Posts Tagged ‘prostate’

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.

Eat Your Way To Prostate Health-Prostate Cancer Risk Reduction Through Diet

October 27, 2013

Prostate cancer is the most common cancer in men and the second most common cause of death from cancer in men. (Lung cancer causes more deaths than prostate cancer) Whereas the cause of lung cancer can be clearly traced to smoking, the causes of prostate cancer are less well known. However, there are dietary recommendations that may make a difference.
According to a study by the Mayo Clinic, choosing a healthy diet may be beneficial. 
There is some evidence that choosing a healthy diet that’s low in fat and full of fruits and vegetables may reduce your risk of prostate cancer, though study results haven’t always agreed. If you want to reduce your risk of prostate cancer, consider trying to:
Choose a low-fat diet. Foods that contain fats include meats, nuts, oils and dairy products, such as milk and cheese. In studies, men who ate the highest amount of fat each day had an increased risk of prostate cancer. While this association doesn’t prove that excess fat causes prostate cancer, reducing the amount of fat you eat each day has other proven benefits, such as helping you control your weight and helping your heart. To reduce the amount of fat you eat each day, limit fatty foods or choose low-fat varieties. For instance, reduce the amount of fat you add to foods when cooking, select leaner cuts of meat and choose low-fat or reduced-fat dairy products.
Eat more fat from plants than from animals. In studies that looked at fat and prostate cancer risk, fats from animals were most likely to be associated with an increased risk of prostate cancer. Animal products that contain fats include meat, lard and butter. When possible, use plant-based fats in place of animal fats. For instance, cook with olive oil rather than butter. Sprinkle nuts or seeds on your salad rather than cheese.
Increase the amount of fruits and vegetables you eat each day. Fruits and vegetables are full of vitamins and nutrients that are thought to reduce the risk of prostate cancer, though research hasn’t proved that any particular nutrient is guaranteed to reduce your risk. Eating more fruits and vegetables also tends to make you have less room for other foods, such as high-fat foods. Increase the amount of fruits and vegetables you eat each day by adding an additional serving of a fruit or vegetable to each meal. Eat fruits and vegetables for snacks.
Eat fish. Fatty fish — such as salmon, sardines, tuna and trout — contain a fatty acid called omega-3 that has been linked to a reduced risk of prostate cancer. If you don’t currently eat fish, try adding it to your diet.
Reduce the amount of dairy products you eat each day. In studies, men who ate the most dairy products — such as milk, cheese and yogurt — each day had the highest risk of prostate cancer. But study results have been mixed, and the risk associated with dairy products is thought to be small.
Drink green tea. Studies of men who drink green tea or take green tea extract as a supplement have found a reduced risk of prostate cancer. If you like to drink tea, consider choosing green tea.
Try adding soy to your diet. Diets that include tofu — a product made from soy beans — have been linked to a reduced risk of prostate cancer. It’s thought that the benefit of soy comes from a specific nutrient called isoflavones. Other sources of isoflavones include kidney beans, chickpeas, lentils and peanuts.
Drink alcohol in moderation, if at all. If you choose to drink alcohol, limit yourself to no more than a drink or two each day. There’s no clear evidence that drinking alcohol can affect your risk of prostate cancer, but one study found men who drank several drinks each day over many years had an increased risk.
Maintain a healthy weight 
Men with a body mass index (BMI) of 30 or higher are considered obese. Being obese increases your risk of prostate cancer. If you are overweight or obese, work to lose weight. You can do this by reducing the number of calories you eat each day and increasing the amount of exercise you do.
Bottom Line: If you are concerned about the risk of prostate cancer or if you have a family relative such as a father, brother, cousin or uncle with prostate cancer which will certainly increase your risk of prostate cancer, you may want to consider a dietary modification as I have described which may decrease your risk of developing prostate cancer.

