Archive for the ‘cancer screening’ Category

PSA Testing for Prostate Cancer-To Screen or Not to Screen That is the Question

September 28, 2016

Today, nothing is more confusing for men than the concept of screening for prostate cancer.  Prostate cancer is the second most common cancer in men, following lung cancer, and there are 250,000 men each year diagnosed with prostate cancer and causes nearly 30,000 deaths a year.  About one in seven men will be diagnosed with prostate cancer during his lifetime.

But some prostate cancers develop slowly, and, as the disease is more common in elderly men, most men with prostate cancer die with it and not from it. Thus, screening, diagnosis and treatment of the disease are controversial.

There is no consensus about prostate cancer screening as early diagnosis can be associated with very bothersome side effects such as erectile dysfunction and urinary incontinence.  Also screening has not been universally shown to increase survival or decrease the death rate from prostate cancer.  This article will discuss the pros and cons of PSA screening for men.

Men who opt for screening undergo a digital rectal exam and a blood draw to measure a chemical called PSA or prostate specific antigen. This level of PSA can be increased in men with prostate cancer. Other conditions may cause the increase in the PSA such as benign enlargement of the prostate gland and prostate infections.

The best way to detect an early potentially deadly case is to collect yearly PSA tests over three to five years so trends can be assessed.

I like most other urologists are concerned about over treatment of prostate cancer — in other words, being too aggressive in using surgery or radiation when a small amount of potentially slow-growing cancer is found on a biopsy.

The federal government has also become concerned about this issue. A large medical research trial called the Prostate Lung Colorectal and Ovarian (PLCO) Cancer Screening Study released results from 2009 showing no benefit from screening for prostate cancer when comparing a large group of unscreened men to a large group of aggressively screened men.

Researchers across the country are assessing the effects of the USPSTF recommendations on prostate cancer mortality since 2012. In a recent study from Northwestern University in Chicago, researchers found a significant increase in the cases of advanced prostate cancer already spread to other parts of the body from 2004 to 2013. As a result we could be missing serious cancers because of decreased screening.

Prostate cancer also has a hereditary predilection and men with a father, brother, cousin, or uncle should consider having screening around age 40.  This also applies to African-American men who have a greater risk of prostate cancer than Caucasian men and should also have testing after age 40.

My best advice is to ask your doctor\urologist about the decision to undergo prostate cancer screening.

Owner Maintenance Suggestions For Men

May 2, 2015

June is Male Health Awareness Month. These are a few tests that are unique for men I suggest that they have these tests on a regular basis in order to maintain good health.

TESTICULAR SELF-EXAM

Testicular cancer is a young person’s disease. Please pay close attention to this section if you are between the ages of 15 and 40.

There’s a lot of media coverage for women getting regular mammograms and doing breast self-exams. Men need to examine their testicles as well.

Once a month, after you take your shower, roll each testicle around between your thumb and first two fingers. Look for any bumps, changes, hardness, heaviness, or an enlargement of the entire testicle. Also be on the lookout for changes in the skin of the scrotum. If you detect any of those changes, see a urologist and get it checked out.

PROSTATE CHECKUPS

It is unusual to find prostate cancer in men under the age of 50, but many men will have a diagnosis of prostate cancer by the time they are 70. For a lot of those men who are first diagnosed with prostate cancer after the age of 70, the cancer will grow very slowly and may not require treatment. The doctor will monitor the cancer with regular PSA and digital rectal exams to make sure it stays contained. Many men can live a healthy life with the diagnosis, but for some it can grow very quickly, spread beyond the prostate, and be life threatening. Nearly one-fifth of all men in the United States will eventually receive a diagnosis of prostate cancer, and many more may have prostate cancer because it goes undetected in men who show no symptoms. 3% of men with prostate cancer will die from the disease.

DRE: Digital Rectal Exam

The prostate gland can be physically checked to see if there might be cause for concern about cancer even when the patient has no symptoms. The Digital Rectal Exam is inexpensive, indicator of bumps or abnormal areas on the prostate gland, and you receive the results right after the examination. I suggest a DRE with every year between the ages of 50 and 80. The doctor can tell if your prostate is unusually large. This will tell you if the prostate is pressing against the bladder and causing frequent urination. Because of the mild discomfort of the DRE, it’s sometimes difficult to have men have the exam.

