The Prostate
The prostate is a gland about the size of a ping-pong ball, located deep inside the groin, between the base of the penis and the rectum. A capsule of connective tissue that contains muscle fibers surrounds the prostate, making the prostate feel elastic to the touch. It is important for reproduction, because it supplies part of the seminal fluid (semen), which mixes with sperm from the testes. The urethra, a narrow tube that connects to the bladder, runs through the middle of the prostate and along the length of the penis, carrying both urine and semen out of the body. A normal functioning prostate is not critical for a person to continue living, but it is essential for reproduction.
The following layers make up the prostate, beginning with the outer capsule and ending inside the prostate:

  • Anterior zone: Made of muscle and fibrous tissues, medical professionals call this zone the anterior fibromuscular zone.
  • Peripheral zone: Mostly situated toward the back of the gland, this is where most of the glandular tissue sits.
  • Central zone: This surrounds the ejaculatory ducts and makes up around 25% of the prostate’s total mass.
  • Transition zone: This is the part of the prostate that surrounds the urethra. It is the only portion of the prostate that continues to grow throughout life.

By the time you reach age 40, your prostate might have gone from the size of a walnut to the size of an apricot. By the time you reach 60, it might be the size of a lemon. Because it surrounds part of the urethra, the enlarged prostate can squeeze that tube. This causes problems when you try to pee. Typically, you won’t see these problems until you’re 50 or older, but they can start earlier.

         1. Prostatitis: 

  • An infection or inflammation of the prostate;
  • Acute Prostatitis – caused by an infection (considered a subtype of a UTI), usually by bacteria and results in the sudden onset of painful urination, a small stream and often fever and chills. Most patients can be managed with outpatient antibiotics for 10 to 14 days
  • Chronic Prostatitis – persistent or recurrent pelvic discomfort, pain or burning with urination, an increased urge to urinate, difficulty emptying your bladder and/or painful ejaculation. The underlying cause can be a chronic inflammation with or without an infection and often the exact reason for symptoms can’t be found.
  • Between 9% and 16% of men develop prostatitis (inflamed prostate) at some point during their lives.
  • Acute prostatitis affects younger and older men equally.
  • Prostatitis is not contagious

    2. Prostate Cancer:

  • Prostate cancer is the abnormal growth of cells
  • Prostate cancer can be localized (limited to the prostate itself), regionally advanced (spread to surrounding tissue) or metastatic (spread to more distant sites).
  • Men whose fathers or brothers had prostate cancer are two to three times likelier to get it themselves.
  • Rates among African Americans are 60% higher than in white men.
  • A diet high in red meat and saturated fats has been associated with increased risk
  • Gaining a significant amount of weight is one of the leading factors in whether a man develops prostate cancer in his life.
  • Recent years have seen great advancements in prostate-cancer screening, testing and treatment.

           3. Benign Prostatic Hyperplasia (BPH):

  1. Commonly called an “enlarged prostate” refers to the excessive growth of the gland that usually occurs after age 50
  2. The prostate can double or triple in weight during the latter decades of life.
  3. BPH can be considered an expected part of the aging process for most men.
  4. About half of cases are asymptomatic, but some men experience problems
  5. As the prostate expands in size, it effectively pinches off the urethra (the tube carrying urine from the bladder to the penis), making the muscular walls of the bladder have to work harder and causing problems with urination.
  6. Researchers have found correlations between BPH and a diet high in sugar, red meat and refined grains.

The hallmark of BPH (benign prostatic hyperplasia, or enlarged prostate) is a cluster of symptoms known by the acronym LUTS (Lower Urinary Tract Symptoms). They include a weak, interrupted urine stream, more frequent urination (especially during the night), frequent urge to urinate, leaking or dribbling, and the feeling that you can’t quite empty the bladder. Over time, those symptoms may escalate to the point that the bladder can no longer push urine past the obstructing prostate causing what’s known as acute urinary retention. An inability to urinate at all is not just painful but a true medical emergency because it can damage the kidneys. BPH also can raise PSA levels above the normal range.The PSA test is a blood test used primarily to screen for prostate cancer. PSA, or prostate-specific antigen, is a protein produced by the prostate with very small amounts released into the bloodstream. When there’s a problem with the prostate—such as the development and growth of prostate cancer—more PSA is released. The test measures the amount of prostate-specific antigen (PSA) in your blood. PSA is a protein produced by both cancerous and noncancerous tissue in the prostate. Many conditions besides cancer might cause an elevated PSA score.

Recently, doctors have realized the importance of food nutrition and diet to maintain a healthy prostate life.

