Archive for the ‘cancer’ Category

Treating Prostate Cancer With Hormone Therapy

September 28, 2014

For men with advanced prostate cancer, hormone therapy is a treatment option. The goal is to reduce levels of male hormones, called androgens or testosterone, in the body, or to prevent them from reaching prostate cancer cells. Using drugs to decrease the testosterone is one of the most common methods of treating advanced prostate cancer.

The main androgens are testosterone and dihydrotestosterone (DHT). Most of the body’s androgens come from the testicles, but the adrenal glands also make a small amount. Androgens stimulate prostate cancer cells to grow. Lowering androgen levels or stopping them from getting into prostate cancer cells often makes prostate cancers shrink or grow more slowly for a time. However, hormone therapy alone does not cure prostate cancer and eventually, it stops helping.

Hormone therapy may be used:

  • If you are not able to have surgery or radiation or can’t be cured by these treatments because the cancer has already spread beyond the prostate gland
  • If your cancer remains or comes back after treatment with surgery or radiation therapy
  • Along with radiation therapy as initial treatment if you are at higher risk of the cancer coming back after treatment (based on a high Gleason score, high PSA level, and/or growth of the cancer outside the prostate)
  • Before radiation to try to shrink the cancer to make treatment more effective

Several types of hormone therapy can be used to treat prostate cancer. Some lower the levels of testosterone or other androgens (male hormones). Others block the action of those hormones.

Treatments to lower androgen levels

Orchiectomy (surgical castration)

Even though this is a type of surgery, its main effect is as a form of hormone therapy. In this operation, the surgeon removes the testicles, where most of the androgens (testosterone and DHT) are made. With this source removed, most prostate cancers stop growing or shrink for a time.

This is done as a simple outpatient procedure. It is probably the least expensive and simplest way to reduce androgen levels in the body. But unlike some of the other methods of lowering androgen levels, it is permanent, and many men have trouble accepting the removal of their testicles.

Some men having the procedure are concerned about how it will look afterward. If wanted, artificial silicone sacs can be inserted into the scrotum. These look much like testicles.

Luteinizing hormone-releasing hormone (LHRH) drugs

These drugs lower the amount of testosterone made by the testicles. Treatment with these drugs is sometimes called chemical castration because they lower androgen levels just as well as orchiectomy.

Even though LHRH analogs (also called LHRH agonists) cost more than orchiectomy and require more frequent doctor visits, most men choose this method. These drugs allow the testicles to remain in place, but the testicles will shrink over time, and they may even become too small to feel.

LHRH analogs are injected or placed as small implants under the skin. Depending on the drug used, they are given anywhere from once a month up to once a year. The LHRH analogs available in the United States include leuprolide (Lupron®, Eligard®), goserelin (Zoladex®), triptorelin (Trelstar®), and histrelin (Vantas®).

When LHRH analogs are first given, testosterone levels go up briefly before falling to very low levels. This effect is called flare and results from the complex way in which LHRH analogs work. Men whose cancer has spread to the bones may have bone pain. If the cancer has spread to the spine, even a short-term increase in tumor growth as a result of the flare could compress the spinal cord and cause pain or paralysis. Flare can be avoided by giving drugs called anti-androgens for a few weeks when starting treatment with LHRH analogs. (Anti-androgens are discussed further on.)

Degarelix (Firmagon®)

Degarelix is an LHRH antagonist. LHRH antagonists work like LHRH agonists, but they reduce testosterone levels more quickly and do not cause tumor flare like the LHRH agonists do.

This drug is used to treat advanced prostate cancer. It is given as a monthly injection under the skin and quickly reduces testosterone levels. With degarelix no anti-androgens are necessary. The most common side effects are problems at the injection site (minimal pain, redness, and swelling) and increased levels of liver enzymes on lab tests. Other side effects are discussed in detail below.

Abiraterone (Zytiga®)

Drugs such as LHRH agonists can stop the testicles from making androgens, but other cells in the body, including prostate cancer cells themselves, can still make small amounts, which may fuel cancer growth. Abiraterone blocks an enzyme called CYP17, which helps stop these cells from making certain hormones, including androgens.