Men, Having Trouble Urinating? A Pin In the Prostate May Cure Your Problem

September 29, 2013

Men with enlarged prostate glands have symptoms of going to the bathroom frequently, dribbling after urination, and getting up at night to go to the bathroom.  The problem is usually caused by a benign enlargement of the prostate gland, which blocks the flow of urine from the bladder to the outside of the body. 

Prostate, shown in yellow, with blockage of the urethra

Prostate, shown in yellow, with blockage of the urethra


The cause of the benign enlargement is not known but is probably related to alternations in the hormones, testosterone, of middle aged and older men.  Treatment usually consists of medications, alpha blockers and medications to actually relax the muscles in the prostate gland but these are often ineffective especially if used for long period of time.  The other options include minimally invasive procedures such as microwaves that can actually shrink the prostate gland.  Now there’s a new treatment option that will soon be available. 

The UroLift system, made by NeoTract Inc. of Pleasanton, Calif., is the first permanent implant to relieve low or blocked urine flow in men age 50 and older with an enlarged prostate.

By pulling back prostate tissue that presses on the urethra, the system allows more natural urine flow.  

4 pins in the prostate open the gland and allow improvement in urinary symptoms

4 pins in the prostate open the gland and allow improvement in urinary symptoms


The procedure can be done in the doctor’s office under a local anesthesia and will actually open up the urethra to allow the flow of urine and reduce the urinary symptoms of frequency of urination, improve the force and caliber of the urine stream, and decrease the number of times a man needs to get up at night to empty his bladder.

Of course with any procedure there may be side effects and complications.  Some patients reported pain or burning during urination, increased urgency, decreased urine flow, incomplete bladder emptying, and blood in the urine.  Most of these symptoms and side effects were temporary and resolved a few days or weeks after the Urolift was performed.

 

Bottom Line:  Millions of American men suffer from symptoms as a result of an enlarged prostate gland.  Certainly medications are a first line treatment option.  However, the Urolift may be a permanent solution to this common problem and help men get a good night’s sleep!

Eating and Exercising Your Way To Prostate Health and Preserving Your Potency

December 30, 2012

Location of prostate gland at the base of the bladder and surrounding the urethra

Location of prostate gland at the base of the bladder and surrounding the urethra


I am frequently asked by my patients “What can I eat to reduce my risk of developing prostate cancer?” This is one of the most common questions I am asked by men concerned about prostate health. Undoubtedly, many hope that their doctor will rattle off a list of foods guaranteed to shield them from disease. Although some foods have been linked with reduced risk of prostate cancer, proof that they really work is lacking, at least for now.
Aim for a healthy eating pattern
Instead of focusing on specific foods, dietitians, physicians, and researchers tout an overall pattern of healthy eating — and healthy eating is easier than you might think. In a nutshell, here’s what experts recommend:
1. Eat at least five servings of fruits and vegetables every day. Go for those with deep, bright color.
2. Choose whole-grain bread instead of white bread, and choose whole-grain pasta and cereals.
3. Limit your consumption of red meat, including beef, pork, lamb, and goat, and processed meats, such as bologna and hot dogs. Fish, skinless poultry, beans, and eggs are healthier sources of protein.
4. Choose healthful fats, such as olive oil, nuts (almonds, walnuts, pecans), and avocados. Limit saturated fats from dairy and other animal products. Avoid partially hydrogenated fats (trans fats), which are in many fast foods and packaged foods.
5. Avoid sugar-sweetened drinks, such as sodas and many fruit juices. Eat sweets as an occasional treat.
6. Cut down on salt. Choose foods low in sodium by reading and comparing food labels. Limit the use of canned, processed, and frozen foods.
7. Watch portion sizes. Eat slowly, and stop eating when you are full. One of my best suggestions that I have tried to adopt is to eat my entre from a smaller salad plate which makes the portion look bigger. Also, try eating with your non-dominate hand as this will slow down your eating. Finally, after you eat your first portion, wait 10-15 minutes before taking a second portion. This allows your brain to catch up with your stomach and will give you a feeling of satiety without overeating.

