Study: Many men with prostate cancer can avoid early surgery – – UrologyTimes

Many men with prostate cancer do not need immediate treatment, especially if they have low PSA scores or low-risk tumors that are unlikely to grow and spread, according to a multicenter study that suggests such men who undergo radical prostatectomy fare no better than those undergoing observation.

The study, published in the New England Journal of Medicine (2012; 367:203-13), drew a fast response from the AUA, which pointed out that the study’s data show the benefit of surgery in high-risk patients.

via Study: Many men with prostate cancer can avoid early surgery – – UrologyTimes.

This was a summary of a recent study published in the NEJM.  It reaffirms that active surveillance is a good option for men with early stage and less aggressive prostate cancer.  At the 10 years, patients that had died were about equally likely to die of prostate cancer and other causes.

The important thing to keep in mind is that this does not apply to young men who may have 30-40 years to live.

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.

Urologists Condemn Task Forces Anti-PSA Testing Stance

The U.S. Preventive Services Task Force (USPSTF) on May 21 released its final recommendations on PSA-based screening forprostate cancer (PCa), which advises against the practice and gives it a grade D rating, meaning the task force believes there is “moderate or high certainty that the service has no net benefit or that the harms outweigh the benefit.”

Since the introduction of PSA screening in the United States, the PCa death rate has decreased by more than 40% and the percentage of men who have distant metastases and incurable disease at the time of diagnosis has decreased by 75%. In addition, he noted that statistical teams at the National Institute of Health concluded that up to 70% of these results are attributable directly to PSA testing.“We think that men should be made aware and offered an opportunity to make an informed decision for themselves,” Dr. Catalona said. “The PSA test provides very powerful predictive information about a mans risk for prostate cancer.”

via Urologists Condemn Task Forces Anti-PSA Testing Stance – Renal and Urology News.

The government has recently issued a recommendation against prostate cancer screening.   The panel that issues this recommendation did not have a single urologist, radiation oncologist, or medical oncologist on the panel.

I agree with some of the conclusions of the task force that men often undergo negative prostate biopsies, which have a risk of infection and bleeding and are uncomfortable.  Negative biopsies cause anxiety without a cancer diagnosis.  It is also true that men are sometimes treated for cancers that may never cause them symptoms.

The benefits of screening were not given significant consideration.  Prostate cancer still kills men and screening does save lives.  Metastatic prostate cancer causes significant pain and its treatment, hormonal therapy causes long term side effects such as osteoporosis and decreases quality of life.

The other change has been the decreasing morbidity to treat prostate cancer.  Most men that have early stage prostate cancer are cured with surgery, but most of them have full return of urinary function.  The advantage of having surgery are a decrease in long term BPH (benign prostate growth) symptoms.  As men get older, they have increasing frequency, nocturia (urinating at night), slowing stream, and a hesitancy (difficulty in starting to urinate).  After surgery, men have a strong stream that does not change as they age.  The morbidity that panel looked at from treatment was worse than patients would face today.

 

PCa Patients on HD Would Benefit from Early Kidney Transplantation – Renal and Urology News

However, study findings presented at the National Kidney Foundation 2012 Spring Clinical Meetings suggest that patients with prostate cancer (PCa) might be better served by undergoing transplantation instead of waiting two years to be declared cancer-free.

via PCa Patients on HD Would Benefit from Early Kidney Transplantation – Renal and Urology News.

 

This study looked at patients how had prostate cancer diagnosed within 6 months after transplantation.  Most patients were doing well after 2 years.  This is relevant since patients on dialysis need to wait 2 years after having surgery for cancer to be disease free prior to transplantation.  The risk to patients of being on hemodialysis for 2 years is higher than the risk of having prostate cancer in a transplant patient.  Studies like this should be done to see if patents with certain cancers, like kidney and prostate, may not need to wait the 2 years that they traditionally have.

Prostate Cancer Screening: Moving Beyond PSA – Renal and Urology News

In nearly 1,000 men undergoing initial or repeat biopsy, these investigators found that urinary PCA3 prior to a prostate biopsy improved the prediction of PCa and high-grade disease with a high positive predictive value 90% in the initial biopsy setting and a high negative predictive value 88% in the repeat biopsy setting. The investigators conclude that counseling men undergoing prostate biopsy in the context of PCA3 would reduce the burden of prostate biopsies.

via Prostate Cancer Screening: Moving Beyond PSA – Renal and Urology News.

