Prostate Cancer Radiotherapy Hikes Risk of Second Cancers – Renal and Urology News

A total of 570 patients were diagnosed with second cancers. The rate of second cancers was 15.5/1,000 person-years in radiotherapy recipients compared with 11.4/1,000 person-years in those not treated with radiation, a difference that translated into a 25% increased relative risk of second cancers in radiotherapy recipients. Compared with men not treated with radiation, those who were had a 60% increased risk of lung cancer, after adjusting for age, race, education, family history of cancer, smoking, and chronic obstructive pulmonary disease.

via Prostate Cancer Radiotherapy Hikes Risk of Second Cancers – Renal and Urology News.

This study looked at men involved with NCIs Prostate, Lung, Colorectal, and Ovarian Cancer trial. It found men that underwent radiation had a higher chance of contracting lung cancer later in life. This is an interesting finding which would not be expected since the lungs are not in the radiation field. The same patients radiation patients did not have a higher risk of developing bladder cancer as compared to the surgical patients. This is in contrast to past studies that found a higher risk of developing bladder cancer for patients that received radiotherapy, especially if they were prior smokers.

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.

Radical Prostatectomy May Prevent LUTS Progression – Renal and Urology News

A prospective study of 1,788 men who underwent RP found that men who had clinically significant LUTS preoperatively experienced a decline in LUTS severity and remained stable over a 10-year interval, researchers reported. Prior studies have shown a progressive increase in LUTS for aging men with an intact prostate.

via Radical Prostatectomy May Prevent LUTS Progression – Renal and Urology News.

One of the areas that is affected after prostatectomy is urinary function. Men are counseled that there will be urinary leakage (incontinence) after surgery.

I have been telling men for over 10 years that their urinary stream will improve and bothersome urinary symptoms of frequency and a slow stream would be improved in the long term. This study followed men for 10 years and showed that men have less urinary problems compared to men who never had prostate problems. The reason for this is that men have an enlarging prostate as they get older. This causes a smaller opening for the bladder to empty through. Once the entire prostate is removed, there is a benefit of not having the prostate and resultant obstruction.

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.

First Man Has Prostatectomy Because of BRCA Gene Mutation

The man who underwent the surgery is described as a 53-years-old businessman from London who is married with children and has several family members who have had breast or prostate cancer. When he found out he was carrying the BRCA2 mutation, he asked to have his prostate removed.

Initially, the ICR researchers were reluctant, the newspaper reports, because there was no indication of a problem, either from prostate-specific antigen tests or from a magnetic resonance imaging scan. However, a biopsy showed microscopic malignant changes.

via First Man Has Prostatectomy Because of BRCA Gene Mutation.

This report describes a young man who has his prostate removed because he has an oncogene that means he has a much higher risk of developing prostate cancer. It is unclear whether his biopsy showed cancer or premalignant changes. I once felt that men with genetic changes would one day have prophylactic prostatectomies similar to women having prophylactic mastectomies. The key is to find men that are more likely to develop aggressive cancers at younger ages.

AUA: Five tests, treatments may be unnecessary | Urology Times

The AUA’s list identified the following five recommendations:

A routine bone scan is unnecessary in men with low-risk prostate cancer.

Do not prescribe testosterone to men with erectile dysfunction who have normal testosterone levels.

Do not order creatinine or upper tract imaging in men with BPH.

Do not treat an elevated PSA with antibiotics for patients not experiencing other symptoms.

Do not perform ultrasound on boys with cryptorchidism.

via AUA: Five tests, treatments may be unnecessary | Urology Times.

The AUA has made recommendations on several areas.  There were two that were important for men in the area of prostate cancer.

Men with early stage prostate caner do not need a routine bone scan.  During my training at Indiana University from 1997-2003 this was the standard of care in my residency. Historically, all men with prostate cancer had a bone scan and CT scan.  Both of these are not necessary for men with low grade prostate cancer.  I have not ordered routine bone scans since coming to west Orange, NJ in 2003.

The other important recommendation was in the treatment of an elevated PSA with antibiotics.  This is the first time I have seen the AUA make the recommendation.  If men have stable urinary symptoms and no inflammatory (WBC) cells in the urine, antibiotics should not be prescribed.  I have been practicing in this fashion my entire career, but many physicians including urologists would often prescribe antibiotics to see if an elevated PSA  would return to normal values.

