed men, weeding out most cases of late stage disease. In a study just published online in the Journal of Urology, Platz and colleagues again found no association between statin use and early prostate cancer among some 10,000 men enrolled in the Prostate Cancer Prevention Trial who were followed for a period of seven years.

“Overall," says Platz, “if you take all of the literature together, it appears as though statin drugs may be inversely associated with aggressive disease—meaning the cancer progresses to the point of distant metastatic spread, or death of the patient—but not associated with the development of the most common form of prostate cancer in men, which is very early disease."

Why and how might statin use affect development of aggressive prostate cancer?

Clearly this needs to be better understood, but there are several likely avenues of action statins can exert on cancer cells. Pre-clinical research has shown that these cholesterol-lowering drugs can inhibit prostate cancer cell growth, and may encourage cancer cell death and prevent tumor blood vessel growth as well as modulate immune system factors. Additionally, it has been suggested that statins may tamp down the activity of certain oncoproteins. Dr. Mucci’s team, in their work just beginning on tumor tissue samples and statin use, will help suss out such molecular activity and pathways involved.

Dr. Platz and colleagues have now twice found, in two different study groups of men, that individuals with lower levels of cholesterol (within the normal ranges, not the super low ranges) had a lower risk of developing more aggressive disease, as defined by high Gleason scores. (This is yet another reason for men to put aside that plate of fried chicken and head for the salad bar, in order to naturally lower their cholesterol levels.)

Moving forward to better answers

And while the indications are fairly ripe for an interventional randomized clinical study of statins as one agent in the treatment of men with advanced prostate cancer, it is very important to do the groundwork to best determine which subset of men and at what time in their treatment scope, statin use may yield the best results, says Dr. Howard Soule, chief science officer at PCF. Large randomized studies are very costly and if not properly set up, may not bring forth the best information.

From a public health standpoint, it doesn’t make sense to give healthy men, who do not have elevated cholesterol levels, statins for prevention of cancer, says Platz. “Even though these drugs are quite safe, they are not without side effects," she says.

Dr. Jonathan Simons, president and CEO of the Prostate Cancer Foundation, says, “This tantalizing possibility that statins may be used in conjunction with other therapeutics to lower a man’s risk of death from aggressive prostate cancer is well worth further exploration." Simons adds: “Finding that subset of men who might most benefit from statin use in order to hold their cancer in check, or discovering what genes and molecular pathways might be targeted with other new drugs, is a definite goal." And with the recent advent of blood tests that use genetic signatures to help separate out risk of less aggressive from risk of more aggressive disease, and the discovery of constellations of single point mutations—changes in DNA sequence called SNPs—that add up to a higher risk of lethal disease , it may be that evaluating statin use in men who are deemed at higher risk of aggressive disease may be ideal candidates in whom to study statin use as a treatment option. In fact, says Platz, such a research strategy would be feasible because in a high-risk group of men the likelihood of having an event of aggressive prostate cancer is higher, so the study would be more manageable in term of size and duration—fewer men would need to be enrolled and follow up time could be shorter in order to get actionable data.

If you noticed in the article, these studies were conducted on non-metastatic cancer patients, and the studies did not progress far enough to see if any of the patients did suffer from metastasis. Although in one of the studies mentioned, "men who used statins after their diagnosis were 23% less likely to develop distant metastatic cancer spread during the study period." But how long was the study period?

Statins, Metastasis, and Red Blood Cells

One of the emerging theories for the metastasis of prostate cancer is that the cancer stem cells have found a way to "hijack" red blood cells, which allows them to move through the body undetected by the immune system and to eventually hide out in bone morrow, where they are safe from radiation and chemotherapies, and where they also have a steady blood flow to keep them alive.

So the question, then, is how do they get into the red blood cells?

Research (Honda, Yamada, Endo, Ino, Gotoh, et al., 1998³) demonstrates that regulation of the actin cytoskeleton of erythrocytes (red blood cells) likely plays a central role in cell motility and cancer invasion. These authors believe that nonmuscle actinin-1 associates with cell adhesion molecules, such as integrin β1 and α-catenin, and is plays an important role in stabilizing cell adhesion and regulating cell shape and cell motility (Otey et al., 1990, 1993; Glück et al., 1993; Glück and Ben-Ze'ev, 1994; Knudsen et al., 1995).

Their research found that cytoplasmic actinin-4 (a novel isoform of nonmuscle α-actinin) regulates the actin cytoskeleton and increases cellular motility. However, it becomes inactivated when it is transferred to the cell nucleus, which "abolishes the metastatic potential of human cancers." So, in essence, activation of actinin-4 increases cell motility. But how?

It's long been known that inflammatory substances in the immune system can damage erthrocytes, which creates an opening for cancer stem cells to enter. The above study showed that actinin-4 was markedly induced in cells along the edges of a wound to the cytoskeleton.  

Actinin-4 was expressed in a limited population of normal cells, including erythrocytes, endothelial cells, and epithelial cells in various tissues at their border with stromal connective tissue.

So where I am going with all of this?

Simvastatin (Zocor), one of the more common statins, has been shown (Clapp, Ellsworth, Sprague, and Stephenson, 2013⁴) to increase erythrocyte deformability, which means red blood cells are more easily deformed, as in the research above. It is highly likely that other statins produce the same risks.

Deformed erthrocyes, whether from cytokines or statins, increase the risk that cancer cells, including prostate cancer, can invade the damaged blood cells and metastasize throughout the body.

So when you read that statins might be an effective treatment for prostate cancer, please keep this in mind.


