Archive for the ‘cancer treatment’ Category

Treating Prostate Cancer By Close Monitoring or ActiveSurveillance

November 25, 2016

Prostate cancer is the most common cancer in older men and second most common cause of death due to cancer in men over the age of 50.  This year more than 180,000 men will be diagnosed with prostate cancer and more than 30,000 men will die of this disease.  There are multiple treatment options for prostate cancer including surgery, radiation, hormone therapy and now there’s a new option: watchful waiting or active surveillance.  Active surveillance means no treatment but careful monitoring with regular digital rectal exams, PSA testing, and possible other tests and\or imaging studies.  This blog is intended to help men who have received a diagnosis of prostate cancer to help guide them in the decision of active surveillance or more aggressive standard treatment options.

What you need to know

The prostate gland is a walnut-sized organ at the base the bladder and surrounds the urethra or the tube in the penis that transports urine from the bladder to the outside of the body.  The prostate gland’s function is to make the fluid that mixes with the sperm and provides the sperm with nourishment to help fertilize an egg and start the process of conception.

For the first part of a man’s life the prostate gland provides pleasure and enjoyment.  After age 50 for reasons not entirely known, the prostate gland starts to grow and compresses the tube or the urethra and produces difficulty with urination.  Again, for reasons not entirely known the prostate cells grow uncontrollably and this results in prostate cancer.

Prostate cancer is a very common as one in seven American men will develop prostate cancer.

There are two tests used to detect prostate cancer: 1) the digital rectal exam and 2) the PSA or prostate specific antigen test.  PSA is a protein made by the prostate gland.  An increased level of PSA can be a sign of prostate cancer but an elevation is also seen in men with prostate gland infections and benign enlargement of the prostate gland.

Active surveillance is now considered an acceptable management option in certain men with prostate cancer.  Active surveillance is a type of close follow up. In addition to the PSA and digital rectal exam, a repeat biopsy may be indicated.  A biopsy test called a fusion-guided biopsy is one of these newer tests that combines the MRI with real-time ultrasound images of the prostate.  Genomic tests are another development for prostate cancer assessment.  These tests look at the DNA of the cancer to decide if the cancer is stable or growing.  If any of these tests indicate that the cancer is growing, you may require additional treatment.

At the present time there is no universal agreement about how often the tests should be done for men who are participating in active surveillance.  Patients who are at low risk, that is have a low PSA and a biopsy that reveals a reasonably favorable pathology report, then he can have his PSA check every six months.  It is also common to have a repeat biopsy 12-18 months after the diagnosis.

Candidates for Active Surveillance

Men with early stage prostate cancer that is confined to the prostate gland are the best candidates for active surveillance.  Also, good candidates are men without symptoms and have prostate cancer that is slow growing.  Finally, older men with serious other medical problems which may interfere with treatment are potential active surveillance candidates.

The benefits of active surveillance is that it is low cost, safe, and has no side effects.  Men are able to maintain day-to-day quality of life and not have any of the complications of treatment such as impotence\ED or urinary incontinence.  The risk is that men can become complement and not follow up as often as they should and that the cancer can grow and become more aggressive.

Bottom Line:  Prostate cancer is a common problem in middle age and older men.  Most men if they live long enough will develop prostate cancer.  However, most men with the diagnosis of prostate cancer will die with the cancer and not from it.  My best advice is to have a conversation with your doctor and see if active surveillance is right for you and your cancer.

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Advance To Every Cancer Patient

January 24, 2015

Cancer and cardiovascular disease are the most common medical causes of death in America. Tremendous advances have been in the treatment of cancer and there is often more than one treatment option for any disease. This is certainly true for prostate cancer where there are multiple treatments such as surgery, radiation, chemotherapy, and even no treatment at all but watchful waiting.

Here are my suggestions for each patient who has cancer:

1. Get a second opinion. Each patient needs to be aware of all the treatment options and to feel confident and informed about the options available. For example, a urologist who performs surgery is not likely to recommend radiation therapy when radiation therapy may be the better option for the patient. A second opinion is a chance to gain ore knowledge and insight into the accuracy of the diagnosis. Also if a pathologist looking at a biopsy or surgical specimen makes the diagnosis, I suggest that another pathologist provide a second opinion to confirm the diagnosis.