PSA Test

I know there is controversy over the PSA test, which is a blood test that measures the level of a protein produced by the cells of the prostate gland when there is cancer—and sometimes when there is no cancer. In other words, the PSA Test sometimes has “false positives.” But by giving you both tests annually or every other year, your doctor can get a good idea of the likelihood that you might have a problem, and then you can discuss how serious the problem might be and what you can do about it.

Prevention of prostate cancer

I am also asked what can men do to prevent prostate cancer or if they have prostate cancer is there a diet that helps control prostate cancer. Evidence shows that the risk of prostate cancer is reduced by a diet that is lower in red meat, fat, and dairy products and higher in fruits and vegetables—especially broccoli, cauliflower, cabbage, Brussels sprouts, bok choy and kale (all the cruciferous vegetables)—plus tomatoes. Such a diet, along with limiting alcohol consumption, maintaining an exercise program, and keeping body weight down, is associated with a lower risk of prostate cancer and other cancers as well.

Bottom Line: Men need to be involved in their healthcare. These few tests and suggestions are just a few suggestions that all men can and should do.

PSA Testing For Prostate Cancer-New Recommendations For 2015

February 16, 2015

In 2012 the United States Task Force released guidelines for PSA testing for prostate cancer that stated that no man should be tested for prostate cancer with a PSA test since there was far too many man who were over-diagnosed and who had treatment and complications from the treatment and that the cancer was so slow growing that few men would die of their prostate cancers.

Two physicians’ groups are now recommending informed decision-making when it comes to screening for prostate cancer. This is in line with American Cancer Society guidelines for early detection of prostate cancer.

The American Urological Association (AUA), the leading organization representing urologists, is recommending more moderate use of prostate cancer screening tests.

In its new guidelines, the AUA recommends that men ages 55 to 69 discuss the benefits and harms of prostate cancer screening with their doctors before deciding whether to be screened. It recommends against screening for men younger than 55 who are at average risk, as well as for men 70 and older.

The American College of Physicians (ACP) released a similar guidance statement in April 2013. The ACP says men between the ages of 50 and 69 should discuss the limited benefits and substantial harms of the prostate-specific antigen (PSA) test with their doctor before undergoing screening for prostate cancer. The guideline says only men between the ages of 50 and 69 who express a clear preference for screening should have the PSA test.

These new recommendations are closer to those of the American Cancer Society and several other groups issued in recent years. The American Cancer Society recommends that men discuss the possible risks and benefits of prostate cancer screening with their doctor before deciding whether to be screened. The discussion about screening should take place starting at age 50 for men who are at average risk of prostate cancer and expect to live at least 10 more years. It should take place at age 40-45 for men who are at higher risk, this includes African-American men and men who have a father or brother diagnosed with prostate cancer.

The discussion with the doctor should include an explanation to men of the uncertainty of the PSA test, potential harms from the prostate biopsy and treatments such as surgery and radiation, and potential benefits of PSA screening. Use of this test should be a decision made by the individual patient in collaboration with his healthcare provider.

Some limitations of screening

Screening looks for disease in people who have no symptoms. The main goal of prostate cancer screening is to reduce deaths due to prostate cancer. But the studies showed that the number of men who avoided dying of prostate cancer because of screening after 10 to 14 years was very small.

And screening isn’t perfect. Sometimes screening misses cancer, and sometimes it finds something suspicious that turns out to be harmless. The PSA test often produces false-positive results. For example men with an enlarged prostate gland or men with an infection of the prostate gland can have an elevated PSA level. Also, there aren’t reliable tests yet to tell the difference between prostate cancer that’s going to grow so slowly it will never cause a man any problems, and dangerous or aggressive prostate cancer that will grow quickly. Treatments for prostate cancer can have urinary, bowel, and sexual side effects that may seriously affect a man’s quality of life.

Bottom Line: The PSA is not a perfect test. It is inexpensive and it is non-invasive. It is useful as a baseline test and can help a man decide if he should proceed to a biopsy or to have treatment for his cancer. A thorough discussion between the man and his doctor is the best recommendation that I can provide for all men who are concerned about prostate cancer.

Preventing Prostate Cancer

September 4, 2014

Prostate Cancer is a disease of aging and at this time there is no vaccine or sure fire way to completely prevent prostate cancer. However, there are steps you can take to reduce your risks.

