Radical Surgery Hard to Justify for Low-Risk Prostate Cancer

RUN > Urology > Prostate Cancer > Radical Surgery Hard to Justify for Low-Risk Prostate Cancer

Jody A. Charnow

April 23, 2012

Radical prostatectomy (RP) for prostate cancer (PCa) is difficult to justify for patients with Gleason 6, T1 disease, researchers concluded.

These patients have a relatively low risk of cancer-related death and metastasis. “Such patients would appear appropriate for an active surveillance program, with curative treatment considered for state or grade progression,” they reported online ahead of print in European Urology.

Andrew Vickers, MD, ofMemorialSloan-KetteringCancerCenterinNew York, and colleagues analyzed data from 695 men with T1 or T1 PCa who participated in the Scandanavian Prostate Cancer Group 4 trial. At age 65, the 10-year predicted cumulative incidence of PCa mortality associated with RP (versus watchful waiting) was 4% among men with Gleason 6, T1 disease. The 10-year predicted cumulative incidence of metastasis was 6%.

Little expected benefit was associated with surgery much beyond age 70, the investigators noted.

“Our findings can be used to counsel individual patients who are considering treatment options for localized prostate cancer,” the authors noted.

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Warren Buffett diagnosed with prostate cancer

Billionaire investor Warren Buffet was diagnosed with prostate cancer this year. The 81 year old chairman and CEO ofBerkshireinvestors, was diagnosed with stage 1 prostate cancer. Warren Buffett’s decision to undergo radiation therapy for Stage 1 prostate cancer has refocused attention on a debate of screening and treating older men for a disease that most often kill them.

“Generally, in a person over 80 years old, you’d be very hesitant to treat a prostate cancer unless it’s clearly life-threatening,” said Dr. Peter Scardino, chairman of the surgery department atMemorialSloan-KetteringCancerCenterinNew York. “Doctors caution men that at that age, prostate cancer is very common. Most of the time it’s not dangerous to their life or their health. It’s unusual, in our experience, to treat someone over 80, although I’ve done it.”  No doctor wants to second guess Buffet’s decision, especially without at least two key pieces of information that he didn’t disclose when he announced his diagnosis last Tuesday: PSA and his Gleason score. This could help determine how aggressive the tumor is.

“Although stage 1 prostate cancer, by definition, hasn’t spread beyond the prostate gland, you could still have stage 1 and have an aggressive tumor,” said Dr. Patrick Walsh, a urology professor at Johns Hopkins Medical Institutions inBaltimore. While acknowledging the he didn’t have the important details of Buffett’s case, Dr. Walsh suggested that “the fact that he is waiting three months to begin radiation suggests to me that he might be going to receive neoadjuvant hormonal therapy and that is consistent with more aggressive disease.”

CPC neither aggress nor disagrees with the prostate cancer specialists, it is mainly the patients decision if they would like treatment. We do encourage men who have atleast a 10 year life expectancy to consider treatment. Mr. Buffett could have an excellent quality of life and live for another 15-20 years.

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New Study confirms PSA screening saves lives

For the past 20 years studies have shown a nearly 40% decrease in deaths from prostate cancer, although there has been no increase in incidence during this interval. A follow-up study of the European Randomized Study of Screening for Prostate Cancer was published in the New England Journal of Medicine. The study confirmed what physicians have known for years: PSA screening is a valuable life-saving tool. Six months ago, the U.S. Preventive Task Force recommended that healthy men should no longer receive PSA tests as a part of their routine cancer screening. This decision against routine PSA screening was made by a panel that does not include urologists or oncologists.

Dr. Deepak A. Kapoor wrote, “What is particularly disturbing about all this discussion is that PSA screening itself is not a treatment, but merely a simple blood test. There are essentially no risks to screening, and with screening results, patients have the information they need to make a better informed decision about their health.” Dr. Kapoor also stated “the decision on how to screen and treat prostate cancer should stay where it has always been: between the patients and their physicians.”

CPC agrees with Dr. Kapoor. Prostate cancer screenings, which include the PSA blood test and digital rectal exam, help detect prostate cancer in the earlier stages. Patients should be able to get all of the information possible to make an informed decision regarding their health.