Stay active
In addition to eating a healthy diet, you should stay active. Regular exercise pares down your risk of developing some deadly problems, including heart disease, stroke, and certain types of cancer. And although relatively few studies have directly assessed the impact of exercise on prostate health, those that have been done have concluded, for the most part, that exercise is beneficial. For example:
1. Based on questionnaires completed by more than 30,000 men in the Health Professionals Follow-up Study, researchers found an inverse relationship between physical activity and BPH symptoms. Simply put, men who were more physically active were less likely to suffer from BPH. Even low- to moderate-intensity physical activity, such as walking regularly at a moderate pace, yielded benefits.
2. Using data from the Health Professionals Follow-up Study, researchers also examined the relationship between erectile dysfunction (ED) and exercise. They found that men who ran for an hour and a half or did three hours of rigorous outdoor work per week were 20% less likely to develop ED than those who didn’t exercise at all. More physical activity conferred a greater benefit. Interestingly, regardless of the level of exercise, men who were overweight or obese had a greater risk of ED than men with an ideal body mass index, or BMI.
Italian researchers randomly assigned 231 sedentary men with chronic prostatitis to one of two exercise programs for 18 weeks: aerobic exercise, which included brisk walking, or nonaerobic exercise, which included leg lifts, sit-ups, and stretching. Each group exercised three times a week. At the end of the trial, men in both groups felt better, but those in the aerobic exercise group experienced significantly greater improvements in prostatitis pain, anxiety and depression, and quality of life.

Bottom Line: There’s not much you can do about your genetics or what you inherited from your parents. But there’s a lot you can do by eating healthy and exercising regularly. Your prostate gland will thank you.

This article was modified from an article appearing in The Harvard HealthBeat on October 4, 2011 http://www.HarvardProstateKnowledge.org.

Take Two (Aspirin) and You May Not Need To Call Me In the Morning-Aspirin May Decrease Death From Prostate Cancer

August 28, 2012


A recent article from the New York Times reports that men treated for prostate cancer who took aspirin regularly for other medical conditions were less likely to die of their cancer than patients who weren’t taking aspirin. Prostate cancer is the most common cancer occurring among men and the No. 2 cancer killer of men.

The new report adds to a growing body of evidence suggesting that aspirin may play a beneficial role in the treatment and possibly the prevention of a variety of cancers including prostate and colon cancer.
In the new study looked at nearly 6,000 men who had localized prostate cancer and were treated with surgery or radiotherapy. Just over one-third of the men, or 2,175 of the 5,955, were taking aspirin.
Those taking aspirin were less than half as likely as those who were not to die of prostate cancer over a 10-year period. The prostate cancer death rate for those taking aspirin was 3 percent, the researchers found, compared with 8 percent for those who did not. The aspirin users were also significantly less likely to experience a recurrence of prostate cancer or have the disease spread to the bones, the study found.

The study is not the first to find a reduction in recurrence among prostate cancer patients who took aspirin. Researchers at the Fox Chase Cancer Center in Philadelphia reported this year that among 2,051 prostate cancer patients, those not using aspirin were twice as likely to experience a recurrence within 18 months, as detected by rising scores on the prostate-specific antigen test, a strong predictor of metastasis and survival.

While many Americans, inclduing myself, use baby aspirin to reduce their risk of heart disease, taking aspirin regularly is risky. Patients generally are advised to do so only when their cardiac risk is presumed to outweigh the risks, which include an increase in gastrointestinal bleeding and hemorrhagic stroke.
Dr. Otis Brawley, chief medical officer of the American Cancer Society, said he believes that aspirin’s anti-inflammatory properties may play a role in the prevention of both heart disease and cancer.