• Advanced age increases your risk. Despite this, prostate cancer is not an “old man’s disease:” 35 percent of those affected are younger than 65.
• Family history may play a role. A strong family history of prostate cancer can increase your chances of developing the disease. While these factors are beyond our control, having awareness of increased risk can motivate us to focus on the areas we can affect.
• If there are factors that put you at higher risk, it’s important to be vigilant in areas you can control, including regular screenings. Talk with your doctor about the pros and cons of prostate screening. For African-Americans or those with a family history of prostate cancer, ask if screening should begin earlier.
1. Eat healthy. Avoid foods high in sodium, saturated fat, cholesterol, refined sugar and trans fat, which contribute to cancer risk. Instead, choose foods high in Omega-3 fatty acids (salmon, almonds) and monounsaturated fats (olive oil, peanuts) as well as fruits, vegetables and whole grains. Eating right doesn’t just lower your risk for prostate cancer, but prevents weight gain and improves your overall health.

2. Be active. Participate in 75 minutes of vigorous activity, or 150 minutes of moderate activity, weekly. This can include walking, swimming, biking or any exercise your doctor recommends.

3. Get screened. The National Comprehensive Cancer Network recommends baseline PSA screening for healthy men ages 50 to 70 every one to two years, and a majority of the panelists recommend baseline testing for men ages 45 to 49, too especially for men with a family history of prostate cancer or are of African American heritage.

Bottom line: Prostate cancer affects 250,000 men each year and causes 40,000 deaths making it the second most common cause of cancer death in men. Eating a healthy diet, exercising regularly and getting tested with a digital rectal exam and a PSA test on a regular basis is the best prevention strategy available today.

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. 

 

The End Of Screening For Prostate Cancer In Men Over Age 75

October 4, 2013

In a move that could lead to significant changes in medical care for older men, a national task force on Monday recommended that doctors stop screening men ages 75 and older for prostate cancer because the search for the disease in this group was causing more harm than good.

The guidelines, issued by the U.S. Preventive Services Task Force and published on Tuesday in the Annals of Internal Medicine, represent an abrupt policy change by an influential panel that had withheld any advice regarding screening for prostate cancer, citing a lack of reliable evidence.
Screening is typically performed with a blood test measuring prostate-specific antigen, or PSA, levels. Widespread PSA testing has led to high rates of detection. Last year, more than 218,000 men learned they had the disease.
Yet various studies suggest the disease is “overdiagnosed” — that is, detected at a point when the disease most likely would not affect life expectancy — in 29 percent to 44 percent of cases. Prostate cancer often progresses very slowly, and a large number of these cancers discovered through screening will probably never cause symptoms during the patient’s lifetime, particularly for men in their 70s and 80s. At the same time, aggressive treatment of prostate cancer can greatly reduce a patient’s quality of life, resulting in complications like impotency and incontinence.
Past task force guidelines noted there was no benefit to prostate cancer screening in men with less than 10 years left to live. Since it can be difficult to assess life expectancy, it was an informal recommendation that had limited impact on screening practices. The new guidelines take a more definitive stand, however, stating that the age of 75 is clearly the point at which screening is no longer appropriate.
Dr. Calonge said it was important that the guidelines not be viewed as “giving up” on older men. While the new rules should discourage routine testing of older patients, the recommendations will not prevent a man from seeking screening if he desires it, Dr. Calonge said. The new guidelines are not expected to alter Medicare’s current reimbursement for annual PSA screening of older men.
The guidelines focus on the screening of healthy older men without symptoms and will not affect treatment of men who go to the doctor with symptoms of prostate cancer, like frequent or painful urination or blood in the urine or the semen.
While the verdict is still out on younger men, the data for older men are more conclusive, experts say. The American Cancer Society and the American Urological Association both say annual PSA screening should be offered to average-risk men 50 and older, but only if they have a greater than 10-year life expectancy.
Treatments for prostate cancer can cause significant harm, rendering men incontinent or impotent, or leaving them with other urethral, bowel or bladder problems. Hormone treatments can cause weight gain, hot flashes, loss of muscle tone and osteoporosis.
Bottom Line: If you are 75 years of age or older, you probably don’t need any additional screening for prostate cancer.

This blog was excerpted from The New York Times, October 4, 2013
http://www.nytimes.com/2008/08/05/health/research/05prostate.html?_r=0

7 Ways to Cancer-Proof Your Body

August 21, 2013

Recent research reveals 7 stealth strategies to keep the killer at bay. It’s time to raise your carcinogen shields—and your overall health—using these smart anti-C tips.