 

I have been using PCA-3 tests in a variety of ways.  I perform it yearly for men at high risk of prostate cancer, to determine if men need repeat prostate biopsies, and also in my active surveillance prostate cancer patients.

Prostate-Cancer Mortality at 11 Years of Follow-up — NEJM

After a median follow-up of 11 years in the core age group, the relative reduction in the risk of death from prostate cancer in the screening group was 21% rate ratio, 0.79; 95% confidence interval [CI], 0.68 to 0.91; P=0.001, and 29% after adjustment for noncompliance. The absolute reduction in mortality in the screening group was 0.10 deaths per 1000 person-years or 1.07 deaths per 1000 men who underwent randomization. The rate ratio for death from prostate cancer during follow-up years 10 and 11 was 0.62 95% CI, 0.45 to 0.85; P=0.003. To prevent one death from prostate cancer at 11 years of follow-up, 1055 men would need to be invited for screening and 37 cancers would need to be detected. There was no significant between-group difference in all-cause mortality.

via Prostate-Cancer Mortality at 11 Years of Follow-up — NEJM.

This NEJM published study is a 2 year update from the European Randomized Study of Screening for prostate cancer.  This is a timely article given the debate in this country as to the utility of prostate cancer screening.

Prostate cancer is a slow growing cancer that rarely cause mortality in months.  As more time goes by I would expect the updated version of this study to show a larger amount of people being helped by the treatment of their prostate cancer.

PCA3 Test Okayed to Help Decide Need for Repeat Prostate Biopsy – Renal and Urology News

“Over-expression of the PCA3 gene is highly specific to cancerous prostate tissue,” John Wei, MD, MS, Professor of Urology at the University of Michigan Health System in Ann Arbor, said in a company-issued statement. “When evaluated with other risk factors, the PROGENSA PCA3 assay fills an important unmet clinical need by helping physicians identify which men suspected of having prostate cancer should undergo a repeat prostate biopsy.”

via PCA3 Test Okayed to Help Decide Need for Repeat Prostate Biopsy – Renal and Urology News.

 

I’ve been using the PCA-3 test for a few years.  I have used it for this indication, as well as for patients who opt for active surveillance for their prostate cancer.  I am glad the test was approved for this use by the FDA.

5-ARI delays prostate cancer progression in men with low-risk disease – ModernMedicine

The 5-alpha-reductase inhibitor dutasteride Avodart appears to delay disease progression and the initiation of active treatment in men with low-risk, localized prostate cancer, results of a 3-year international clinical trial indicate.Treatment with dutasteride also reduces cancer-related anxiety, study authors found.”The results prove that using active surveillance plus dutasteride is a viable, safe, and effective treatment option for men who often undergo aggressive local treatment despite low risk of dying from the disease,” said first author Neil Fleshner, MD, of the University of Toronto’s Princess Margaret Hospital.

via 5-ARI delays prostate cancer progression in men with low-risk disease – – ModernMedicine.

This is the first study I’ve seen that shows that 5-alpha-reductase inhibitors may help slow the progression of prostate cancer.  These medicines are tolerated well by most patients and treatment with avodart can be considered.

Couples Counseling Boosts Sex Lives After Prostate Cancer

But a new study finds that counseling helped married men and women figure out what sorts of treatments for erectile dysfunction worked for them and how to incorporate those methods during sex. In doing so, they returned some luster to their love lives.

via Couples Counseling Boosts Sex Lives After Prostate Cancer.

Couples often have a hard time dealing with the emotional and physical changes after prostate cancer surgery.  There are ways to help men have erections after surgery if oral medicines are not working.

I try to bring up the need to have erections and the impact on the couple at most visits.  This article states counseling for couples if sexual function is important is helpful as well.

Statins During Radiotherapy for High-Risk Prostate Cancer Improve Outcomes – Renal and Urology News

Statins During Radiotherapy for High-Risk Prostate Cancer Improve Outcomes

via Statins During Radiotherapy for High-Risk Prostate Cancer Improve Outcomes – Renal and Urology News.

Statins are medicines that are taken to lower cholesterol.  Many studies have shown they are beneficial in preventing heart disease and many diseases.  Some experts believe that these medicines help prevent prostate  cancer and this study shows that patients with HIGH risk prostate cancer receiving radiation therapy had a better result when they were on statins.

 

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