Archive for the ‘active surveillance’ Category

Movember-A reminder To Have a Prostate Check With Your Doctor

November 4, 2014

November is a month dedicated to men’s health and male health awareness.  Thousands of men will change their appearance this month by growing a moustache for the 30 days of Movember.

Not only are the ‘Mo bros’ bring back the moustache, they are raising funds and awareness for prostate cancer, testicular cancer and mental health.

By taking a few simple steps such as maintaining a good diet and taking action early when experiencing a health issue, every man can improve their chances of living a happy and healthy life.

If prostate cancer is spotted early, prostate cancer can be very effectively treated. And many men will be able to lead a normal life for years to come. Prostate cancer has one of the best survival rates of all cancers.

The most important thing to remember about prostate cancer is that even if the doctors confirm you have it, it doesn’t mean you will die of it,

Many of the men immediately start thinking about their own mortality and worrying about their families and loved ones after they are gone.

This is why ‘Movember’ is so important – to encourage men to be more proactive about looking after their own health.”

Prostate cancer is the most common cancer in men with 250,000 new cases each year and nearly 30,000 deaths in the U.S. It is often slow-growing, but there are more aggressive forms which need active treatment.

The prostate is a walnut-sized gland located between the bladder and the penis which secretes fluid that nourishes and protects sperm.

Conditions that can affect the prostate include infections, enlarged prostate – the gland grows in nearly all men over 50, prostate infections, and prostate cancer.

The first step is to make an appointment with your primary care physician and request a PSA test. If you have an elevated PSA level, your doctor will often refer you to a urologist.  The urologist may recommend a prostate biopsy and will treat you as an individual and work out what the best treatment is depending on your age, health and other conditions you may have.

Surgery or radiotherapy is not right for everyone and sometimes a ‘watch and wait’ or surveillance plan of action is recommended if the prostate cancer is not aggressive.

A lot of men find it embarrassing to turn to a doctor about men’s issues about urinary symptoms as they fear they have prostate cancer.

A much more common condition is the enlarged prostate gland.  This is a benign condition that impacts nearly all men over the age of 60 and causes difficulty with urination such as a decrease in the force and caliber of the urinary stream, urinary frequency, urgency of urination, and getting up at night to urinate.

The condition makes life uncomfortable as it can place pressure on the bladder and urethra, the tube through which urine passes, and can make it difficult to urinate or cause a frequent need to.

Most men can be helped with oral medication such as alpha blockers and medications to actually reduce the size of the prostate gland such as Proscar or Avodart.  If medications are in effective, there are minimally invasive procedures such as microwaves, lasers and now the new Urolift procedure.  This procedure has FDA approval and consists of using an implant that pulls the prostate gland open the us making urination much easier and more comfortable.

Prostate cancer – what you need to know if you are a man:

  • Ask your primary care Dr. for a special test (called PSA) – spotting prostate cancer early is really important , this is especially important if you are in your 50s or have any risk factors
  • Many diagnoses of prostate cancer will not cause problems and can be effectively treated and cured
  • There are no symptoms of prostate cancer unless it is very advanced
  • Contrary to popular belief difficulty in passing water is not a necessarily a sign of prostate cancer
  • You are three or four times more likely to develop the disease if your brother, father or close male relative has been diagnosed with it
  • If you are African American, then there is an increased risk you will develop prostate cancer.
  • It is a known fact that all men will develop prostate cancer if they live long enough.

Prostate and prostate cancer facts:

  • The prostate is a walnut-sized gland located between the bladder and the penis. It secretes fluid that nourishes and protects sperm
  • Conditions that can affect the prostate include infections, enlarged prostate (the gland grows in nearly all men over 50) and prostate cancer.
  • Prostate cancer is the most common cancer in men with 250,000 new cases each year and 30,000 deaths in the U.S.
  • Prostate cancer is often slow-growing, but there are more aggressive forms need active treatment
  • Most men who are diagnosed with prostate cancer survive 10 years or more
  • Familial inheritance represents 1-5% of all prostate cancers diagnosed
  • It is predicted that there will be 60% more diagnoses over the next 20 years
  • The number of advanced cancers is falling as awareness spreads

Prostate cancer – what happens:

The doctor will take some blood and test it to measure the amount of protein called prostate specific antigen – PSA.