  • Maximize the amount of vegetables and fruits in your diet.
  • Red and leafy vegetables like broccoli, cabbage and spinach are linked to prostate cancer resistance (cruciferous vegetables).
  • Buy whole foods. Whole foods have very low food processing and preservatives which gives you the closest thing to fresh vegetables. Often, the food in the grocery store is too processed and filled with preservatives to give your body the nutrition it needs.
  • Drink teas, liquids and broths. Teas are healthy for the body because they are easy to digest and remove toxins built up in the prostate gland – they also contain nutrients not found in water. You can find teas specific for prostate health or drink regular black or green tea.
  • That’s right, beans—an excellent source of protein and fiber, which is essential for proper prostate function. The protein found in beans should be maximized while limiting the protein found in red meats. It is also found that a diet high in red meat may be a risk factor for heart disease, colon cancer and prostate cancer.

Identification of a prostate issue is usually made by a screening test. Screening tests are essential in early detection of BPH and prostate cancer.

  1. The U.S. Preventive Services Task Force does not currently recommend a digital rectal exam as a screening test because of lack of evidence of the benefits.
  2. The American Cancer Society recommends that men who choose to have a PSA blood test and who have a PSA less than 2.5 ng/mL may only need to be retested every 2 years, while men who have a PSA level greater than 2.5 ng/mL should be screened yearly.
  3. Any symptoms that a patient may have with his prostate should also be addressed

All men should be aware that their prostate needs to be checked – discuss this with your doctor if you’re not sure that’s being done. Also be aware that any changes in urine flow or burning during urination may be related to a prostate issue and not be a bladder or kidney problem.

Second Booster’s
Just because you can get an additional booster now, does that mean you should?
This week the FDA and CDC officially recommended a second mRNA vaccine booster for certain immunocompromised individuals and people over the age of 50 who received an initial booster dose at least 4 months ago. Remember, the second booster is recommended, not mandated. Here are some points to consider:

  1. Risk tracks with age, and older people have the highest risk.
  2. There have been no studies showing a second booster’s efficacy in ages 50-60yo
  3. Other countries are targeting additional boosters only for older people. Germany has authorized a fourth shot for people over 70. The U.K. is targeting people over the age of 75 and Sweden is giving fourth shots to people over 80.
  4. An unhealthy 55-year-old is probably at the same risk as a healthier 65-year-old
  5. If you had the first booster and a confirmed Omicron infection (i.e. positive antigen test or PCR test), there’s really very little need to get a fourth dose. Vaccine + infection is called “hybrid immunity” and over 20 studies have shown this works as well or even better than a second booster.
  6. Weirdly, the FDA and CDC do not recognize hybrid immunity as an option even though before Omicron, evidence found that hybrid immunity worked great for at least 1 year. 
  7. Consider mixing your fourth dose. If you got three doses of Pfizer then get Moderna for your fourth dose. Or vice versa. While Moderna and Pfizer are both mRNA vaccines, they are not identical and have subtle but meaningful differences. This was confirmed from another peer-reviewed study.
Because so many of us had side effects after these vaccines, you may want to make sure you really need to be boosted again because maybe you can avoid another shot and a possible reaction. So, I recommend to my patients who want to get a second booster that they should draw blood to get their antibody levels checked. They should also check an antibody test for the nucleocapsid of the virus to see if they had an asymptomatic infection which is like getting a fourth shot.

Currently, virus activity is very low. There’s expected to be an upswing in the fall/winter like there is for all coronaviruses. Assuming this booster lasts 6 months, you ideally want that extra protection to last through the winter. If your antibody levels are already high now, it won’t hurt you to get that second booster immediately, but in September your levels will again be dropping. If your antibody levels are solid now and you waited a few months until your levels drop, this second booster will take you through the winter.

The benefits of vaccines continue to outweigh the risks, however I would not rush out to get a second booster without checking your antibodies unless you are:

  • immunocompromised – from disease or medication
  • over 50 yo and in poor health
  • over 65 years old – independent of your overall health.
There is a new government website called COVID.gov. that went live on March 30th. It’s one-stop shop for everything—current transmission levels (according to new CDC guidelines), vaccine and test & treat locations, ordering free antigen tests, etc. Definitely click on this and check it out.
COVID UPDATES

  • Philadelphia Statistics:
  1. 76.7 % of Philadelphia adults are fully vaccinated
  2.  94.6 % of Philadelphia adults have received at least one dose of COVID-19 vaccine.
  3. 35.3 % of 5-to-11-year-olds in Philadelphia have received at least one vaccine dose.
  4. Ages 12 and older, 75.8 percent are fully vaccinated, and 93.4 percent have received at least one dose of COVID-19 vaccine.
  5. 51 patients with COVID-19 are currently being treated in Philadelphia hospitals, with a total of four on ventilators.
  • The COVID-19 Seroprevalence Studies Hub, known as COVID-19 SeroHub, is an online dashboard intended to help researchers and policymakers to identify the proportion of people in the population who possess antibodies to SARS-CoV-2. The COVID-19 datahub from NIH shows a high rate of natural infection in children – up to 70% positivity in 0-17 yo.