2. Find the right doctors. Nearly 20% of patients who receive a diagnosis of cancer have the disease in an advanced stage where the cancer has spread to other organs or other areas of the body. These patients with cancer that has spread, as well as all newly diagnosed patients, should get advice from physicians experienced in treating the specific type of cancer. You want to be sure that you are in the right hands.

3. Know what questions to ask. There are 10 questions compiled by the Cancer Treatment Centers of America (www.cancercenter.com/secondopinion) that would be helpful for newly diagnosed cancer patients to bring to their visit with the doctor. These are:

1 What types of diagnostic testing do you perform? An accurate diagnosis is critical because it is the basis upon which your treatment plan will be determined. For example, PET/CT scans help determine the precise location of cancer in the body to accurately plan treatment. Tumor molecular profiling identifies a tumor’s unique blueprint to choose targeted chemotherapy drugs. It’s important to have access to advanced diagnostic tests, as well as physicians who are experienced in performing them.
2 What does my diagnostic testing tell me? The information you should receive from diagnostic tests includes: where the cancer originated, the size of the tumor, the stage of cancer and whether or not it has spread to the lymph nodes or other parts of the body.
3 What treatment options are available? What do you recommend and why? Many types of cancer have a variety of treatment options available. Your doctor should be able to explain the potential benefits of each to help you understand your options, even if he or she doesn’t perform a specific treatment.
4 What happens if a treatment approach doesn’t work for me? At any point, you should feel comfortable asking your doctor about the status of your treatment. When choosing a care team, you may want to consider doctors willing to try new therapies, depending on your response. Look for professionals who will tailor treatments to your specific diagnosis, and who are willing to pursue other options if your treatment isn’t progressing as expected.
5 What are the side effects of treatment, and how often do your patients experience them? No two people will have the exact same response to cancer treatment, and side effects may vary depending on what type of treatment you choose. Ask your doctor what side effects you might experience, so that you can plan ahead and choose with all of the information you need.
6 How will you help me manage side effects? Integrative therapies can help prevent or manage side effects, so you stay strong and avoid treatment interruptions. Some therapies that can support your wellness during cancer treatment include: nutrition therapy, naturopathic medicine, mind-body medicine, acupuncture, oncology rehabilitation, spiritual support and pain management. Ask your doctor if any of these are available at your hospital, and how they can be incorporated into your treatment plan.
7 How many patients have you treated with my type and stage of cancer, and how successful have you been? Ask how much experience your doctor has treating your type and stage of cancer and whether he/she is a board-certified specialist. You may also want to ask about his/her facility’s treatment results so you can see how successful they have been in treating your cancer type.
8 Who will be involved in my care, how often will they meet and who is my main point of contact? An integrated care team including a surgical, medical, and/or radiation oncologist; dietitian; naturopathic oncology provider; clinical nurse and medical advocate (often a nurse care manager) can ensure you get support for your entire well-being during treatment. If you don’t already have a team like this in place, talk to your doctor about assembling a multidisciplinary team.
9 Where will all my treatments, appointments, tests, etc., take place? When looking for a treatment facility, consider the coordination and convenience of your treatment. Having appointments and procedures in one location can make treatment less stressful for you, and it may allow you to start treatment sooner.
10 How will you help me balance my cancer care with the demands of my normal life? Your cancer treatment should adapt to your individual needs, and family and professional obligations. Talk to your doctor about your personal needs, so that all aspects of your life are considered when choosing a treatment plan.

4. Stay strong. You will often experience significant side effects dealing with your treatment or the disease. I recommend that you consult with a nutritionist to be sure that you are receiving the right combination of calories, vitamins, and nourishment in order to be in the best physical shape to fight the disease. I also suggest a regular program of exercise that enhances your heart, lungs, and muscles to keep you in the best body-mind condition.

Bottom Line: The cancer diagnosis is often shocking and requires each patient to muster all of his\her energies to engage and fight cancer. These are a few suggestions that will help you prepared to carry the biggest fight of your life.

Bladder Cancer-Shedding “Blue” Light On Detection and Treatment

February 14, 2014

Blood mixed with any bodily fluids, such as sputum and stool is worthy of medical attention. However, blood in the urine is particularly ominous and requires prompt medical attention.
Bladder cancer is the ninth most common cancer worldwide, with more than 380,000 new cases each year and more than 150,000 deaths per year. It is more common in elderly and affects approximately four times the number of men than women. The US National Cancer Institute estimates that there will be 72,570 new cases of bladder cancer in the US in 2013 and 15,210 deaths.