References

1. Di Stasi, SL, MacLeod, TD, Winters, JD, and Binder-Macleod, SA. (2010, Oct). Effects of Statins on Skeletal Muscle: A Perspective for Physical Therapists. Physical Therapy; 90(10): 1530–1542.
2. Parker, BA, Capizzi, JA, Grimaldi, AS, Clarkson, PM, Cole, SM, et al. (2013). Effect of Statins on Skeletal Muscle Function. Circulation; 127: 96-103. doi: 10.1161/​CIRCULATIONAHA.112.136101 
3. Honda, K, Yamada, T, Endo, R, Ino, Y, Gotoh, M, Tsuda, H, Yamada, Y, Chiba, H, and Hirohashi, S. (1998, Mar 23). Actinin-4, a novel actin-bundling protein associated with cell motility and cancer invasion. Journal of Cell Biology; 140(6):1383-93.
4. Clapp, KM, Ellsworth, ML, Sprague, RS, and Stephenson, AH. (2013, Mar 1). Simvastatin and GGTI-2133, a geranylgeranyl transferase inhibitor, increase erythrocyte deformability but reduce low O2 tension-induced ATP release. Am J Physiol Heart Circ Physiol.; 304(5): H660–H666.

If you read the health section of your local newspaper or favorite online news aggregater last week, you no doubt saw the frightening headlines about eating meat being as bad as smoking, or how high-protein diets are now linked to cancer. Here are a few of them:

* Why High-Protein Diets May Be Linked To Cancer Risk
Forbes
* Too much protein as bad as smoking
Independent Online
* High-protein diet in middle age can lead to early death
eMaxHealth
* Are burgers as bad as cigarettes? Unravelling the truth about diet and disease
Telegraph.co.uk (blog)

The research involving humans is so badly conducted that it cannot be seen as representative of even a correlation, let alone causation. The mouse portion of the study is a little more interesting, but it's still not capable of showing cause and effect.

Fortunately, New Scientist has a short but sweet debunking of all those scare-tactic headlines. And National Geographic looks at the real issue, according to other research, which is blood levels of
insulin-like growth factor-1 (IGF-1).

I can has cheezburger? Protein cancer risk overblown

18 March 2014 by Catherine de Lange

Are you middle-aged and partial to cheeseburgers? If so, you may be concerned by a study suggesting you have a much greater risk of dying from cancer than your peers who favour a less protein-rich diet. But not all researchers agree with the study's findings.

Morgan Levine at the University of Southern California in Los Angeles and her colleagues analysed a dietary survey of more than 6300 people in the US aged over 50. Those aged 50-65 at the time of the survey and who had a high-protein diet – one where protein supplied a fifth of calories – were 75 per cent more likely to have died over the next 18 years than peers who only got 10 per cent of their calories from protein.

The high-protein eaters had a cancer death rate four times that of their low-protein peers. Statistical analyses showed that the findings only held for animal protein diets – in other words, protein from meat and dairy rather than beans and pulses.

In a follow-up study in mice, the team also found that animals fed a low-protein diet had a lower incidence of cancer than those on a high-protein diet. The low-protein mice that did develop the disease had slower-growing tumours.

Lots of leaps

But Tim Key, a Cancer Research UK epidemiologist based at the University of Oxford, says the dietary survey is too small to provide any robust conclusions.

Catherine Collins, chief dietician at St George's Hospital, London, doesn't dispute the results in mice, but says the authors make a lot of leaps when trying to apply the findings to humans. What's more, the conclusions are based on a single survey of what people reported eating in the preceding 24 hours. "As a dietician that's worrying," she says. "There are so many errors with the data collection. It implies people's diet doesn't change over 18 years."

Study co-author Valter Longo, also at the University of Southern California, counters that the participants said that the 24 hour period was representative of their diet. "Most people don't change their diet very often," he says.

Different health organisations recommend consuming different amounts of protein. Longo says that people in middle age should try to eat at the lower end of these recommendations.

Collins isn't convinced. "We don't need to do anything different, and nor should we be worried [on the strength of this study]," she says.

Journal reference: Cell Metabolism, DOI: 10.1016/j.cmet.2014.02.006

Here is the National Geographic article about IGF-1 and the health risks of having too high of levels of this growth factor (a molecule created by the metabolizing of human growth hormone).

Behind the News: Why a High-Protein Diet in Middle Age May Increase Risk of Death

Levels of a growth-related molecule in the blood may be key.

Eating a high-protein diet during middle age may be as harmful as smoking, a scientist says.  PHOTOGRAPH BY ANDREW SCRIVANI, THE NEW YORK TIMES/REDUX

Stephen S. Hall
for National Geographic
Published March 8, 2014

On March 4, scientists reported that people who ate a diet rich in protein during their middle-aged years (ages 50-65) were four times more likely to die from cancer than those who ate a low-protein diet, and had a 75 percent increase in overall mortality.

Valter Longo of the University of Southern California, who led the study, likened the risk of a high-protein diet to that of smoking. The key to these startling findings—underreported in many media accounts—is the role of a molecule called insulin-like growth factor-1 (IGF-1).

This same molecule was the prime player in a highly publicized study published three years ago by Longo, along with Jaime Guevara-Aguirre of the Institute of Endocrinology, Metabolism and Reproduction in Quito, Ecuador, and their colleagues, that looked at patients in a remote area of southern Ecuador. The subjects of the study had a rare mutation that interfered with the normal functioning of IGF-1, blocking the body's normal growth pathway. As a result, adults with the disease (known as Laron syndrome) rarely grew beyond 3 1/2 feet tall.

But the scientists observed an unusually beneficial side effect of the disease: The "Larons" did not get cancer, they claimed, and did not get diabetes, even though they were often obese. (Read "On Beyond 100" in National Geographic magazine.)

For the recent study, published in the journal Cell Metabolism, the scientists analyzed data from the Center for Disease Control and Prevention's National Health and Nutrition Examination Survey (NHANES).