Europe Gives Nod to Prostate Cancer Pill Before Chemo

The European Medicines Agencys Committee for Medicinal Products for Human Use CHMP has recommended extending the use of the prostate cancer pill abiraterone acetate Zytiga, Janssen to include men with advanced prostate cancer who fail on androgen-deprivation therapy.The drug is currently approved in Europe and the United States for these same men, but only as second-line treatment, after docetaxel chemotherapy. If approved, abiraterone could be used by European clinicians as a first-line treatment for men who progress on androgen-deprivation therapy.Specifically, CHMP recommended that abiraterone be administered in combination with prednisone for the treatment of patients with metastatic castration-resistant prostate cancer mCRPC who are asymptomatic or mildly symptomatic after the failure of androgen-deprivation therapy.

via Europe Gives Nod to Prostate Cancer Pill Before Chemo.

Abiraterone is a well tolerated oral medication that currently has been FDA approved in the treatment of men with advanced (metastatic castrate resistant prostate cancer {mCRPC}) prostate cancer who have received previous chemotherapy containing docetaxel.  This indication is being sought in the US as well.

 

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.

Safe removal of the urethral catheter 2 days following laparoscopic radical prostatectomy – Abstract | Prostate Cancer | UroToday | Urology Information

Results:Of the 114 patients who underwent laparoscopic prostatectomy, 64 56% were deemed suitable for removal of catheter on second postoperative day prior to discharge. The first 20 patients selected for early removal of urethral catheter were covered with a suprapubic catheter inserted at the time of surgery. Out of 64 patients deemed suitable for early removal of urethral catheter, 53 83% were able to pass urine without complication. 11 patients 17% developed urinary retention that necessitated recatheterisation. In all cases, reinsertion of catheter was performed easily and successfully without the need for cystoscopic guidance or adjuncts.

via Safe removal of the urethral catheter 2 days following laparoscopic radical prostatectomy – Abstract | Prostate Cancer | UroToday | Urology Information.

 

This study looked at patients who were deemed suitable to have their catheters removed after 2 days of laparoscopic prostatectomy.  This was not done robotically, which makes the skill of the surgeons in accurate suturing very impressive.  They had a relatively high re-cathetrization rate of 17%.  I wonder if these patients were still in the hospital on day number 2.  Urinary retention is a bigger deal if the patient is at home and has to come to the office or emergency room for catheter reinsertion.

I did not read the paper, just the abstract, but I assume they did not perform any reconstructive techniques that I have been performing since 2007.  This reconstructive work makes the bladder neck more fixed and I have not seen very much retention (2-3%) when I have removed catheters after 2-3 days after dvP.

Is the transitional zone biopsy specimen significant for prostate cancer detection? – Abstract | Prostate Cancer | UroToday | Urology Information

RESULTS: PCa was detected on biopsy in 192 39.8% patients. PCa was detected only in the TZ for 10 patients 5.2%, only in the PZ for 69 patients 35.9%, and in both the TZ and PZ for 113 patients 58.9%. Obtaining a biopsy only from the TZ resulted in a significantly lower cancer detection rate than obtaining the biopsy only from the PZ or from the combined PZ and TZ P < .05. High GSs ≥ 7 were found in 3 of 10 patients 30% with PCa detected in the TZ, 29 of 69 patients 42% with PCa detected in the PZ, and 90 of 113 patients 79.6% with PCa detected in the combined TZ and PZ. Among the patients with PSA levels < 10 ng/mL, none of the 4 patients with PCa detected only in the TZ had GSs ≥ 7; however, 14 of 41 patients 34.1% with PCa detected only in the PZ and 18 of 32 patients 56.3% with PCa detected in the combined TZ and PZ had GSs ≥ 7. Patients with a biopsy only from the TZ had significantly fewer GSs ≥ 7 than patients with a biopsy only from the PZ or from the combined PZ and TZ in this PSA rangeP < .05.CONCLUSION: It may be possible to omit a prostate biopsy from the TZ for patients with serum PSA < 10 ng/mL.

via Is the transitional zone biopsy specimen significant for prostate cancer detection? – Abstract | Prostate Cancer | UroToday | Urology Information.

A transition zone biopsy is when tissue is taken from the middle part of the prostate.  This part usually has benign elements from BPH and not cancer.  I usually biopsy the transition zone in patients that have had a negative biopsy and need a repeat biopsy for a rising PSA.

From memory, I have seen patients with transition only prostate cancer and have performed robotic prostatectomy on them.  The ones that had a surprising (more than we would expect) amount of prostate cancer were the ones with the PSA over 10.

I will continue to perform the prostate biopsy as I have done after this article, but will think of ways of looking into this more with my practice.  I do not think the morbidity of 2 extra transition zone biopsies is very different than a standard biopsy.  My standard biopsy currently has 12 cores with 2 extra cores from the anterior apex, which has led to a better cancer detection rate and I have used the presence of cancer at the apex to better delineate the amount of tissue I leave on the anterior prostate apex.

 

 

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