If detected at an early stage, this cancer can be successfully treated and has a good prognosis. Nearly half of bladder cancer patients will experience cancer recurrence. A new technique, blue-light cystoscopy, is an improved option for the diagnosis and the treatment in order to reduce the recurrence of bladder cancer.

Bladder cancer occurs when cells in the bladder start to grow out of control, typically on the inner layers of the bladder. Some may spread into the deeper layers of the bladder, eventually penetrating the walls of the bladder, making it much harder to treat.

The most common initial sign of bladder cancer is hematuria or blood in the urine. A look into the bladder with a lighted tube or cystoscopy is recommended in all patients with symptoms suggestive of bladder cancer. This test is done in the doctor’s office and requires a local anesthetic to reduce the paint and discomfort of the procedure. There are two forms of bladder cancer: non-muscle invasive and muscle invasive bladder cancer.

Non-muscle invasive bladder cancer accounts for about 75% of all newly diagnosed bladder cancer cases. Most of these cases show a high probability of recurrence and 10-20 % will progress to muscle invasive bladder cancer. The treatment will consist of using a cystoscope to remove the affected bladder areas followed by post–operative treatment options such as early instillation of chemotherapy or instillation of BCG which stimulates an immune response to prevent recurrence of the cancer.

Cysview is a new modality for detecting bladder cancer. Cysview is a chemical agent used to detect early bladder cancer. This agent is instilled into the bladder prior to cystoscopy and will stain or highlight bladder cancer when using a blue light inside the bladder much more effectively than using the standard white light of the conventional cystoscope. As a result the blue light cystoscopy using Cysview exposes cancer earlier when it is confined to the lining of the bladder and is easily treatable by removing the tumor using the cystoscope. Also the blue light treatment leads to improved tumor removal, since every tumor detected can be removed at the time of diagnosis and not requiring any additional procedures.

Bottom Line: Cancer of the bladder is a common urologic condition. The hallmark symptom is blood in the urine, either microscopic or visible to the eye. A new diagnostic option is the use of blue light Cysview that helps with the diagnosis and treatment of bladder cancer. For more information see your urologist.

Prostate Cancer-Watch, Wait, and Not Whither

January 28, 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.

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

New Hope For Prostate Cancer Patients

October 7, 2012

Prostate cancer is the most common non-skin cancer in the USA; 242,000 cases are expected this year. There is no way yet to distinguish between the benign ones that will stay in the prostate and the dangerous ones that will start creeping into the bones, the mostly likely place of spread.
Most doctors manage prostate cancer in the advanced stages by finding ways to decrease the testosterone level as it is felt that testosterone is responsible for the growth of prostate cancer. For decades, men who relapsed were treated with drugs or surgery that decreased the testosterone level. A common medication used in the late 1990s and early 2000 was Lupron or similar drugs. If men failed on Lupron or similar drugs, they were told to wait and get their affairs in order as death was imminent.

Then in the early ’90s, when troubled financier Michael Milken publicized his prostate cancer battle and the lack of funding. In 2005, the Department of Defense began to invest heavily, and drug companies got interested. Collaboration of activists, academics, government and drug makers led to more than 100 clinical trials.
Provenge bought him another 2 years with no cancer growth, long enough to qualify for a trial of enzalutamide last year. His prostate- specific antigen number, a measure of the disease’s progression , is down from 30 to 4.5, as good as it has been in decades.

Most trials are conducted on patients who have advanced disease. The drugs might be more effective if started earlier, but that’s yet to be proven.
Now, figuring out which patients will do well on which drugs is mostly a game of chance. “In the future, the hope is we’ll be smarter and be able to pick out the right therapies at the right time,”

So what are the drugs that have been shown to prolong life?
Provenge is a vaccine approved by the FDA that primes a man’s immune system to attack prostate cancer cells. A course consists of three treatments.

Cabazitaxel is FDA approved and consists of six cycles of treatment.

Abiraterone deprives tumors of testosterone.

Enzalutamide blocks the ability of testosterone to enhance cancer cells growth.

Radium 223 is awaiting FDA approval and carries radioactive particles deep into the bone where cancer from the prostate gland has spread and kills the cancer cells in the bone.

Bottom Line: Prostate cancer remains one of the most common cancers in men. New treatments are on the horizon and men need to speak with their doctors about the most effective treatments that can help prolong their lives.