In an unexpected twist, the researchers also reported evidence that after age 65, a high-protein diet seemed to have the opposite effect: It protected against mortality.

In other words, a low-protein diet during middle age appears to be protective, but the same low-protein diet in older adults has deleterious effects.

To explore these puzzling results and the role of IGF-1, National Geographic spoke with Longo earlier this week.

For a number of years you've been studying a population in Ecuador with a growth disorder, and in 2011 you reported the relative absence of cancer and diabetes mortality in people with Laron syndrome. How does this new report tie in to that earlier research?

The Laron study was a continuation of our work that we started 20 years earlier. When we put it all together, the obvious thing was, in both in mice and humans, when they eat [a low-protein diet], we predicted that they would have low levels of IGF-1. So I started bugging everybody in the world that had any databases. It turned out that here at USC, downstairs from our lab, we had some people who had been studying NHANES for years. It was a perfect database to look at, because it was nationally representative; it's done by the CDC, and the sample and the measurements are considered to be very reliable.

There are several surprising claims in this new study, but let's talk about perhaps the biggest: A high-protein diet during middle age was associated with a much greater risk of dying of any cause, especially cancer, than a low-protein diet. In fact, you liken the mortality risk of the high-protein diet to that of smoking. How would you explain this association?

The more protein you eat—and this is very clearly shown by clinical work by others—the more IGF-1 activity you have. And we see the same in mice. There was a paper that came out in the same issue of Cell Metabolism, looking at all kinds of combinations of micronutrients, and in fact the best combination for longevity was low-protein, high carbs.

And just to be clear: When you say high-protein or medium-protein diet versus low protein, what exactly do you mean?

High protein means 20 percent or more of the calories is coming from protein; moderate is 10 to 20 percent; low is less than 10. We looked at animal-based and plant-based proteins.

One of the other surprises in the study is what you refer to as a "dramatic switch"—a point when a low-protein diet seems to stop being protective and starts having negative effects. How did you identify that shift, at what age does it occur, and why do you think it happens?

So when I first sat down with the epidemiologist, the analysis was done for the whole survey, from ages 50 on up. And we saw nothing. But we were seeing in mice that if you starve a young mouse or a middle-aged mouse, it does very well. But we started seeing that when we starved old mice in the same way, they were struggling. That's when I started thinking, "Hmm, I think that there are two major phases, if not more."

I went back to the epidemiologist and said, "Can you reanalyze the data and break it down into two groups? [Up to 65 years old, and after 65.] And sure enough, she came back and said to me, "Valter, it's incredible." Now we know why we didn't see it before. [In the original analysis] the effects in the old were offsetting the effects in the middle-aged.

You also conducted complementary studies of high-protein and low-protein diets in mice and yeast. Those studies suggested a role for IGF-1. Can you explain your working hypothesis about the possible role of IGF-1 in cancer, and in mortality in general?

We know that in either animals or humans, if the diet is low in protein, the level of IGF-1 goes down—or way down, depending how severely you restrict protein. If you look at humans, it's a pretty large change [in IGF-1 levels] between the high-protein group and the lowest-protein group, with the moderate-protein group in between.

So then how does it lead to cancer? Well, that was basically our paper three years ago on the Larons, which showed that if you take the blood from the Larons [which essentially has no IGF-1] and you expose human cells to it, and then you try to damage those cells to make them precancer cells, the absence of IGF-1 has a protective effect in two ways. First, as we have known for years from yeast, the lack of IGF-1 protects DNA from damage in the first place. Second, the lower IGF-1 now makes the mammalian cell more likely to go into what is called "programmed cell death," or apoptosis.

And the cell dying in that instance is a good thing?

Yes—because it's a cell that's about to become a cancer cell. So there's a dual protective effect. You try to prevent DNA damage from happening in the first place, but when the damage does happen, the [precancerous] cell is much more likely to die.

We showed this very clearly in this new study, where a cancer [in mice] progresses more slowly on the low-protein diet.

This new paper suggests that animal proteins, as in red meat, have a different effect on this biochemical pathway than plant proteins, as in vegetables. At the biochemical level, why would cells see a difference between animal proteins and plant proteins?

When we did the mouse studies, we did see a trend for decreasing IGF-1 with soy protein versus animal protein. We are doing more studies now, looking at different protein sources and IGF-1 levels. We suspect that the amino acid profile of plant proteins is going to control IGF-1 differently, but we need to test that more carefully.

Just to make sure the proper caveats are introduced here: This study finds an association between diet and mortality, but doesn't prove that a high-protein diet in middle age causes an increased risk of dying. And one of the limitations with the NHANES study is that it is based on a single, one-time recall of a person's diet over a 24-hour period, and then you're associating mortality up to 18 years later from that single dietary report.

Well, there's not many things you can do that are not going to have limitations. I think this needs to be viewed in the context of a number of other studies done, including the Laron study.

Frank Hu at Harvard looked at high animal proteins and fats in diets and low carbs, and even if he didn't break it down into age segments, he still saw that people eating high animal food diets and low carbs were the ones with the highest overall mortality risk, the highest cancer risk, the highest cardiovascular risk.

And certainly if you look at long-lived populations around the world, this is really consistent with that. So whether it's the California centenarians, the Okinawans, the southern Italians—the common denominator seems to be a low-protein, high-plant-food-based diet.

Every experimental result points to the next experiment. What's the next step here?

We're doing a clinical trial that we started a year ago, and in that clinical trial we're basically saying to people, "Don't change what you do in terms of diet." But we do ask them to switch once a month for five days to a diet that mimics fasting. We want to see if this periodic exposure to these more extreme diets can actually reprogram the system so the IGF-1 pathway is switched to a more beneficial mode, similar to what you would see in somebody having the perfect diet.

