Latest Dietary Advice for Prostate Cancer – Renal and Urology News

A range of foods, nutrients, and dietary patterns are being studied for prostate cancer prevention or treatment, according to a 2015 research review.

Source: Latest Dietary Advice for Prostate Cancer – Renal and Urology News

While the ideal diet prescription has yet to be determined, the investigators suggest counseling men with these tips, in line with emerging research and a heart healthy diet:

  • Increase fruits and vegetables.
  • Replace refined carbohydrates with whole grains.
  • Reduce total and saturated fat intake.
  • Avoid overcooked meats (such as charred barbecue).
  • Consume fewer calories (by reducing carbohydrates, for example) to achieve a healthy body weight.

Men often ask about dietary changes if they have prostate cancer.  I have been telling them for years to follow a heart healthy diet, which also will help with their prostate cancer.

Study: MRI Missed 1 in 6 High-Grade Prostate Cancers

Study: MRI Missed 1 in 6 High-Grade Prostate Cancers.

The much ballyhooed multiparametric (mp) MRI does not appear to be suited as stand-alone test for diagnosing prostate cancer after an elevated PSA, according to new research.

The expensive and powerful technology failed to identify 16% of men with high-grade cancer (Gleason score ≥7) in a prospective study of 1044 men with an elevated PSA.

This study looked at patients who had negative MRI searching for prostate cancer. It found that the MRI missed almost half of all prostate cancers, but more importantly, missed 1 in 6 moderately aggressive cancers which are the ones that most need treatment.

I have been using MRI as a tool to help stratify the risk of prostate cancer, but I do not rely solely on the MRI results.

Mist worrisome to me is that at some place, radiologists are the only specialists trying to diagnose prostate cancer.

In my opinion, MRIs are useful, as our are radiology colleagues in helping to read the MRIs, but this should be done with the leadership of a urologist.

3D vs 2D laparoscopic radical prostatectomy in organ-confined prostate cancer: Comparison of operative data and pentafecta rates: A single cohort study – Abstract

3D vs 2D laparoscopic radical prostatectomy in organ-confined prostate cancer: Comparison of operative data and pentafecta rates: A single cohort study – Abstract.

This study shows one surgeons experience performing laparoscopic prostatectomy with 3d vision. There are headsets that doctors can wear to overcome the 2d limitation of conventional surgery. The 3d vision improved outcomes. This is an expected results since surgeons that can see better can perform more accurate surgery. Robotic surgery has the advantage of 3d vision, as well as allowing the surgeon to make more precise movements based on the dexterity of the waisted instruments.

Statins Benefit ADT-Treated Prostate Cancer Patients | Cancer Network

Prostate cancer patients starting treatment with androgen deprivation therapy (ADT) who were already taking cholesterol-lowering statins had a 10-month prolonged time to cancer progression compared with patients who were not on statins, according to the results of a new study published in JAMA Oncology. – See more at: Statins Benefit ADT-Treated Prostate Cancer Patients | Cancer Network.

This study reported men starting on hormonal therapy who already were taking statin therapy for high cholesterol had better results than men not taking statins.

There have been many studies that show that taking statins help reduce the risk of prostate cancer recurrence.

I encourage patients that have borderline high cholesterol to speak to their primary care doctors about starting on statin therapy.

Lower PSA Predicts Favorable Salvage Radiotherapy Outcomes – Renal and Urology News

The overall median follow-up was 63.5 months. The 5-year BCR-free survival rate was 58.2% for the cohort overall and 76.2% for the 118 patients 55.7% who had early salvage RT, defined as RT started when the PSA level was 0.5 ng/mL or less, the investigators reported online in PLoS One

via Lower PSA Predicts Favorable Salvage Radiotherapy Outcomes – Renal and Urology News.

When patients have a PSA that rises over 0.1 after robotic prostatectomy, they likely have recurrent prostate cancer somewhere. This study shows that patients treated with salvage XRT (external beam radiotherapy) had better results if the treatment was started below a PSA of 0.5.