1. Drink pomegranate juice. 
Some say this luscious, lusty red fruit is Eve’s original apple, but what the pomegranate truly banishes is cancer risk. The fruit’s deep red juice contains polyphenols, isoflavones, and ellagic acid, elements researchers believe make up a potent anticancer combo. It’s been shown to delay the growth of prostate cancer in mice, and it stabilizes PSA levels in men who’ve been treated for prostate cancer.

pomegranate juice

pomegranate juice


2. Eat blueberries. 
 Got pterostilbene? Rutgers University researchers say this compound—found in blueberries—has colon cancer-fighting properties. When rats with colon cancer were fed a diet supplemented with pterostilbene, they had 57 percent fewer precancerous lesions after 8 weeks than rats not given the compound did. Eat blueberries and you’ll also benefit from a big dose of vitamin C (14 milligrams per cup).

3. Relax a little. 
 Purdue University researchers tracked 1,600 men over 12 years and found that half of those with increasing levels of worry died during the study period. Talk about flunking the exam. Only 20 percent of the optimists died before the 12-year study was completed. More anxiety-producing news: Thirty-four percent of the neurotic men died of some type of cancer.

4. Take Selenium. Selenium has long been thought of as a cancer fighter, but you can have too much of a good thing. A study of almost 1,000 men, published in the Journal of the National Cancer Institute, found that when those with the lowest initial levels of selenium in their bodies received a daily supplement over a 4 1/2- year period, they cut their prostate-cancer risk by an impressive 92 percent.

5. Vitamin D every day. 
Scientists have viewed vitamin D as a potent cancer fighter for decades, but there’s never been a gold-standard trial—until now. A Creighton University study published in the American Journal of Clinical Nutrition found that women who supplemented their diets with 1,000 international units of vitamin D every day had a 60 percent to 77 percent lower incidence of cancer over a 4-year period than did women taking a placebo. Vitamin D is necessary for the best functioning of the immune system—it causes early death of cancer cells.



6. Clear your air. 
Secondhand smoke may be even worse for you than we thought. A recent American Journal of Public Health study reveals that nonsmokers working in smoky places had three times the amount of NNK, a carcinogen, in their urine than nonsmoking workers in smoke-free joints had. And their levels of NNK rose 6 percent for every hour worked. There is no safe level of exposure to secondhand smoke, and the greater the exposure, the higher the risk.

7. Invest a little sweat equity. 
Study after study has pointed to the cancer-beating power of exercise. Now research from Norway has found that even a tiny dose of exercise has big benefits. A study of 29,110 men published last year in the International Journal of Cancer shows that men who exercised just once a week had a 30 percent lower risk of metastatic prostate cancer than did men who didn’t work out at all. Increasing the frequency, duration, and intensity of the exercise correlated with a further, gradual reduction in risk.



Just Say “No”…To Soda Pop! The Pop And Prostate Cancer Connection

July 2, 2013

There’s an obesity epidemic in America and soda pop is one of the fuels of that problem. If you are looking for reason to kick the soda pop habit, you may have just found it. According to a study out in Sweden, men who drink as little as one soda beverage a day have a greater risk of contracting prostate cancer. The increased risk goes up as far as 40%.
The study, carried out by Swedish scientists, tracked the health of more 8,000 men aged 45-73 over a 15 year span. Those men who on average drank just one can of soft drink a day appeared 40 percent more likely to develop aggressive prostate cancer. The researchers stressed that one of the most important factors in risk-association was genetics. However, they noted this research would appear to suggest that dietary factors could play a stronger role than previously thought in terms of men developing prostate cancer.

Prostate cancer is among the most common cancers in men. It is estimated that some 241,740 new cases of prostate cancer will be diagnosed in the US this year, with 28,170 men dying of prostate cancer by the end of 2012. There are of course plenty of other reasons to drop soft drinks from your diet. Previous studies have found that soft drinks–and in particular their high concentrations of sugar–may cause increased heart disease risk, an elevated stroke risk, the potential for long-term liver damage, increased rates of diabetes and more.

Maybe just a glass of water then?

Bottom Line: Want to stay healthy? Drink less soda and a lot more water!
– Read more: http://www.care2.com/causes/yet-another-reason-to-avoid-soda-prostate-cancer.html#ixzz2XiaYVde1
– See more at: http://www.vibe.com/article/put-pop-down-study-links-soda-prostate-cancer-risk#sthash.cczMrxXv.dpuf

Man Has Prostate Gland Removed Because He Tested Positive For The BRCA-Gene

May 25, 2013

BRCA-2 Gene

BRCA-2 Gene


Angelina Jolie has come forward and shared with the world her story about having prophylactic bilateral mastectomies and breast reconstruction after learning that she tested positive for the BRCA2 gene mutation that is highly predictive of developing breast cancer.