Mark McManus's 10 Reasons We Should Eat More Broccoli

Mark McManus (of MuscleHack) gives 10 excellent reasons to make broccoli a more consistent part of out diets. Because I am dedicated to your health, especially the male readers, I am going to give you 2 additional reasons to eat more broccoli.

11. Cruciferous vegetables, including cabbage, broccoli, Brussels sprouts, and cauliflower all contain diindolylmethane (or DIM), a plant indole that helps the body metabolize estrogens (eliminate them, especially estrodial and 16-hydroxy estrogens) more efficiently. Consumption of cruciferous vegetables has been associated with risk reduction for several estrogen-related cancers, including prostate cancer.

12. Broccoli contains other chemicals, glucosinolates, including glucoraphanin, that are known anti-cancer nutrients. Researchers have also found that those who consumed glucoraphanin-rich vegetable showed signs of an improved metabolism

And now on to the article.

10 Top Reasons You Need Broccoli In Your Diet

by Mark McManus on September 18, 2013 updated September 18, 2013

Want to get healthy or even lose weight? Broccoli needs to be included in your diet.

Here’s 10 reasons why broccoli is good for you!

(1) Broccoli is the king of low carb vegetables – 1.1 grams of net carbohydrate per 100g! (after fiber subtracted) Sometimes I fill my plate up with broccoli and drench it in melted butter or cheese.

(2) A chemical in vegetables such as broccoli, cauliflower and cabbage can boost DNA repair in cells and may stop them becoming cancerous

(3) Eating steamed broccoli reduces the risk of a heart attack by boosting the body’s ability to fight off cell damage, researchers have found.

(4) Did you know broccoli contains more vitamin C than an orange? (ounce for ounce) Vitamin C is great for your hair, skin, teeth, fighting infections and keeping red blood cells healthy.

(5) Did you know broccoli contains as much calcium as a glass of milk? (ounce for ounce) Calcium helps to keep you heart beating regularly and promotes sleep.

(6) Broccoli is also a good source of folate. Folate is necessary for the production and maintenance of new cells.

(7) Broccoli is also a good source of iron. Iron is an essential component of haemoglobin and, therefore, iron is required for normal blood formation and oxygen transport around the body.

(8) Broccoli is also a great source of fiber.

(9) Broccoli is also a good source of potassium. Potassium plays an important role in the physical fluid system of humans and it assists nerve functions.

(10) Broccoli is also a good source of vitamin K. Vitamin K is known to be needed to coagulate blood and to maintain proper bone density. It also plays a key role in proper development of the fetus.

If you’re gonna eat low-carb, broccoli should be a regular feature in your diet. Whether you’re focused on gaining muscle or losing fat, broccoli will greatly assist you in your goal.

Michael Douglas: Oral Sex Caused My Throat Cancer

I've seen this more and more in recent years - as human papillomavirus (HPV) becomes more and more prevalent, more and more men who enjoy giving their women oral sex are getting mouth and throat cancers. This is definitely a cautionary tale for men (and lesbian women) - giving cunnilingus can kill us, or at the very least make our lives very uncomfortable.

Michael Douglas: oral sex caused my cancer

Actor reveals to the Guardian that HPV, transmitted through oral sex, was responsible for his throat cancer

Catherine Shoard
The Guardian, Sunday 2 June 2013

Michael Douglas: 'There was a walnut-size tumour at the base of my tongue that no other doctor had seen.' Photograph: APImages/ALIVEpress/Corbis

Michael Douglas – the star of Basic Instinct and Fatal Attraction – has revealed that his throat cancer was apparently caused by performing oral sex.

In a surprisingly frank interview with the Guardian, the actor, now winning plaudits in the Liberace biopic Behind the Candelabra, explained the background to a condition that was thought to be nearly fatal when diagnosed three years ago. Asked whether he now regretted his years of smoking and drinking, usually thought to be the cause of the disease, Douglas replied: "No. Because without wanting to get too specific, this particular cancer is caused by HPV [human papillomavirus], which actually comes about from cunnilingus."

Douglas, the husband of Catherine Zeta Jones, continued: "I did worry if the stress caused by my son's incarceration didn't help trigger it. But yeah, it's a sexually transmitted disease that causes cancer. And if you have it, cunnilingus is also the best cure for it."

The actor, now 68, was diagnosed with cancer in August 2010, following many months of oral discomfort. But a series of specialists missed the tumour and instead prescribed antibiotics. Douglas then went to see a friend's doctor in Montreal who looked inside his mouth using a tongue depressor.

"I will always remember the look on his face," Douglas has previously said. "He said: 'We need a biopsy.' There was a walnut-size tumour at the base of my tongue that no other doctor had seen."

Shortly afterwards he was diagnosed with stage four cancer, which is often terminal, and embarked on an intensive eight-week course of chemotherapy and radiation. He refused to use a feeding tube, despite his palate being burnt on account of the treatment, and so lost 20kg (45lb) on a liquids-only diet. "That's a rough ride. That can really take it out of you," he told the Guardian. "Plus the amount of chemo I was getting, it zaps all the good stuff too. It made me very weak."

The treatment worked and Douglas is now more than two years clear of cancer. He has check-ups every six months, he said, "and with this kind of cancer, 95% of the time it doesn't come back".

The cause of Douglas's cancer had long been assumed to be related to his tobacco habit, coupled with enthusiastic boozing. In 1992, he was hospitalised for an addiction which some at the time claimed to be sex. Douglas himself denied this and said he was in rehab for alcohol abuse. He has also spoken of recreational drug use.

HPV, the sexually transmitted virus best known as a cause of cervical and anal cancer and genital warts, is thought to be responsible for an increasing proportion of oral cancers.