Abiraterone can be used in men with advanced castrate-resistant prostate cancer (cancer that is still growing despite low testosterone levels from LHRH agonists, LHRH antagonists, or orchiectomy). Abiraterone has been shown to shrink or slow the growth of some of these tumors and help some of these men live longer.

This drug is a pill and the most common dose is 4 pills every day. Since this drug doesn’t stop the testicles from making testosterone, men who haven’t had an orchiectomy need to continue with treatment to stop the testicles from making testosterone (LHRH agonist or antagonist therapy). Because abiraterone lowers the level of other hormones in the body, prednisone (a cortisone-like drug) needs to be taken during treatment as well to avoid the side effects caused by lower levels of these other hormones.

Bottom Line:  Nearly 250,000 cases of prostate cancer are identified each year.  Nearly 40,000 men die from prostate cancer, second most common cause of death due to dancer after lung cancer.  For men who have elevated PSA levels after treatment, hormonal therapy is a consideration.

The Relationship Between Tomatoes and Prostate Cancer

September 5, 2014

There has been media attention to the role of lycopenes found in tomatoes as a possible prevention of prostate cancer.

A study from England showed that men who eat over 10 portions a week of tomatoes have an 18% lower risk of developing prostate cancer.

Researches examined the diets and lifestyle of 1,806 men between the ages of 50 and 69 years with prostate cancer and compared them with 12,005 cancer-free men.
The study is the first study of its kind to develop a prostate cancer dietary index consisting of dietary components—selenium, calcium, and foods rich in lycopene—that have been linked to prostate cancer.
The results showed that men who had optimal intake of these three dietary components had a lower risk of prostate cancer, researchers found.

Tomatoes and tomato products, such as tomato juice and baked beans, were shown to be most beneficial, with an 18% reduction in risk found in men eating over 10 portions a week. This is thought to be due to lycopene, an antioxidant that fights off toxins that can cause DNA and cell damage.

The findings suggest that tomatoes may be important in prostate cancer prevention.

Bottom line: Men should still eat a wide variety of fruits and vegetables, maintain a healthy weight, and stay active.

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.

Vasectomy And Prostate Cancer-What’s the Risk

July 10, 2014

I often receive calls about the relationship between prostate cancer and vasectomy. There have been many studies that have looked into this relationship and this blog will shed some light on the issue and help men make an informed decision on having a vasectomy, one of the best methods of permanent contraception.

Men who had a vasectomy had a significantly greater risk of developing aggressive, potentially fatal prostate cancer, according to data from a 50,000-patient cohort study.
A recent study in the Journal of Clinical Oncology stated that the overall association between vasectomy and prostate cancer was modest.

The lead authors was quoted as saying, “I think we need to tell men that vasectomy has some risk with prostate cancer, may be linked, but we don’t know. It’s something they need to be aware of and monitored, but really, to me, this is not something that is such a strong association that we need to be changing the way we practice, either prostate cancer screening or vasectomy.”
Studies dating back to the early 1990s have yielded conflicting results about the association between vasectomy and prostate cancer. Some studies have shown as much as a twofold increase in the risk of prostate cancer after vasectomy, whereas others showed no association, the authors noted.

During follow-up through 2010, 6,023 participants had newly diagnosed prostate cancer, including 811 lethal cases. The data showed that 12,321 of the men had vasectomies. The primary outcomes were the relative risk (RR) of total, advanced, high-grade, and lethal prostate cancer, adjusted for a variety of possible confounders.

Vasectomy did not have a significant association with low-grade or localized prostate cancer.

The study adds information to the discussion and controversy surrounding vasectomy and prostate cancer but leaves many questions unanswered. Use of transurethral resection of the prostate, statins used to treat elevated cholesterol levels, selenium, and a number of other factors can influence prostate cancer risk.

The study added little information that goes beyond what previous studies had shown, said Gregory Zagaja, MD, of the University of Chicago. The study suffered from the same limitations of studies that came before it.