 

  • The U.S. Centers for Disease Control and Prevention reported in a statement to Reuters, that it made adjustments to its COVID Data Tracker’s mortality data on March 14 because its algorithm was accidentally counting deaths that were not COVID-19-related. The reduction cut the CDC’s estimate of deaths in children by 24% to 1,341 as of March 18. Children accounted for about 19% of all COVID-19 cases, but less than 0.26% of cases resulted in death, according to the American Academy of Pediatrics, which summarizes state-based data.

 

  • The CDC estimates that the BA.2 strain now accounts for more than half — 54.9% — of coronavirus infections nationwide, according to new data. It’s even more prevalent in certain parts of the country. For example, over 70% of COVID-19 cases in the Northeast are BA.2, the CDC estimates. The BA.2 variant does not appear to make people any sicker than the original omicron strain of the coronavirus, and vaccines still offer protection against it.

 

  • Americans have been polarized over the mitigation measures the CDC recommended for schools during the pandemic from urging schools to be remote, require masks and set up social distancing measures. It now advises that for most of the country, children should be in school and can be without masks.

 

  • In the beginning of the pandemic, most were concerned about droplets of transmission, but scientists quickly learned that aerosol transmission was a main driver. But it wasn’t until April 2021 that the WHO and May 2021 that the CDC changed their guidance to recognize airborne spread as the key mode of infection.
  1. Droplets can travel up to 6 feet, but then they fall to the ground due to gravity. This is why the famous 6 foot rule was implemented. People spread droplets by coughing and sneezing.
  2. Aerosols become suspended in air and float. There are 100 times more aerosols than droplets. And you don’t need to sneeze or cough. These can be spread by just talking. Aerosols can stay in the air for up to 16 hours. So, hypothetically, a sick person doesn’t need to be in the room with you to transmit the disease. They could be in the room before you and leave particles everywhere.

 

  • According to a Centers for Disease Control and Prevention survey of blood donor samples, conducted in December and updated last month, an estimated 95% of Americans ages 16 and older have developed identifiable Covid antibodies. Those come from both vaccinations — roughly 77% of the U.S. population has received at least one Covid vaccine dose, according to the CDC — and prior Covid infections.
  1. Antibodies from vaccinated individuals tend to decline after about four to six months post-shot
  2. Unvaccinated people could have immunity against reinfection for anywhere from three to 61 months after getting Covid. ( October 2021 study by the Yale School of Public Health, published in The Lancet Microbe)

 

  • A second booster dose of Pfizer or Moderna’s COVID-19 vaccine was authorized for adults ages 50 and up at least 4 months after their first booster dose of vaccine the FDA said on Tuesday. Immunocompromised people will receive five doses of mRNA vaccine in total: a three-dose primary series and two boosters.

 

  • Airlines including Delta, American, United and Southwest, plus cargo carriers and industry group Airlines for America, are all calling for an end to both the mask mandate on public transportation and the pre-travel testing requirement for international arrivals to the United States. Dr. Leana Wen, a CNN medical analyst, says lifting both the mask mandate and pre-travel testing requirement for international arrivals makes sense — for vaccinated travelers. Right now, all travelers heading into the United States, regardless of citizenship or vaccination status, must have a negative result from a test taken within one day of departure. Lifting that requirement is the most immediate, “right step” that could be taken for fully vaccinated travelers, Wen said.

 

  • The Center for Disease Control and Prevention has lifted its risk advisory for cruise ship travel Wednesday following two years of issuing warnings to travelers about the possibility of contracting COVID-19 onboard a cruise. Officials say it’s up to the passengers to determine their own health risks before going onboard a cruise ship. The agency says it will continue to provide guidance to the cruise ship industry in order for cruise lines to operate in a way that will provide “safer and healthier” environments for crews, passengers and communities.

 

  • With all the do’s and don’ts of the COVID-19 pandemic, the U.S. Centers for Disease Control and Prevention has rolled out a new tool that will help those who have or have been exposed to the virus figure out how long to quarantine and isolate. The agency recently launched its “Quarantine and Isolation Calculator” on its website saying it’s a “tool to help determine how long you need to isolate, quarantine, or take other steps to prevent spreading COVID-19.” Click on this and try it out!

 

  • Cvs, Walgreens and grocery chain Albertsons are offering second-round boosted doses of the Pfizer and Moderna. Eligible individuals can schedule appointments online or in stores. Patients must provide their date of birth as well as indicate the make and date of their last COVID-19 shot