It is normal to have a small amount of PSA in your blood. An elevated PSA level may be a sign of prostate cancer but equally the elevated PSA could be something like a urine\prostate infection or an enlarged prostate which is a benign condition.

An elevated PSA level may require an ultrasound prostate biopsy, which is where a small part of the prostate removed for further testing, or recommend an MRI scan, or both

If the scans and the biopsy confirm prostate cancer, your urologist will examine the information to determine exactly what risk type of cancer it is

You may need to have further scans such as bone scan or a CT scan

Types of treatment include active surveillance, radiotherapy or surgery depending on the type and severity of the cancer.

The important thing to remember is that prostate cancer can be effectively treated and you can live a perfectly normal life

More information on treatment options are available on my website: http://neilbaum.com/services/prostate-cancer

Bottom Line: Prostate cancer is the most common cancer in men and the second most common cause of death in American men. Most men with prostate cancer can be successfully treated. It starts with a digital rectal exam and a blood test, PSA.

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Prostate Cancer: A New Test To Determine if Watchful Waiting is Appropriate

October 10, 2014

Prostate cancer affects 1 in 6 American men and causes over 25,000 deaths per year, making prostate cancer the second most common cause of death due to cancer in men (first is lung cancer).

Men who have a biopsy that is positive for prostate cancer are confronted with a decision regarding treatment. If the man has a life expectancy of greater than 10 years, he would be a candidate for surgical removal of the prostate gland, radiation therapy, or even a program of watchful waiting or referred to as active surveillance. So what is a man to do with a diagnosis of prostate cancer? Now there is a test, Prolaris, that will help men decide which cancers are aggressive and may require more aggressive treatment, i.e., surgery or radiation, and which cancers are indolent and the men may be candidates for watchful waiting.

Until now the only consideration for men with prostate cancer was the grade of the cancer and the stage of the cancer. However, there are men with low PSA levels and a low grade or Gleason score, who have an aggressive tumor as determined by the Prolaris test and perhaps should consider additional treatment.

How is the Prolaris test performed?

The doctor can submit your original prostate biopsy for analysis and this will look at several genetic markers to determine the Prolaris score. No additional blood test or biopsy is required. The Prolaris test provides an accurate assessment of the aggressiveness of your tumor.

The Prolaris score provides information that helps you and your doctor make the best treatment decision. For example a low risk Ca and low Prolaris score, may persuade you to consider watchful waiting and have close follow up with a digital rectal exam and a PSA test every 3-4 months. On the other hand, a high Prolaris score is suggestive of an aggressive tumor and more aggressive treatment may be selected.

Bottom Line: Until now no lab test or imaging study can determine the aggressiveness of your prostate cancer. Now you and your doctor can make a more informed decision about the potential of your cancer to remain slow growing and you would be a candidate for watchful waiting or the prostate cancer is more aggressive and more aggressive therapy is in order.

Prostate Cancer-Watch, Wait, and Not Whither

January 24, 2014

Prostate cancer is the most common cancer in men and the second most common cause of death in men after lung cancer.  The diagnosis is made with a PSA blood test and a digital rectal exam and if either of these are abnormal, the man is subjected to a prostate biopsy.  Then comes the big decision: does the man proceed to treatment and face the risk of urinary incontinence and\or erectile dysfunction\impotence?

In the past few years there has been a trend towards active surveillance or after receiving the diagnosis of prostate cancer, the man accepts close monitoring with repeated blood tests and possibly repeat prostate biopsies to make certain that the cancer is not progressing or escaping from the prostate and spreading to other organs or structures. 

First a comment on screening.  Men between the ages of 55 and 69 are those most likely to benefit from screening with a PSA blood test and a digital rectal examination.  A man should only be screened after a discussion with his\her physician about the benefits and harms of screening.  A new trend is not to treat every man diagnosed with prostate cancer or active surveillance.   Not every man qualifies for active surveillance. 

Men with a very low risk of cancer progression have a low-grade cancer of the prostate.  Prostate cancers are graded from 1-10 and those with a score of 6 or less may be candidates for active surveillance.  Men are in the very low risk group if only a few of the biopsies are positive for cancer and that the cancer is not felt on the digital rectal exam. 