Multiple experts state that no consensus exists about potential biological explanations for reported associations between vasectomy and prostate cancer or whether the association is biologically plausible.

Bottom Line: There is a modest risk of prostate cancer in men who undergo a vasectomy. All men, whether or not they have had a vasectomy, need to have a regular PSA and digital rectal exam. For more information on this topic and the relationship between prostate cancer and vasectomy, speak to your doctor.

10 Reasons That Sex Contributes to Good Health

June 1, 2014

On so many occasions many of my male and female patients have indicated that as they reach middle age, that sexual intimacy has taken a back seat and is less important than it was years ago. For this blog, I would like to illuminate 10 reasons to take the sex drive off the back shelf and put it on the front burner. Both you and your partner will be glad you did.
Sex not only feels good. It can also be good for you. Here’s what a healthy sex life can do for you.
1. Revs Up Your Immune System Humming
Sexually active people miss fewer days of work and make fewer visits to the doctor.
People who have sex have higher levels of what defends your body against germs, viruses, and other foreign substances. Researchers found that those men and women who had sex once or twice a week had higher levels of the a certain antibody compared to those who had sex less often.
You should still do all the other things that make your immune system happy, such as:
Eat right.
Stay active.
Get enough sleep.
Keep up with your vaccinations.
Use a condom if you don’t know you and your partner’s STD status.
2. Boosts Your Libido
Having sex will make sex better and will improve your libido.
For women, having sex increases vaginal lubrication, blood flow to the pelvis, and elasticity of the vagina, all of which make sex feel better and help you crave more of it.
3. Improves Women’s Bladder Control
A strong pelvic floor is important for avoiding incontinence, involuntary loss of urine, something that will affect about 30% of women at some point in their lives.
Good sex is like a workout for your pelvic floor muscles. When you have an orgasm, it causes contractions in those muscles, which strengthens them.
4. Lowers Your Blood Pressure
Research suggests a link between sex and lower blood pressure. Numerous studies have reported that sexual intercourse lowered systolic blood pressure, the first or top number on your blood pressure test.
5. Counts as Exercise
Sex is a really great form of aerobic exercise. It won’t replace the treadmill, but it counts for a short cardio workout.
Sex uses about five calories per minute, four more calories than watching TV! It bumps up your heart rate.
So get busy! You may even want to clear your schedule to make time for it on a regular basis. Consistency or regular sex helps maximize the benefits.
6. Lowers Heart Attack Risk
A good sex life is good for your heart. Besides being a great way to raise your heart rate and provide you with a cardio workout more fun than spinning, sex helps keep your estrogen levels in women and testosterone levels in men in balance.
When either one of those is low you begin to get lots of problems, like osteoporosis and even heart disease.
Having sex more often may help. During one study, men who had sex at least twice a week were half as likely to die of heart disease than the less sexually active men who had sex rarely.
7. Lessens Pain
Before you reach for an aspirin, ibuprofen or a pain pill, try an orgasm.
An orgasm can block pain by releasing endorphins which are much more powerful than morphine. Orgasm releases endorphins that helps raise your pain threshold.
Stimulation without orgasm can also be effective. Vaginal stimulation can block chronic back and leg pain, and many women report that genital self-stimulation can reduce menstrual cramps, arthritic pain, and in some cases even headache.
8. Send Big “C” Out To Sea
Going for the sexual homerun or orgasm may help ward off prostate cancer.
The prestigious the Journal of the American Medical Association reported that men who ejaculated frequently (at least 21 times a month) were less likely to get prostate cancer.
You don’t need a partner to reap this benefit: Sexual intercourse, nocturnal emission, and masturbation were all part of the equation.
9. Improves Sleep
You may nod off more quickly after sex, and for good reason.
After orgasm, the hormone prolactin is released, which is responsible for the feelings of relaxation and sleepiness after sex.
10. Eases Stress
Being close to your partner can soothe stress and anxiety.
Even touching and hugging can release your body’s natural feel-good hormones. Sexual arousal releases a brain chemical that revs up your brain’s pleasure and reward system.
Sex and intimacy can boost your self-esteem and happiness, too,
Bottom Line: Who would have “thunk” that sex is good for you and can help keep you healthy and well. As my wise Jewish mother, St. Sara, would say, “It may not help but it voidn’t hoit!” Rest in peace St. Sara.