Some suggest that changes in sexual behaviour – a rise in oral sex in particular – are responsible. Such changes might be cultural, but could also be linked to fears about the safety of penetrative sex in the wake of the Aids epidemic.

Mahesh Kumar, a consultant head and neck surgeon in London, confirmed that the last decade has seen a dramatic rise in this form of cancer, particularly among younger sufferers. Recent studies of 1,316 patients with oral cancer found that 57% of them were HPV-16 positive.

"It has been established beyond reasonable doubt that the HPV type 16 is the causative agent in oropharyngeal cancer," said Kumar, who also testified to increased recovery rates among this kind of cancer sufferer. This would help explain why Douglas was given an 80% chance of survival, despite the advanced stage of his illness.

But Kumar expressed scepticism that Douglas's cancer was caused solely by HPV, and surprise at Douglas's assertion that cunnilingus could also help cure the condition. "Maybe he thinks that more exposure to the virus will boost his immune system. But medically, that just doesn't make sense."

Ann Robinson, a GP, expressed interest in how confirmation of this association would affect the rollout of the HPV vaccine, which is currently restricted in the UK. "My main priority with diagnosing a patient with oral cancer is to get them referred, as early intervention can be so crucial. Asking for a detailed sexual history would be inappropriate at that stage."

Douglas has two children, aged 10 and 12, with his second wife, Zeta Jones, as well as an older son, Cameron, from a previous marriage. In 2010, Cameron was sentenced to five years in prison for drugs possession and dealing, and a year later had his sentence extended until 2018 after he pleaded guilty to possessing drugs in prison.

HPV: the facts

• There are more than 100 variants of HPV (human papillomavirus). They appear in different parts of the body and manifest themselves in different ways – some cause warts, but most are symptomless.
• Some are spread by skin-to-skin contact, while others are typically spread during sex. When HPV is found in the mouth, it probably got there as a result of oral sex.
• HPV is common – if you're a sexually active adult, you've probably had it. By the age of 25, 90% of sexually active people will have been exposed to some form of genital HPV.
• Around 15 types of HPV are linked to increased cancer risk, but it can't be explicitly said to cause any particular cancers. It's a long-term risk factor: over years and decades the risk is increased, rather than overnight.
• It is calculated that between 25% and 35% of oral cancers are HPV-related – meaning that it seems to be involved in 1,500-2,000 diagnoses a year.
• Overall, HPV-related oral cancers are most common in heterosexual men in their 40s and 50s.
• Teenage girls in the UK and elsewhere are now vaccinated against HPV, which should in time both protect them from cervical cancers and – it's believed – future partners from HPV-related oral cancers.

Read Xan Brooks' full interview with Michael Douglas

Here is some more information:

Michael Douglas says cunnilingus gives you cancer – but is he right?

Michael Douglas, who was diagnosed with throat cancer in 2010, says oral sex was the cause. But what's the risk?

James Ball
guardian.co.uk, Sunday 2 June 2013

Michael Douglas Photograph: AAPimages/ALIVEpress/ AAPimages/ALIVEpress/dpa/Corbi

Actors are often accused of being irritatingly reticent about their private lives – unwilling to satisfy fans' and journalists' curiosity about aspects of their life off the film sets.

But that's not something that can be said of Michael Douglas' latest interview, with Xan Brooks, for the Guardian. Asked whether he ascribed his 2010 throat cancer diagnosis to a lifetime of drinking and smoking, he replied particularly frankly:

"No. Because without wanting to get too specific, this particular cancer is caused by HPV [human papillomavirus], which actually comes about from cunnilingus."

"I did worry if the stress caused by my son's incarceration didn't help trigger it. But yeah, it's a sexually transmitted disease that causes cancer. And if you have it, cunnilingus is also the best cure for it."

So, now that's out there, how much of it is true? Is oral sex linked to mouth and throat cancers? Is there a difference between the genders? And what can be done? We've dug into the stats – especially this NHS guide – to dig out a few answers.

HPV and you

There are more than 100 variants of HPV, otherwise known as the human papilloma virus, and they appear in different parts of the body and manifest in different ways – some, for example, can cause warts (including genital warts), while in most cases most appear symptomless.

Some are spread simply by skin-to-skin contact, while others are typically spread during sex. It's these latter types that are typically found in the mouth, suggesting that when HPV is found in the mouth, it's probably got there as a result of oral sex. HPV can also be spread to the relevant areas through vaginal and anal sex.

HPV is really, really common – to the point that if you're a sexually active adult, you've probably had it. By the age of 25, 90% of sexually active people will have been exposed to some form of genital HPV (whether high or low risk), almost none of whom will ever have had any visible warts or other symptoms.

HPV and cancer

Around 15 types of HPV are linked to increased cancer risk, and it's been associated with oral cancers, cervical and vaginal cancers, as well as anal and penile cancers.

HPV increases cancer risk, but can't be explictly said to have caused any particular cancers (though some variants are HPV-related and others not): just because someone with cancer also has HPV doesn't necessarily mean they wouldn't have got it anyway.

It's also a long-term risk factor: over years and decades the risk is increased, rather than overnight.

When it comes to oral cancers, here's a rough guide to the statistics. In 2010, around 6,000 people were diagnosed. For comparison, in 2010 there were also 2,850 diagnoses of cervical cancer and 49,900 diagnoses of breast cancer.

Noting the above caveats, it's calculated that between 25% and 35% of oral cancers are HPV-related – meaning it seems to be involved in somewhere between 1,500 to 2,000 diagnoses a year.

Around 15 types of HPV are linked to increased cancer risk, and it's been associated with oral cancers, cervical and vaginal cancers, as well as anal and penile cancers.

