Dr. Krieger and Dr. Savatta discuss prostate cancer and PSA screening

In June of 2013 I joined my partner and president of UGNJ, Alan Krieger, MD to educate the public about prostate cancer.

Recently a governmental agency recommended against prostate cancer screening with PSA without recommending a replacement for PSA. We had a thorough discussion about the need to screen for prostate cancer and what men and their loved ones should know about the prostate.

Swedes Stop Inappropriate Prostate Cancer Imaging

"The joint campaign by local county governments and the National Prostate Cancer Register [NPCR] of Sweden, which is an association of Swedish urologists, was incredibly effective at stamping out inappropriate imaging," lead author Danil V. Makarov, MD, from the NYU Langone Medical Center in New York City, told Medscape Medical News.

However, the campaign also decreased appropriate imaging in men with high-risk prostate cancer. The rate of appropriate screening in high-risk cancer patients fell from 63% to 43% over the same 10 years.

via Swedes Stop Inappropriate Prostate Cancer Imaging.

This is Medscapes summary of an article published 2 weeks ago in the Journal of the National Cancer Institute.

The AUA has recommended that patients with low stage prostate cancer do not have metastatic imaging tests for many years. The European community has similar guidelines. The Swedish government has linked itself with urologists and has dropped the rate of imaging from 45% to 3%. This is a positive finding since it saves cost in a rational way and prevents patients from having testing that sometimes leads to more testing and radiation exposure.

One troubling finding is that the patients who need imaging, the high risk patients have had a drop in their testing from 63% to 47%. If the reason why the testing for low risk patients dropped was that urologists were following guidelines more accurately, than there should have been a comparable increase in the appropriate testing of high risk prostate cancer patients. Since this didn’t happen, one has to question why there was a drop in both.

Once concern I have had about government involvement is that testing would be limited with the priority being to save health care expenditures.

As the affordable care act becomes implemented, we will need to see what changes doctors and patients will need to make.

Shared decision-making uncommon for PSA tests | Reuters

They found 64 percent of those men had not discussed the pluses and minuses of PSA tests with their doctors, or the scientific uncertainty of their effect. Of the rest, about half had talked only about the advantages of screening.

About 44 percent of study participants hadn’t been screened for prostate cancer in the past five years. The majority of those – 88 percent – reported no discussions regarding that choice, according to findings published in the Annals of Family Medicine.

via Shared decision-making uncommon for PSA tests | Reuters.

There was a study done in the Annal of Family Medicine that found that almost half of men have not been screened for prostate cancer in the last 5 years. Most of these did not have a discussion with their doctors as to whether they should be screened.

As a urologist who specializes in prostate cancer, I am concerned that we will have more men presenting with metastatic prostate cancer in the years to come.

Diet changes reduce all-cause mortality risk in prostate cancer patients | Urology Times

The authors found that men who replaced 10% of their total daily calories from carbohydrates with healthy vegetable fats had a 29% lower risk of developing lethal prostate cancer and a 26% lower risk of dying from all causes.

Adding a single serving of oil-based dressing per day (one tablespoon) was associated with a 29% lower risk of lethal prostate cancer and a 13% lower risk of death, the authors found. And adding one serving of nuts per day (one ounce) was associated with an 18% lower risk of lethal prostate cancer and an 11% lower risk of death.

via Diet changes reduce all-cause mortality risk in prostate cancer patients | Urology Times.

I have been telling patients for many years about eating a heart healthy diet. This study reveals that replacing calories from carbohydrates and animal fat with vegetable fat will help prevent prostate cancer deaths and deaths from other causes.

An easy way to accomplish this is to have a small portion of nuts with dinner as a replacement for sweets or animal fat.

Intuitive Robot Probe Threatens Trend-Setting Surgeries – Bloomberg

The safety of robots made by Intuitive Surgical Inc. (ISRG) is being probed by U.S. regulators, raising questions about the prospects of one of the hottest technologies in health care.

The Food and Drug Administration asked surgeons at key hospitals to list the complications they may have seen with the machines, which cost about $1.5 million each and were used last year in almost 500,000 procedures. The doctors were also surveyed on which surgeries the robots might be most and least suited for, and asked to discuss their training, according to copies of the survey obtained by Bloomberg News.

via Intuitive Robot Probe Threatens Trend-Setting Surgeries – Bloomberg.

Bloomberg has reported that The FDA has inquired into complications resulting during robotic surgery.  I believe this inquiry is targeted towards gynecologic surgery.

I have been involved with robotic surgery for 9 years and have seen many different instruments and different robotic platforms (davinci, davinci S, davinci Si).  There is inherent risk in any surgical procedure, whether surgery is performed robotically, laparoscopically, or with an open incision.  I believe an experienced surgeon and team can  lead to lower complication rates and I do feel that robotic surgery is inherently safer in that it has a lower complication rate in my personal experience at least.

Green Tea May Inhibit Prostate Cancer Tumor Growth – Renal and Urology News

Drinking green tea may play a role in the inhibition of prostate cancer tumor growth, according to a study presented at the American Association for Cancer Research’s International Conference on Frontiers in Cancer Prevention Research in Anaheim, Calif.

via Green Tea May Inhibit Prostate Cancer Tumor Growth – Renal and Urology News.

Green tea is one of the drinks that I think is helpful for men with prostate cancer.  This study showed intracellular changes seen in prostate cancer cells in men that were drinking it.

Domenico Savatta, MD FACS selected as “Top Cancer Doctor”

Domenico Savatta, M.D., graduated Tau Beta Pi, and summa cum Laude from The Cooper Union with a B.S. in engineering. He then attended SUNY Stony Brook School of Medicine and was an AOA graduate. Thereafter, he completed a residency in urology at the prestigious Indiana University Medical Center, world renowned for the treatment of testicular cancer and other urologic malignancies. Dr. Savatta has combined his undergraduate training in engineering with his surgical training in open and laparoscopic surgery to provide state-of-the-art treatments for urologic disorders. Dr. Savatta has been pioneering robotic surgery since 2004 when he performed the first robotic prostatectomy in Essex county. He has contributed to the field of urologic robotic surgery by publishing papers with national leaders describing how to perform robotic inguinal hernia surgery during robotic prostatectomy and robotic partial nephrectomy for kidney cancer. He performed the first robotic surgeries in New Jersey for bladder and kidney cancer in 2005 and has performed over 1300 robotic surgeries. He has developed techniques for robotic prostatectomy that allows for an earlier return of urinary control and less postoperative pain. Dr. Savatta’s goal is to provide the most compassionate and informative care while preserving and maximizing patients quality of life.

via Domenico Savatta, MD FACS in West Orange, New Jersey 07052 – NJ.com.

I was recently selected by Inside NJ as one of the “top cancer doctors”in New Jersey

They got it wrong again – www.phillyburbs.com: Reader Voices

While prostate cancer is still the second leading cause of death for American men, early detection and advanced treatments have combined to reduce the mortality rate from prostate cancer by nearly 40 percent in the last two decades. During that same time period, we have seen dramatically less metastatic disease than in my earliest days of treating men with prostate cancer in New Jersey 25 years ago before the PSA screening era.

via They got it wrong again – www.phillyburbs.com: Reader Voices.

This editorial was written by a colleague of mine at Garden State Urology in response to the USPSTF Final Recommendation on PSA Screening states that men should not receive PSA testing.

As a urologist who deals with prostate cancer on a regular basis, this is an extremely disappointing recommendation.  The issue will remain in the forefront of health care debates in the months and years to come.

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