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Data Show 15 Percent Drop in Prostate Cancer Deaths

Each year more men are being diagnosed with prostate cancer, but fewer men are dying from the disease. Data from the North American Association of Central Cancer Registries and the national Center for Health Statistics, Centers for Disease Control and Prevention show that in 2002, incidence rates of prostate cancer will increase slightly, while death rates from the disease will decrease. Skip Lockwood, CEO of Zero – – The Project to End Prostate Cancer said “This year alone, more than 241,000 men will be diagnosed with prostate cancer and more than 28,000 will die from the disease.” Because of early detection efforts, more than 90% of prostate cancers are discovered in the local or regional stages. When prostate cancer is detected in the earlier stages, the survival rate approaches 100%. For reasons still unclear, prostate cancer incidence rates are significantly higher in African Americans than in Caucasians, and death rates in African Americans remain more than twice as high as those in Caucasians. Other risk factors for prostate cancer include age and family history of the disease.

CPC encourages men to consult with their physicians and make an appointment to have their PSA (prostate specific antigen)checked along with a DRE (digital rectal exam), to maintain a healthy prostate.

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Prostate Cancer Radiation is Expensive

In a study of prostate cancer treatments comparing external radiation therapy, brachytherapy (radiation seed implant) and prostatectomy (surgical removal), researchers found that brachytherapy was the most economic option for patients and was also associated with the least side effects. Researchers from the Cleveland Clinic analyzed data on 137,427 prostate cancer patients to compare external-based radiation therapy against prostatectomy and brachytherapy.

The lead author and Cleveland Clinic Radiation Oncologist, Jay Ciezki, M.D. stated, “We were able to get a good picture of the long-term costs of patient care and we were surprised to see such dramatic differences among the three treatment strategies.”

External Radiation therapy, such as IMRT, was the most expensive option, double the cost of a prostatectomy or brachytherapy. External Radiation therapy or IMRT, also had the highest rate of urinary bleeding or scarring, with 7.1 % of patient’s developing problems, compared to prostatectomy at 6.7 % and 3.4 % for brachytherapy.

Brachytherapy (seed implant) is a one time, out-patient procedure, where small, radioactive seeds are placed inside the prostate tumor to kill the cancer.

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High Milk Intake Linked to Prostate Cancer

Researchers at theUniversityofIcelandinReykjavikperformed a study on milk intake during puberty in men. The study group was comprised of 8,894 men born between 1907 and 1935 inIceland. Through linkage to cancer and mortality registries, the men were followed for prostate cancer diagnosis and mortality from study entry (in waves from 1967 to 1987) through 2009. From 2002-2006, a subgroup of 2,268 participants reported their milk intake in early, mid-, and current life. During a 24-year follow-up, 1,123 men were diagnosed with prostate cancer, including 371 with advanced disease. Men who spent the first 20 years of life nearReykjavikwere 29% less likely to be diagnosed with advanced prostate cancer, compared with those who as teens lived in the rural areas. Among men who were born before 1920, the risk was 64% higher for men in the rural areas, compared with those in nearReykjavik.

This study also states that they are not suggesting for teenage boys to avoid milk products. The researchers support the idea that milk from cows is designed for baby cows. All mammals produce a species-specific type of milk. It is not necessary to consume milk products; other sources of calcium are plentiful, such as calcium-fortified orange juice, calcium-fortified soy milk, or calcium tablets.

CPC recommends maintaining a healthy life style, getting your annual PSA checks and consulting your physician for any health concerns you have.

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Prostate Cancer Hormonal Therapy Cuts Deaths, Report Says

According to a new review of men with aggressive prostate cancer, hormone-targeted therapy cuts the overall risk of death. It also does not increase the chances of men dying from cardiovascular disease, which some researchers suggested might be the case.

