[Prevention and complementary medicine in aging]. / Prävention und komplementärmedizinische Massnahmen beim Altern.

The subsequent brief review is based on a systematic literature search (Medline, http://www.lef.org and books under the topic Antiaging from 2001). Among the preventive and complementary measures against aging, caloric restriction with an adequate diet is in first place. If the energy supply is reduced by 17%, cardiovascular mortality drops to 31-41%. Among the mechanisms of aging, impaired formation of reactive oxygen species (oxidative stress) plays an important role. Moreover, antioxidants (vitamins A and B as well as selenium) provide protection. If obesity is complicated by a metabolic syndrome, a formula diet should be employed under the supervision of the urologist. The hormonal changes involved in the male climacteric should be treated by hormone replacement therapy. Testosterone given as a gel, plaster, or injection compensates for the secondary hypogonadism and treats osteoporosis. The muscle function can be improved by physical activity only. Sexual dysfunction, however, is not corrected with androgen hormone replacement therapy, whereas an appropriate physical training program may even improve potency by inducing a reactive penile hyperemia. In his office the urologist may implement a program specifically for the "aging male." If he diagnoses a metabolic syndrome, effective countermeasures are required to prevent early onset of arteriosclerosis.

[Early detection and follow-up of prostatic carcinoma. Responsibilities of the general practitioner]. / Früherkennung und Nachbetreuung des Prostatakarzinoms. Aufgaben für den Hausarzt.

Apart from digital rectal examination, the determination of prostate specific antigen is essential for the early detection of cancer of the prostate. The combination of these two examinations significantly improves screening efficacy. With the aid of a well-tested algorithm, the family doctor can establish the need for a urological investigation, and thus help to ensure early, curative treatment. Preventive measures can be rendered more effective by providing individual advice on such matters as lifestyle (risk factors, diet). It now appears that dietary measures are capable of slowing the increase in PSA following definitive treatment. Schematic disease-specific aftercare is usually the domain of the urologist. The general practitioner, however, is confronted by such problems as logistical considerations, documentation, palliative management (e.g. treatment of pain) and the problems associated with concomitant symptoms, the relevance of which needs to be assessed. Overall, however, the main concern of the general practitioner is with aspects of rehabilitation.

Oral treatment of erectile dysfunction with apomorphine SL.

Apomorphine SL (Ixense, Uprima) is a new oral medication shown to be effective in the treatment of erectile dysfunction. This compound is a dopaminergic agonist with affinity for dopamine receptor sites - mostly D(2) - within the brain known to be involved in sexual function. Apomorphine induces selective activation in the nucleus paraventricularis leading to erectogenic signals. More than 5,000 men with erectile dysfunction participated in phase II/III clinical trials assessing the safety and efficacy of doses ranging from 2 to 6 mg. The most favorable risk/benefit ratio is seen with a dose-optimization regimen of 2-3 mg: the 3-mg dose provides efficacy comparable to that of 4 mg but with fewer side effects. Consequently, review of clinical studies focuses on data with the 2- to 3-mg dose, the registered dose for use in clinical practice. The primary efficacy endpoint in most clinical trials with apomorphine SL was the percentage of attempts resulting in erections firm enough for intercourse - one of the most rigorous endpoints used in ED trials to date. These data were collected from both patients and their partners by reviewing entries in patient diaries and partner BSFI questionnaires. Secondary endpoints included percentage of attempts resulting in intercourse and improvement in ED severity based on the International Index of Erectile Function (IIEF). The proportion of attempts resulting in erections firm enough for intercourse was 49.4% with 3 mg compared with the baseline value of 24.3%. Partner evaluations corresponded with those of the patients. Erections occurred between 18 and 19 min after taking apomorphine SL 2 or 3 mg. The most common side effect was nausea which declined with continued use. Vasovagal syncope was reported in <0.2% of men, and was preceded by clear prodromal symptoms. Thus, apomorphine SL is an effective, well-tolerated drug for erectile dysfunction.

[Prognostic parameters of locally confined prostate carcinoma]. / Prognostische Parameter bei lokal begrenztem Prostatakarzinom.

Current methods for patient selection lack the necessary sensitivity and specificity for selecting those for whom cure is required and possible. Prognostic factors must be understood in the light of the nature of prostatic carcinoma and the actual direct benefit of the information to the patient. The absolute impact of prostate cancer at different ages and in all grades varies substantially as indicated by loss of life expectancy. Diagnostic tests are able to distinguish clinically unimportant cancers. Quantitative analysis of systematic biopsy specimens combined with PSA density provides valuable staging information and helps to identify cancers of low biological potential i.e. small (0.5 cm3 or less), well or moderately differentiated and confined to the prostate. The majority of the patients with a maximum cancer length of 2 mm or less and a PSA density of less than 0.1, do not need curative treatment. Multivariate analysis studies identified pathological grade and preoperative serum PSA concentration as independent predictors of clinical progression in up to 1/4 of patients with pathologically organ-confined prostate cancer after radical prostatectomy. Prognostic scoring systems are reported using the regression coefficients from the Cox multivariate model to classify patients further according to risk of progression.

[Benign prostatic hyperplasia: diagnosis in general practice]. / Benigne Prostatahyperplasie: Diagnostik in der Hausarztpraxis.

Despite the availability of modern urological methods, the diagnosis and therapy of benign prostatic hypertrophy (BPH) continues to present problems that are due in part to the discrepancy between the patient's subjective symptoms and the objective findings. With the aim of achieving a "clear" picture of the actual indication or treatment, a differentiated approach involving a careful waighing up of the patient's history, symptoms, basic laboratory investigations and the use of conventional sonography would be desirable in the doctor's office. The present paper describes a rational concept for the "interface" between the general practitioner's office and that of the specialist.