HPV increases cancer risk, but can't be explictly said to have caused any particular cancers (though some variants are HPV-related and others not): just because someone with cancer also has HPV doesn't necessarily mean they wouldn't have got it anyway.

It's also a long-term risk factor: over years and decades the risk is increased, rather than overnight.

When it comes to oral cancers, here's a rough guide to the statistics. In 2010, around 6,000 people were diagnosed. For comparison, in 2010 there were also 2,850 diagnoses of cervical cancer and 49,900 diagnoses of breast cancer.

Noting the above caveats, it's calculated that between 25% and 35% of oral cancers are HPV-related – meaning it seems to be involved in somewhere between 1,500 to 2,000 diagnoses a year.

Men vs women

So – is cunnilingus inherently riskier than fellatio? While studies on sex differences aren't entirely clear, a US study found the prevalence of HPV in the mouths of men was 10%, versus 3.6% for women. Overall, HPV-related oral cancers are most common in heterosexual men in their 40s and 50s, leading the NHS guide to conclude that:

This indicates that performing cunnilingus (oral sex on a woman) is more risky that performing fellatio (oral sex on a man). This seems counterintuitive, but the concentration of HPV in the thinner moist skin of the vulva is mugh higher than the amounts of virus shed from the thicker dry skin of the penis, and this affects how easy it is to pass the virus on.

 

The HPV vaccine

Teenage girls in the UK and elsewhere are now vaccinated against HPV, which should in time both protect themselves from cervical cancers and – it's believed but not yet been demonstrated – future partners from HPV-related oral cancers.

Evidence from Australia suggests things are working, with genital warts (a good short-term proxy) falling markedly in women and heterosexual men in the years after the introduction of a vaccine.

The one group the current vaccination programme does nothing to protect, of course, is men who have sex with men – who are at increased risk of several cancers due to HPV.

So ... smoking's exonerated? 

Douglas used HPV to exonerate smoking for his particular cancer. Unfortunately, the evidence suggests he wasn't quite right to do so. Most people rid themselves of HPV within a few years of catching it – but smoking disrupts this process, meaning the virus remains for far longer in smokers than non-smokers, increasing their risk of HPV-related cancers of all varieties.

Smoking is also, of course, a substantial risk factor for non HPV-related oral cancers, as well as lung cancer.

Staying safe

Unfortunately, there doesn't seem to be much research evidence to back up Douglas' claim that the cure for throat cancer is still more cunnilingus.

One thing that can help, though, is using a condom or a dam during oral sex, the NHS says. It also helps protect against other orally-transmitted STDs too, such as chlamydia and gonorrhoea.

Any other studies or evidence we should've looked at? Anyone got some other good stats on the topic? Let us know below...

Positive Journal Writing about Their Experience Benefits Men With Testicular Cancer

I like this study - it sought to find out if mental/emotional therapy would be beneficial for men dealing with testicular cancer rather than the usual approach of simple physiological therapies. Turns out that writing positively helps their mental health.

The same is likely true for any physical or life challenge - this research should be replicated for other issues to verify that journal writing can be a positive way to heal the psyche as well as the body.

Reference:
Baylor University (2011, September 16). Writing Positively About Their Experience Benefits Men With Testicular Cancer. Medical News Today. Retrieved September 17, 2011 from http://www.medicalnewstoday.com/releases/234492.php

Writing Positively About Their Experience Benefits Men With Testicular Cancer


Men who channeled positive thoughts into a five-week writing assignment about their testicular cancer showed signs of improvedmental health afterward, in contrast to men who wrote negatively or neutrally about their condition, according to results of a Baylor University pilot study. 

The findings are encouraging for those with testicular cancer who are seeking mental and emotional therapy as well as physical treatment, said researcher Dr. Mark T. Morman, professor of communication studies and graduate program director at Baylor University. 

Morman's study was cited in an article titled "Journaling for Health and Peace of Mind," that appears in the current issue ofHealthymagination. The article discusses the benefits of daily journal writing for those suffering the effects of psychological trauma and depression. 

"There's a lot of research that takes this writing-based approach and in a number of varied contexts, but we applied this line of research to the testicular cancer context for the first time that we are aware of," Morman said. "We think writing about the experience could add to the therapy and can help with recovery and quality-of life issues after treatment, as the men try to get on with their lives." 

In the study, 48 men were randomly divided into three groups, with one group assigned to write positively about their cancer experience; one group to write negatively; and one to write about innocuous, unrelated topics. The affect of the writing was measured at the beginning and end of the study, with men responding to 68 questions in which they assessed their mental health, general feeling of well-being, sexual health, and performance and traits of assertiveness and responsiveness. 

Participants in the positive expression group reported improvements in their mental health as a result of their writing; those in the negative expression and neutral groups did not. 

Testicular cancer most often strikes men ages 18 to 30 and is one of the most curable forms of cancer if detected early, according to the National Cancer Institute. 

But articles in the Journal of Clinical Oncology cite findings that men with testicular cancer are more likely to be depressed or anxious. Side effects of chemotherapy or radiation treatment can interfere with sexual performance and fertility, although those conditions are usually temporary. 

Nevertheless, "there are issues of masculinity, sexuality, relationships and self-image that often have significant effects on a survivor's ability to cope and move forward," said Morman, a former communication consultant for the Lance Armstrong Foundation. 

Early detection is important, but men generally are more likely to delay visits to the doctor, Morman said. He noted that seven-time Tour de France winner Lance Armstrong was given a 50-50 chance of survival after he was diagnosed with testicular cancer in 1996. Armstrong waited several months to go to the doctor after finding a testicular lump. By then, the cancer had spread to other parts of his body. 

Men also are less likely than women to join support groups or seek online support, Morman said. 