Dr. Paul Nguyen, lead author of the study from the Dana-Farber Cancer Institute and Brigham and Women’s Hospital inBostonsaid; “I think that these results should be very reassuring for the majority of patient’s who are thinking of androgen deprivation therapy for their prostate cancer.”  The study consisted of 2,500 men that were treated with androgen deprivation therapy for three months or more, and 2,300 that were not. During the follow-up period, 38% of men undergoing hormone-targeted therapy died compared to the higher death rate of 44% of men who did not undergo hormone therapy. When the researchers looked specifically at the deaths caused by prostate cancer, they noted that 14% of men on hormone therapy died from prostate cancer, compared to 22% that were not. There was no extra risk of cardiovascular death from the hormones. “Our study does not leave ADT off the hook in terms of causing things like increased insulin resistance and diabetes. There could very well still be some adverse cardiovascular consequences that don’t lead to death.” Nguyen stated.

This study was on patients with intermediate to high-risk prostate cancer. CPC recommends for patient’s to always consult with their physicians regarding all treatment options.

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Well-Done Red Meat May Increase Risk for Aggressive Prostate Cancer

Researchers from the University of California, San Francisco offer further evidence of a link between aggressive prostate cancer and meat consumption, and suggest it is driven largely by consumption of grilled or barbecued red meat, especially when it is well-done.

The researchers embarked on the study because although established, the link between meat consumption and prostate cancer was not clear. They questioned whether inconsistency reflects an effect whereby different types of tumors are linked to different types of meat preparation, due to different cancer-causing compounds, or carcinogens.

The study consisted of 470 men with aggressive prostate cancer and 512 matched controls that did not have prostate cancer between 2001 and 2004. Each participant completed a questionnaire that enabled the researchers to access not only their meat intake for the past 12 months, but also the type a meat and how the meat was prepared.

The researchers found that:

  • The higher consumption of any ground beef or processed meats was positively linked with aggressive prostate cancer, with ground beef showing the strongest association.
  • Men who ate high levels of well or very well cooked ground beef had twice the odds of developing aggressive prostate cancer compared to the men who ate none. Low consumption raised the odds to 1.5.
  • In contrast, no such link was found between consumption of rare or medium cooked ground beef and aggressive prostate cancer.
  • Looking at the potential carcinogens by cooking meat at high temperatures, they detected an increased risk of aggressive cancer.

CPC recommends annual prostate screening which includes PSA (prostate specific antigen) and digital rectal exam (DRE). Talk to your doctor about maintaining a healthy diet and lifestyle.

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How to Treat Male Menopause

As men age, their total serum testosterone level decreases during the third decade of life and gradually declines by 0.4-2.6. By the age of 60, 20% of the general population is termed testosterone deficient. Many physicians are reluctant to prescribe testosterone therapy, as they have been educated in the past that elevated testosterone levels can cause metastatic prostate cancer.

This data came from researches by the name of Huggins and Hodges. Their study analyzed men that previously had prostate cancer and were treated with brachytherapy, radical prostatectomy or radiation therapy. The men who received testosterone therapy had low-grade prostate cancer without evidence of metastatic disease. Eight out of the nine studies that they reviewed did not show a significant recurrence of the disease with the presence of testosterone therapy; however they did find a positive impact on treating symptoms of androgen deprivation.

If you feel that you are a candidate for testosterone therapy, discuss with your physician the various treatment options. If you do undergo therapy, remember to get your annual digital rectal exam, as well as PSA (prostate specific antigen) to monitor change.

CPC recommends patients always ask their physicians for all treatment options and to also have annual prostate screenings which includes PSA (prostate specific antigen) and a DRE (digital rectal exam).

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Doctors defend prostate screening, PSA test does more good than harm, many argue, and saves lives

Doctors across the US are arguing with the U.S. Preventive Task Force recommendations to prevent healthy men of all ages to have their PSA’s checked, stating that PSA(prostate specific antigen) screening helps diagnosis early stages of prostate cancer. The physicians do understand that early detection of prostate cancer can often lead to unnecessary surgeries and radiation treatment, which can cause life-altering side effects, even though they don’t always extend the life of the patient. They also believe that if the physicians used up-to-date guidelines and techniques, the task force’s concerns would be minimized.

Dr. Scott Eggner, urologic oncologist at the University of Chicago Medical Center stated “In general, I think it’s a bad idea to encourage all young healthy men to stop getting tested. PSA screening definitely saves lives.”

CPC agrees with the physicians. PSA screening along with a digital rectal exam is the best option available to detect prostate cancer.

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