Tomatoes Can Punch Out Prostate Cancer

March 14, 2014

Tomatoes Can Punch Out Prostate Cancer
Prostate cancer remains one of the most common cancers in men and causes the death of nearly 30,000 men each year. The cause of prostate cancer is unknown but we do know that having a family member with prostate cancer and African American men have a higher incidence of prostate cancer which leads me to believe that there is a genetic or hereditary basis for prostate cancer.

A recent study from the Journal of National Cancer Institute has pointed out that increased consumption of lycopenes, which are found in tomatoes, tomato-based products, pink grapefruit, and watermelons appear to decrease the risk of prostate cancer.

The study suggests that increasing the consumption of a diet rick in lycopene-containing foods reduces the aggressive potential of prostate cancer. The study showed that a high in take of tomato or tomato-based products was associated with a 10%-20% decrease in prostate cancer risk and those men who had high blood levels of lycopenes had a 25% decrease risk of prostate cancer.

For those men who do not like tomatoes, you can take a supplement of lycopene, 20-25mg per day.

Bottom Line: No one knows for certain why lycopenes decreases the risk of prostate cancer. But as my wise Jewish mother would say, “It may not help, but it voidn’t hoit.”

Sex and the Prostate Cancer Patient

February 28, 2014

Q. I can’t get erections after prostate cancer treatment. Does that mean I will never have sex again?
A. The quality of your erections may not be the same after treatment for prostate cancer, but that doesn’t mean that you can’t enjoy penetrative sex. There are many options to help the firmness: medication, vacuum erection pumps, injections and implants. It is also important to realize that sex can be about more than penetration. Learning different techniques to pleasure your partner may be just as enjoyable. Improving upon your oral sex techniques, or mutual masturbation may bring pleasure equal to vaginal intercourse. A sex therapist can help you learn with these techniques.

Q. Since my treatment for prostate cancer, I have lost my interest in sex. Will that return?
A. Some of the hormone treatments, Lupron, Zolodex, Firmagon, used to fight prostate cancer can interrupt one’s desire for sex by decreasing the testosterone levels in the man’s blood stream. If you have a partner, it is important to discuss this side effect. You may find it helpful to have scheduled sexual activity to encourage closeness and intimacy. Sometimes, interest in sex builds when people engage in more foreplay. Also, touching by handholding and kissing can be also be pleasurable to both the man and the woman.

Q: Will my sexual function ever return to what it once was?
Many men grieve the function they had in their youth, forgetting that even without cancer, their level of function would likely change as they age. In either case, if you are going through proper rehabilitation starting immediately after treatment, you will have a greater chance of regaining most of your sexual function. Depending on the long-term treatment plan you and your doctor choose, you may find you need assistance through medications, vacuum erection devices, injections, and the surgical implantation of a penile prosthesis.

This Q and A was inspired and modified from an article by Melissa Donahue, LCSW from the New Jersey Center for Sexual Wellness http://www.njsexualwellness.com

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.

X-Rays, CT SCans, Dental X-Rays May Be Killing You

February 3, 2014

Americans are receiving more testing and imaging that makes use of ionizing radiation than ever before. The healthcare profession knows that excessive radiation can be a contributing factor to many forms of cancer such as leukemia (blood cancer) breast cancer, and thyroid cancer just name a few.

Ionizing radiation is high-frequency radiation that has enough energy to remove an electron from (ionize) an atom or molecule. Ionizing radiation has enough energy to damage the DNA or the genetic makeup inside cells, which in turn may lead to cancer.