"With our approach, we move from simply thinking to performing," Morman said. "We asked our participants not to just imagine or contemplate, but rather we asked them to engage their thoughts by processing them and then putting them down in print. 

Morman said that while the "Well Woman" effort promotes yearly health examinations, mammograms and Pap smears for women, "there's no level of promotion or encouragement for men to do so that's equal to or comparable with the messages directed at women to go to the doctor." 

"We want to get the message to doctors and therapists that our preliminary data indicates this worked and can help alleviate a lot of concerns about embarrassment, body image and masculinity." 

To encourage candor, "the writing was done on-line in a secure, private website and in a totally confidential manner; we had no way to connect a person's name with what he wrote," Morman said. 

WebMD - 15 Cancer Symptoms Men Ignore

Men tend to ignore health problems until they reach the crisis stage - I know because I do it, too - and I see it in my male training clients all the time. But there are some things we should never ignore, and this article offers 15 symptoms related to cancer that need our prompt attention.

15 Cancer Symptoms Men Ignore

Men, heed these possible clues and find cancer early, when it's more treatable.

By Kathleen Doheny

Reviewed by Arnold Wax, MD

WebMD Feature

Experts say that men could benefit greatly by being alert to certain cancer symptoms that require a trip to the doctor’s office sooner rather than later. But when it comes to scheduling doctor visits, men are notorious foot-draggers. In fact, some men, would never go to the doctor if it weren't for the women in their life.

Leonard Lichtenfeld, MD, is deputy chief medical officer for the national office of the American Cancer Society. According to Lichtenfeld, men often need to be pushed by women to get screened for cancer. That’s unfortunate. Routine preventive care can find cancer and other diseases in their early stages. When cancer is found early, there are more options for treatment. That means there are also better chances for a cure.

Some cancer symptoms in men are specific. They involve certain body parts and may point directly to the possibility of cancer. Other symptoms, though, are vague. For instance, pain that affects many body parts could have many explanations. It may or may not be a sign of cancer. But you can't rule cancer out without seeing a doctor.

Cancer Symptom in Men No. 1: Breast Mass

If you’re like most men, you’ve probably never considered the possibility of having breast cancer. Although it’s not common, it is possible. "Any new mass in the breast area of a man needs to be checked out by a physician," Lichtenfeld says.

In addition, the American Cancer Society identifies several other worrisome signs involving the breast that men as well as women should take note of. They include:

• Skin dimpling or puckering
• Nipple retraction
• Redness or scaling of the nipple or breast skin
• Nipple discharge

When you consult your physician about any of these signs, expect him to take a careful history and do a physical exam. Then, depending on the findings, the doctor may order a mammogram, a biopsy, or other tests.

Cancer Symptom in Men No. 2: Pain

As they age, people often complain of increasing aches and pains. But pain, as vague as it may be, can be an early symptom of some cancers. Most pain complaints, though, are not from cancer.

Any pain that persists, according to the American Cancer Society, should be checked out by your physician. The doctor should take a careful history, get more details, and then decide whether further testing is necessary. If it's not cancer, you will still benefit from the visit to the office. That’s because the doctor can work with you to find out what's causing the pain and determine the proper treatment.

Cancer Symptom in Men No. 3: Changes in the Testicles

Testicular cancer occurs most often in men aged 20 to 39. The American Cancer Society recommends that men get a testicular exam by a doctor as part of a routine cancer-related checkup. Some doctors also suggest a monthly self-exam.

Cancer Symptom in Men No. 3: Changes in the Testicles continued...

Evan Y. Yu , MD, is assistant professor of medicine at the University of Washington and assistant member of the Fred Hutchinson Cancer Research Center in Seattle. Yu tells WebMD that being aware of troublesome testicular symptoms between examinations is wise. "Any change in the size of the testicles, such as growth or shrinkage," Yu says, “should be a concern.”

In addition, any swelling, lump, or feeling of heaviness in the scrotum should not be ignored. Some testicular cancers occur very quickly. So early detection is especially crucial.  "If you feel a hard lump of coal [in your testicle], get it checked right away," Yu says. 

Your doctor should do a testicular exam and an overall assessment of your health. If cancer is suspected, blood tests may be ordered. You may also undergo an ultrasound examination of your scrotum, and your doctor may decide to do a biopsy. A biopsy requires the removal of the entire testicle.

Cancer Symptom in Men No. 4: Changes in the Lymph Nodes

If you notice a lump or swelling in the lymph nodes under your armpit or in your neck -- or anywhere else -- it could be a reason for concern, says Hannah Linden, MD. Linden is a medical oncologist and an associate professor of medicine at the University of Washington School of Medicine. She is also a joint associate member of the Fred Hutchinson Cancer Research Center in Seattle. "If you have a lymph node that gets progressively larger, and it's been longer than a month, see a doctor," she says.

Your doctor should examine you and determine any associated issues that could explain the lymph node enlargement, such as infection. If there is no infection, a doctor will typically order a biopsy.

Cancer Symptom in Men No. 5: Fever

If you've got an unexplained fever, it may indicate cancer. Fever, though, might also be a sign of pneumonia or some other illness or infection that needs treatment.

Most cancers will cause fever at some point. Often, fever occurs after the cancer has spread from its original site and invaded another part of the body. Fever can also be caused by blood cancers such as lymphoma or leukemia, according to the American Cancer Society. 

It’s best not to ignore a fever that can’t be explained. Check with your doctor to find out what might be causing the fever and to determine its proper treatment.

Cancer Symptom in Men No. 6: Weight Loss Without Trying

Unexpected weight loss is a concern, Lichtenfeld says. "Most of us don't lose weight easily." He's talking about more than simply a few pounds from a stepped up exercise program or to eating less because of a busy schedule. If a man loses more than 10% of his body weight in a time period of 3 to 6 months, it’s time to see the doctor, he says.