Personally, in the patients who are good candidates for salvage XRT, I prefer to start the radiation after the PSA goes higher than 0.2 and sometimes lower.

Penile Shortening After Prostate Surgery Temporary – Renal and Urology News

At six months, men who took a daily PDE5i had no SFPL loss, whereas those who did not take a PDE5i consistently had a significant mean 4.4 mm SFPL loss compared with baseline.“The present study is among the first to show preservation of SFPL in patients using daily PDE5i as compared with those patients not using regular PDE5i,” the authors wrote.

via Penile Shortening After Prostate Surgery Temporary – Renal and Urology News.

There have been reports of men having shorter penises after prostate cancer surgery for many years. This study looked at stretched flaccid penile length (SFPL) in men who were given phosphodiesterase inhibitors, like viagra, levitra, or cialis.

I have been recommending PDE5i for men for many years since the data shows that men who have good preoperative sexual function are more likely to have return of erectile function in assorter time if they take these medications after surgery. The same medication is used to have a full erection, but this use is more for penile rehabilitation after surgery.

This study shows taking PDE5i also helps prevent the shortening of the penis by 4.4 mm. This is about 1/5 of an inch.

LUGPA position aims to clarify prostate cancer screening | Urology Times

In an attempt to clarify what it calls conflicting guideline statements on prostate cancer screening from various organizations, the Large Urology Group Practice Association (LUGPA) has issued its own position on the use of the PSA test as a screening tool.

“Unfortunately, these conflicting statements have resulted in confusion amongst both our patients and fellow physicians,” said Deepak A. Kapoor, MD, president of LUGPA. “It should be made clear that a PSA test is simply a tool that facilitates informed decision making; it is neither a commitment to have a biopsy nor an obligation to receive treatment should prostate cancer be detected.”

According to a LUGPA press release, after careful evaluation of previously published guidelines and thorough review of recent statements from the European Association of Urology and the Prostate Cancer World Congress, the LUGPA Board of Directors, in consultation with thought leaders in the diagnosis of prostate cancer, unanimously adopted the following official position on PSA screening:

Risks of prostate cancer screening must be uncoupled from risks of prostate cancer detection and treatment.

PSA testing facilitates the early detection of prostate cancer, which results in a reduced risk of being diagnosed with or developing locally advanced and/or metastatic prostate cancer, and a reduction in prostate cancer-specific mortality.

A baseline serum PSA level should be obtained in men in their 40s who have made an informed decision to pursue early detection of prostate cancer.

Intervals for an individual’s prostate cancer screening should be adapted to: baseline PSA, prostate cancer risk factors (including African-American heritage and a family history of prostate cancer), and the potentially short preclinical timeline of aggressive cancers.

PSA screening should be offered to men with a life expectancy of greater than or equal to 10 years, regardless of age.

PSA testing should not be considered on its own, but rather as part of a multivariable approach to early prostate cancer detection.

via LUGPA position aims to clarify prostate cancer screening | Urology Times.

 

This is the best recommendation I have seen from any medical entity to help diagnose prostate cancer for men whose life has a high chance of being impacted by the disease.

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.

Pivotal data on radium in PCa published in NEJM | Urology Times

“The publication of the ALSYMPCA data in the New England Journal of Medicine is important, as it will provide physicians with comprehensive data on this recently approved treatment that has demonstrated overall survival in men with castration-resistant prostate cancer, symptomatic bone metastases, and no known visceral metastatic disease,” explained North American principal investigator Oliver Sartor, MD, of the Tulane Cancer Center, New Orleans.

via Pivotal data on radium in PCa published in NEJM | Urology Times.

Prostate cancer frequently spreads to bones if it escapes the prostate. In the ALSYMPCA (ALpharadin in SYMptomatic Prostate CAncer) trial, Radium was shown that it can be safeyl injected into patients with pain from prostate cancer spreading to bones. It was shown to improve survival for these patients, as well as decrease the need for narcotics and radiation therapy for the bone metastases.

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.

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