Bottom Line: Aspirin may be helpful for preventing heart diease and preventing recurrence of prostate cancer. It’s inexpensive, readily available, and has very risks and complications. Check with your doctor before embarking on aspirin therapy. Remember, an aspirin a day may keep the prostate cancer away

Prostate cancer test promising- A Simple urinalysis might lead to more-precise diagnoses

February 6, 2012

Prostate cancer test promising
Urinalysis might lead to more-precise diagnoses.

Researchers said Thursday they are closer to developing a urine test that can better detect which prostate cancers are aggressive and potentially life-threatening.
Such a test would be welcome. More than half of prostate cancers are slow growing and unlikely to kill, and experts say watchful waiting is the best option for many patients — especially if doctors were better able predict their course.
Currently, biopsies — in which several small tissue samples are taken from different parts of the prostate — are used to try to identify large, aggressive tumors.
The hope is that an accurate urine test might in some cases replace the need for biopsy, while easing fears in men who opt to delay or forgo treatment.
The study included 401 men, about 70 from San Antonio, who were picked because doctors thought their cancers were low-risk and good candidates for watchful waiting. Of those, the urine test found about 10 percent had more aggressive disease, making them candidates for surgery — results that were confirmed by biopsy.
Prostate biopsies are invasive and don’t always pick up all of the cancer. Post-digital-rectal exam urine collection is much less invasive. If a urine-based diagnostic test could be developed that could predict aggressive disease or disease progression as well as or better than a biopsy, that would be ideal.
The urine tests, PCA3 and T2-ERG, together provide a kind of genetic profile of the cancer. Added to the current PSA test, a digital rectal exam and factors such as age, race and family history, they could help doctors make more accurate predictions if the results are confirmed in the larger study.

Bottom Line: Ultimately, doctors would like to be able to have these tests and be able to confirm the man has a low-risk cancer which means less treatment, less complications, less side effects, and longer survival. Instead of seeing the patient every six months and doing a biopsy every two years, your doctor might tell men with low risk cancers: “You have a low-risk cancer, see you in five years.”

Read more: http://www.mysanantonio.com/news/local_news/article/Prostate-cancer-test-promising-2969055.php#ixzz1lbdmooJc

PSA Screening-Advice From A Doctor On the Front Line and In The Trenches

October 30, 2011

What are the symptoms of early prostate cancer? Answer: there are NO early symptoms of prostate cancer. At this time, the ONLY way to diagnose prostate cancer is the PSA test or prostate specific antigen blood test.
The PSA test, which measures the amount of PSA protein released into blood, is by far the best tool I have for detecting this dreaded disease. A high PSA reading is a clear red flag. Because this type of cancer is almost always asymptomatic at first, the PSA — to a much greater extent than the annual digital rectal exam — is my best way to find it.
With over 200,000 new cases of prostate cancer every year in the USA, and more than 30,000 deaths (this number is decreasing because of the PSA), prostate cancer is the second leading cause of cancer death among American men.
Two large long-term European studies showed a 30 percent-50 percent reduction in death from prostate cancer as a result of PSA screening. Even though not all studies showed the same dramatic results, to cast aside this test — seemingly on a whim — is bad public policy that appears to treat life with little regard. And mortality rates don’t tell the whole story: without the PSA, prostate cancer would often be detected at an advanced stage, leading to more suffering for the patient.
PSA screening is the way most prostate cancers are diagnosed today. Without the test, many men will learn of their prostate cancer well after there is a chance to cure the cancer.
This month, the U.S. Preventive Services Task Force said there’s no evidence that routine PSA (prostate-specific antigen) testing saves lives. For the vast majority of men, the panel said, it may cause more harm than good. And last Monday, a study by Dartmouth College cast fresh doubt on the value of mammograms in fighting breast cancer. I, as well as most of my colleagues, am outraged at the publicity given to a recent report that suggests that men should not be screen for prostate cancer.
Of course we will diagnose some indolent cancers and miss lethal ones, and perhaps some doctors and frightened patients will rush forward rather than proceeding with caution. But finding exactly how and when to react to a rising PSA is part of the art of medicine.
If we cast aside the PSA, fewer men will become impotent or suffer the discomfort of additional testing. But more men will die.