BRCA gene mutations increase the risk for a number of cancers, including prostate cancer. Now the first man has come forward who tested positive for the BRCA gene mutation who had his prostate gland removed. The surgery took place in London by an eminent surgeon who also had his prostate gland removed for prostate cancer after prostate cancer was found.

Previous results from this trial have shown that a man with a BRCA2 mutation has an 8.6-fold increased risk of developing prostate cancer, and with a BRCA1 mutation has a 3.4-fold increased risk. The same researchers reported that prostate cancer in men with the BRCA2 mutation is more aggressive and more likely to be fatal (J Clin Oncol. 2013;31:1748-1757).

The man who underwent the surgery is described as a 53-years-old businessman from London who is married with children and has several family members who have had breast or prostate cancer. When he found out he was carrying the BRCA2 mutation, he asked to have his prostate removed.

What’s my opinion on this first test case of prophylactic prostate gland removal for men with BRCA gene mutation? First, I don’t think American insurance companies, including Medicare, will pay for prophylactic prostatectomies without a diagnosis of prostate cancer confirmed by a prostate biopsy. Second, I wouldn’t recommend a prostatectomy just on the basis of a positive gene test. I think it is far too early to be removing men’s prostate glands with the associated risk of erectile dysfunction and urinary incontinence just on the basis of a blood test. However, if a man with an elevated PSA blood test has one or two relatives such as a father or brother with prostate cancer and a mother with breast cancer and it is highly likely that he may have or will develop prostate cancer, then I would certainly recommend that the man have a prostate biopsy and close monitoring for prostate cancer.

I do suggest that all men with a family history of prostate cancer have an annual digital rectal exam and a PSA blood test.

PSA Testing -To Screen Or Not to Screen-What the Experts are Saying

May 12, 2013

Prostate cancer is the most common non-skin cancer in men with 250,000 new cases every year. The disease can be detected by screening with a PSA blood test and a digital rectal exam. Some men with prostate cancer will go on to treatment and are at risk for complications including impotence or erectile dysfunction and urinary incontinence or leaking urine.
The American Urologic Association has just released new guidelines for prostate cancer screening that I would like to share with you and hope that you can use this information to make a decision if prostate cancer screening is appropriate for you.

Guideline Statement 1: The Panel recommends against PSA screening in men under age 40 years. In this age group there is a low prevalence of clinically detectable prostate cancer, no evidence demonstrating benefit of screening and likely the same harms of screening as in other age groups.

Guideline Statement 2: The Panel does not recommend routine screening in men between ages 40 to 54 years at average risk, i.e., those men who do not have a family member with prostate cancer or men of African American race. For men younger than age 55 years at higher risk (e.g. positive family history or African American race), decisions regarding prostate cancer screening should be individualized.

Guideline Statement 3: For men ages 55 to 69 years the Panel recognizes that the decision to undergo PSA screening involves weighing the benefits of preventing prostate cancer mortality in 1 man for every 1,000 men screened over a decade against the known potential harms associated with screening and treatment. For this reason, the Panel strongly recommends shared decision-making between doctor and patient for men age 55 to 69 years that are considering PSA screening, and proceeding based on a man’s values and preferences. The greatest benefit of screening appears to be in men ages 55 to 69 years.

Guideline Statement 4: To reduce the harms of screening, a routine screening interval of two years or more may be preferred over annual screening in those men who have participated in shared decision-making and decided on screening. As compared to annual screening, it is expected that screening intervals of two years preserve the majority of the benefits and reduce overdiagnosis and false positives. Additionally, intervals for rescreening can be individualized by a baseline PSA level.

Guideline Statement 5: The Panel does not recommend routine PSA screening in men over age 70 years or any man with less than a 10 to 15 year life expectancy.
Some men over age 70 years who are in excellent health may benefit from prostate cancer screening.

Bottom Line: I think not to screen men at all is probably not a good idea. However, in selected men, the decision not to screen is probably a good one. I do believe that men need to have a discussion with their doctors and decide on a case by case basis whether or not to screen for prostate cancer using the PSA test.