Your doctor should do a general physical exam, ask you questions about your diet and exercise, and ask about other symptoms. Based on that information, the doctor will decide what other tests are needed.

Cancer Symptom in Men No. 7: Gnawing Abdominal Pain and Depression

“Any man (or woman) who's got a pain in the abdomen and is feeling depressed needs a checkup,” says Lichtenfeld. Experts have found a link between depression and pancreatic cancer. Other symptoms of pancreas cancer may include jaundice, a change in stool color -- often gray -- a darkening of the urine. Itching over the whole body may also occur.

Expect your doctor to do a careful physical exam and take a history. The doctor should order tests such as an ultrasound, a CT scan or both, as well as other laboratory tests.

Cancer Symptom in Men No. 8: Fatigue

Fatigue is another vague symptom that could point to cancer in men. But many other problems could cause fatigue as well. Like fever, fatigue can set in after the cancer has grown. But according to the American Cancer Society, it may also happen early in cancers such as leukemia, colon cancer, or stomach cancer.

If you often feel extremely tired and you don’t get better with rest, check with your doctor. The doctor should evaluate the fatigue along with any other symptoms in order to determine its cause and the proper treatment.

Cancer Symptom in Men No. 9: Persistent Cough

Coughs are expected, of course, with colds, the flu, and allergies. They are also sometimes a side effect of a medication. But a very prolonged cough -- defined as lasting more than three or four weeks -- or a change in a cough should not be ignored, says Ranit Mishori, MD, assistant professor and director of the family medicine clerkship at Georgetown University School of Medicine in Washington, D.C. Those cough patterns warrant a visit to the doctor. They could be a symptom of cancer, or they could indicate some other problem such as chronic bronchitis or acid reflux.

Your doctor should take a careful history, examine your throat, listen to your lungs, determine their function with a spirometry test, and, if you are a smoker, order X-rays. Once the reason for the coughing is identified, the doctor will work with you to determine a treatment plan.

Cancer Symptom in Men No. 10: Difficulty Swallowing

Some men may report trouble swallowing but then ignore it, Lichtenfeld says. "Over time, they change their diet to a more liquid diet. They start to drink more soup." But swallowing difficulties, he says, may be a sign of a GI cancer, such as cancer of the esophagus.

Let your doctor know if you are having trouble swallowing. Your doctor should take a careful history and possibly order a chest X-ray and a barium swallow. The doctor may also send you to a specialist for an upper GI endoscopy to examine your esophagus and upper GI tract.

Cancer Symptom in Men No. 11: Changes in the Skin

You should be alert to not only changes in moles -- a well-known sign of potential skin cancer -- but also changes in skin pigmentation, says Mary Daly, MD. Daly is an oncologist and head of the department of clinical genetics at the Fox Chase Cancer Center in Philadelphia.

Daly also says that suddenly developing bleeding on your skin or excessive scaling are reasons to check with your doctor. It's difficult to say how long is too long to observe skin changes, but most experts say not to wait longer than several weeks.

To find out what’s causing the skin changes, your doctor should take a careful history and perform a careful physical exam. The doctor may also order a biopsy to rule out cancer.

Cancer Symptom in Men No. 12: Blood Where It Shouldn't Be

“Anytime you see blood coming from a body part where you've never seen it before, see a doctor,” Lichtenfeld says. "If you start coughing up blood, spitting up blood, have blood in the bowel or in the urine, it’s time for a doctor visit.”

Mishori says it’s a mistake to assume blood in the stool is simply from a hemorrhoid. "It could be colon cancer," he says.

Your doctor should ask you questions about your symptoms. The doctor may also order tests such as a colonoscopy. This is an examination of the colon using a long flexible tube with a camera on one end. The purpose of a colonoscopy is to identify any signs of cancer or precancer or identify any other causes of the bleeding.

Cancer Symptom in Men No. 13: Mouth Changes

If you smoke or chew tobacco, you need to be especially alert for any white patches inside your mouth or white spots on your tongue. Those changes may indicate leukoplakia, a pre-cancerous area that can occur with ongoing irritation. This condition can progress to oral cancer.

You should report the changes to your doctor or dentist. The dentist or doctor should take a careful history, examine the changes, and then decide what other tests might be needed.

Cancer Symptom in Men No. 14: Urinary Problems

As men age, urinary problems become more frequent, says Yu. Those problems include the following:

• The urge to urinate more often,especially at night
• A sense of urgency
• A feeling of not completely emptying the bladder
• An inability to start the urine stream
• Urine leaking when laughing or coughing
• A weakening of the urine stream

"Every man will develop these problems as he gets older," Yu says. "But once you notice these symptoms, you should seek medical attention." That's especially true if the symptoms get worse.

Your doctor should do a digital rectal exam, which will tell him whether the prostate gland is enlarged or has nodules on it. The prostate gland enlarges as a man ages. It’s most often caused by a noncancerous condition called benign prostatic hyperplasia or BPH. 

Your doctor should also order a blood test to check the level of prostate-specific antigen or PSA. PSA is a protein produced by the prostate gland, and the test is used to help determine the possibility of prostate cancer. 

If the doctor notices abnormalities in the prostate or if the PSA is higher than it should be, your doctor may refer you to a urologist and perhaps order a biopsy. Prostate cancer may be present even with a normal PSA level.

Cancer Symptom in Men No. 15: Indigestion

Many men, especially as they get older, think "heart attack" when they get bad indigestion. But persistent indigestion may point to cancer of the esophagus, throat, or stomach. Persistent or worsening indigestion should be reported to your doctor.

Your doctor should take a careful history and ask questions about the indigestion episodes. Based on the history and your answers to the questions, the doctor will decide what tests are needed.