Bottom Line: So what is my recommendation and the bottom line? There certainly is a role for cancer screening including prostate cancer and breast cancer. This is a decision that each man needs to make with the advice of his\her doctor.

Finding Prostate Cancer Recurrence After Treatment With Surgery

August 10, 2011

Finding Prostate Cancer Recurrence After Treatment With Surgery
A new test could reliably detect early increases in prostate specific antigen (PSA) levels — a biomarker commonly used to measure the recurrence of prostate cancer — in men who have undergone prostate cancer-treating surgery. Earlier detection of these rising levels would allow men with cancer recurrence to undergo earlier, more effective treatment for potentially better outcomes.
The new test is the “AccuPSA, which is a simple blood test that can tell your doctor important information about prostate specific antigen levels after radical prostatectomy or removal of the entire prostate gland. AccuPSA has the potential to eliminate unnecessary treatments and enable earlier detection of recurrence, which may lead to earlier treatment, better outcomes.
After undergoing radical prostatectomy, many men remain at a significant risk for cancer recurrence. Because of this, patients are monitored very closely for rapid increases in PSA, which may signal cancer recurrence. Once the prostate is surgically removed, PSA levels are usually undetectable using standard tests. This new test is able to detect PSA with unprecedented sensitivity, and at much lower levels than standard PSA tests because it can selectively capture and measure individual PSA molecules.
What this new test might mean for a post-radical prostatectomy patient is that a low level of PSA could indicate if the patient is effectively considered cured.
Excerpted from: http://www.sciencedaily.com/releases/2011/08/110808104618.htm

Prevent Prostate Cancer-Try a Tomato

June 22, 2011

That wonderful, tasty fruit\vegetable just may be what the doctor ordered for prostate cancer prevention.  The primary nutrient behind tomatoes’ healing power is lycopene, a powerful antioxidant that works by neutralizing free radicals which can be a cause of cellular damage leading to the development of prostate cells becoming cancerous.  Eating foods that are high in lycopenes protects against a wide range of cancers, from prostate cancer to lung and breast cancer.

There’s more good news.  Tomatoes can also help prevent heart attacks by lowering cholesterol levels.  Lycopenes also increase bone mineral density and may be protective against hip fractures.  Also, lycopenes can help prevent type-2 diabetes.

It is estimated that three or more servings a week of tomatoes are adequate for the purpose of prostate cancer prevention.

Bottom Line:  No one is certain about what causes prostate cancer.  However, we do know that dietary abuses are partly responsible for the cause of prostate cancer.  We also know that certain supplements including lycopenes can be helpful in preventing prostate cancer.  So in addition to your apple to keep the doctor away, throw in a few tomatoes.

Watchful Waiting May Be An Option for Low-Grade Prostate Cancer

June 19, 2011

A recent report coming from research at Johns Hopkins University demonstrated that men with very low-grade prostate cancer may be able to be observed closely for any progression and avoid or delay treatment.  The study included over 700 men with localized prostate cancer that was very low-grade or not very malignant who were followed every six months with PSA testing and a rectal exam and a prostate biopsy every year.  Since 1995 none of the men has died from prostate cancer.  One-third of the men had to undergo subsequent treat five or even 10 years later because their PSA increased for their biopsy showed a more aggressive form of cancer was present in the prostate gland.

Nearly 60 percent of men enrolled were able to defer treatment for 5 years or longer and > 40 percent were able to defer treatment for 10 years or longer. This means they were also able to defer all risks associated with active treatment (incontinence, erectile dysfunction, bowel problems associated with radiation therapy, etc.).

Bottom Line: This study offers good evidence that watchful waiting may be an option for older men diagnosed with a very low-grade prostate cancer.  However, these men must be committed to regular follow up.