Men who were on the active surveillance program at John Hopkins School of Medicine had a 2.8% would die of their prostate cancer compared to 1.6% of men who had a very low risk of cancer progression who had surgical removal of their prostate glands.  The researches at John Hopkins found that the average increase in life expectancy after surgical removal of the prostate gland was only 1.8 months and that the men on active surveillance would remain free of treatment for an additional 6.4 years as compared to men who had immediate treatment with surgery on their prostate glands. 

Bottom Line: Men need to have a discussion with their physicians about the benefits and risks of prostate cancer screening.  Men with a life expectancy in excess of 20 years or younger men who have low risk disease may accept the risks of treatment rather than take the chance their cancer will cause harm later.  Men with very low risk disease can take comfort that their disease can safely be managed by active surveillance. 

 

Watching The Results On Watchful Waiting For Prostate Cancer

October 29, 2013

I have seen many changes in medicine during my 35 year career but nothing has changed more dramatically than the diagnosis and treatment of prostate cancer. When I was a medical student in 1968, the treatment was primarily removing a man’s testicles or castration. This drastic treatment removed the source of testosterone, which was the “fuel” to cause prostate cancer to grow. Then came surgery and radiation therapy followed by chemotherapy and now high energy focused ultrasound or HIFU. But many of these treatments have significant side effects like impotence and urinary incontinence which significantly impact a man’s quality of life. As a result conservative forms of treatment have been sought after that doen’t have the side effects and yet prolongs a man’s life. One of those options is watchful waiting or active surveillance where the diagnosis is made and no treatment is used and the man returns regularly for a physical examination which incldues a digital rectal exam, a PSA test and perhaps a repeat prostate ultrasound examination.

Because prostate cancer often grows very slowly, some men (especially those who are older or have other serious health problems) may never need treatment for their prostate cancer. Instead, your doctor may recommend approaches known as expectant management, watchful waiting, or active surveillance.

Active surveillance or watchful waiting is often used to mean monitoring the cancer closely with prostate-specific antigen (PSA) blood tests, digital rectal exams (DREs), and ultrasounds at regular intervals to see if the cancer is growing. Prostate biopsies may be done as well to see if the cancer is becoming more aggressive. If there is a change in your test results, your doctor would then talk to you about treatment options.
With active surveillance, your cancer will be carefully monitored. Usually this approach includes a doctor visit with a PSA blood test and DRE about every 3 to 6 months. Transrectal ultrasound-guided prostate biopsies may be done every year as well.
Treatment can be started if the cancer seems to be growing or getting worse, based on a rising PSA level or a change in the DRE, ultrasound findings, or biopsy results. On biopsies, an increase in the Gleason score or extent of tumor (based on the number of biopsy samples containing tumor) are both signals to start treatment (usually surgery or radiation therapy).

Active surveillance allows the patient to be observed for a time, only treating those men whose cancer grows, and so have a serious form of the cancer. This lets men with a less serious cancer avoid the side effects of a treatment that might not have helped them live longer.

An approach such as this may be recommended if your cancer is not causing any symptoms, is expected to grow slowly (based on a low Gleason score, i.e., 6), and is small and contained within the prostate. This type of approach is not likely to be a good option if you have a fast-growing cancer (for example, a high Gleason score, >8) or if the cancer is likely to have spread outside the prostate (based on PSA levels). Men who are young and healthy are less likely to be offered active surveillance, out of concern that the cancer will become a problem over the next 20 or 30 years.
Watchful waiting is also an option for older men who have other co-morbid conditions such as heart disease, diabetes, or another cancer that has been previously treated. A rule of thumb is that if a man has a life expectancy of less than 10 years and has a low grade prostate cancer, then watchful waiting would certainly be suggestion.

Active surveillance is a reasonable option for some men with slow-growing cancers because it is not known whether treating the cancer with surgery or radiation will actually help them live longer. These treatments have definite risks and side effects that may outweigh the possible benefits for some men.
So far there are no randomized studies comparing active surveillance to treatments such as surgery or radiation therapy. Some early studies of active surveillance (in men who are good candidates) have shown that only about a quarter of the men need to go on to definitive treatment with radiation or surgery.

Bottom Line: Prostate cancer is usually a slow growing tumor that affects millions of American men. One consideration for an older man, with a low Gleason score, and no symptoms from the prostate cancer would be watchful waiting. Each man with prostate cancer needs to have a discussion with his doctor to decide which treatment is best in his situation.