Ionizing radiation is a proven human carcinogen (cancer causing agent). The evidence for this comes from many different sources, including studies of atomic bomb survivors in Japan, people exposed during the Chernobyl nuclear accident, people treated with high doses of radiation for cancer and other conditions, and people exposed to high levels of radiation at work, such as uranium miners.

Even though great strides have been made in cancer prevention and treatment, cancer rates remain high and may soon surpass heart disease as the leading cause of death in the United States. One of the important culprits may come from your doctor who is prescribing excessive imaging studies that make use of ionizing radiation. The use of medical imaging with high-dose radiation — CT scans in particular — has soared in the last 20 years. Our resulting exposure to medical radiation has increased more than six fold between the 1980s and 2006. The radiation dose of CT scans (a series of X-ray images from multiple angles) is 100 to 1,000 times higher than conventional X-rays such as a chest X-ray.

The risks have been demonstrated directly in two large clinical studies in Britain and Australia. In the British study, children exposed to multiple CT scans were found to be three times more likely to develop leukemia and brain cancer. In a 2011 report sponsored by Susan G. Komen, concluded that radiation from medical imaging, and hormone therapy, the use of which has substantially declined in the last decade, were the leading environmental causes of breast cancer, and advised that women reduce their exposure to unnecessary CT scans.

One in 10 Americans undergo a CT scan every year, and many of them get more than one CT scan every year. While it is difficult to know how many cancers will result from medical imaging, a 2009 study from the National Cancer Institute estimates that CT scans conducted in 2007 will cause a projected 29,000 excess cancer cases and 14,500 excess deaths over the lifetime of those exposed. Given the many scans performed over the last several years, a reasonable estimate of excess lifetime cancers would be in the hundreds of thousands. Unless we change our current practices or overusing CT scans, 3 percent to 5 percent of all future cancers may result from exposure to medical imaging.

We know that these tests are overused. But even when they are appropriately used, they are not always done in the safest ways possible. The rule is that doses for medical imaging should be as low as reasonably achievable. But there are no specific guidelines for the imaging centers to use to identify what optimum low doses are, and thus there is considerable variation within and between institutions. The dose at one hospital can be as much as 50 times stronger than at another.

A recent study at one New York hospital found that nearly a third of its patients undergoing multiple cardiac imaging tests were getting a cumulative effective dose equivalent to 5,000 chest X-rays. And last year, a survey of nuclear cardiologists found that only 7 percent of stress tests were done using a “stress first” protocol (examining an image of the heart after exercise before deciding whether it was necessary to take one of it at rest), which can decrease radiation exposure by up to 75 percent.

But we still have a long way to go. Fortunately, we can reduce the rate of medical imaging by simply avoiding unnecessary scans and minimizing the radiation from appropriate ones. For example, emergency room physicians routinely order multiple CT scans even before examining a patient. For example a patient with possible diagnosis of a kidney stone can often be diagnosed with a history, a physical exam, a urine test, and very simple x-ray called a KUB which has minimal radiation exposure compared to a spiral CT scan that is so frequently ordered.

Better monitoring and guidelines would also help. The Food and Drug Administration oversees the approval of scanners, but does not have regulatory oversight for how they are used. We need clear standards, published by professional radiology societies or organizations like the Joint Commission or the F.D.A. In order to be accredited for CT scans, hospitals and imaging clinics should be required to track the doses they use and ensure that they are truly as low as possible by comparing them to published guidelines.

Patients have a part to play as well. Consumers can go to the website, http://www.choosingwisely.org, to learn about the most commonly overused tests. Before agreeing to a CT scan, they should ask: Will it lead to a better treatment and outcome? Would they get that therapy without the test? Are there alternatives that don’t involve radiation, like ultrasound or MRI? Even when we go to the dentist to have our teeth cleaned, we need to question the dentist about the routine use of dental x-rays and if you do get dental x-rays, it is important to wear a neck shield that protects your thyroid gland.

Bottom Line: We are probably receiving more radiation through medical tests and is important to question your doctor about the necessity of using so many imaging tests that increase our exposure to ionizing radiation.

A version of this op-ed appears in print in the New York Times on January 31, 2014.

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.