Risk of prostate cancer unaffected by antibiotic treatment

Source: MedWire News

The average age of the patients was 62.9 years. Average total PSA before and after treatment was 6.05 ng/ml and 5.55 ng/ml, respectively. On biopsy, 23% of patients had histologically proven prostate cancer. There were no significant differences between men with and without prostate cancer in age, pretreatment PSA, free PSA, percent free PSA, and PSA density.
Average total PSA, free PSA, and PSA density decreased after treatment in men with and without prostate cancer. But the reductions in total PSA and PSA density were not significant in prostate cancer patients and the reduction in free PSA in cancer-free patients was not significant.

This paper looked at treating patients with an elevated PSA and a normal rectal exam with antibiotics. The reason why this is important is that many urologists prescribe antibiotics for men with elevated PSA values and only biopsy them if the PSA is still elevated.

This study did not show a significant difference for men with and without prostate cancer for PSA changes. Both groups had a decline in PSA values.

This is not a conclusive study and the use of antibiotics is still an option in treating men with a high PSA. I personally like to start with a biopsy and not antibiotics in men that have never had a prostate biopsy.

SELECT: Selenium, vitamin E show no benefit in prostate cancer prevention – – UrologyTimes

Source: Urology Times

Selenium and vitamin E supplements, taken either alone or together, do not appear to prevent prostate cancer, according to an initial, independent review of study data from the Selenium and Vitamin E Cancer Prevention Trial (SELECT).
The data also showed two concerning trends: a small but not statistically significant increase in the number of prostate cancer cases among the more than 35,000 men age 50 years and older in the trial taking only vitamin E; and a small, but not statistically significant increase in the number of cases of adult-onset diabetes in men taking only selenium.
Because this is an early analysis of the data from the study, neither of these findings proves an increased risk from the supplements, and both may be due to chance, according to the authors.

This was a well recruited study that started many years ago when I was at Indiana. We were one of the sites that were recruiting patients. This is the first analysis I have seen from this, so we will need to wait for more data to come out. According to early findings, neither Vitamin E nor selenium help prevent prostate cancer.

Medical News: ASTRO: Proton Radiation Fails to Impress in Prostate Cancer Study – in Meeting Coverage, ASTRO

Source: Med page today

Proton radiation for early prostate cancer had an acceptable tolerability profile but produced little evidence of a “gee whiz” impact to support its cost, according to preliminary results from a phase I/II clinical trial.
Two-thirds of patients had acute genitourinary or gastrointestinal toxicity, and a third had late GU/GI toxicity, Anthony Zietman, M.D., of Harvard and Massachusetts General Hospital, reported at the American Society for Therapeutic Radiology and Oncology meeting.
Although most of the toxicity was grade 2 in severity, the overall profile provided little reason for enthusiasm.
“The bottom line is that the treatment was safe, it was reasonably well tolerated, but probably no better tolerated than any other form of radiation that we give,” Dr. Zietman said.

According to this study, the less available and much more expensive proton radiation therapy for prostate cancer is not much different than traditional radiation.

UroToday – Trial Evaluation of Erectile Function after Attempted Unilateral Cavernous Nerve-Sparing Retropubic Radical Prostatectomy With Versus Without Unilateral Sural Nerve Grafting for Clinically Localized Prostate Cancer – Abstract

Source Urotoday

The trial planned to enroll 200 patients, but an interim analysis at 107 patients met criteria for futility and the trial was closed. For patients completing the protocol to 2 yr, potency was recovered in 32 of 45 (71%) of SNG and 14 of 21 (67%) of controls (p=0.777). By intent-to-treat analysis, potency recovered in 32 of 66 (48.5%) of SNG and 14 of 41 (34%) of controls (p=0.271). No differences were seen in time to potency or quality of life scores for ED and urinary function. Limitations included slower-than-expected accrual and poor compliance with ED therapy: < 65% for VED and < 40% for injections.
The addition of SNG to a UNS RP did not improve potency at 2 yr following surgery.

This study was comparing men who were going nerve sparing prostatectomy on one side and adding a nerve graft on the other side. Nerve grafting takes more time and has some side effects depending on which nerve you use. This study, like many before it, did not find a benefit in performing a nerve graft.

I’ve always felt that this wwould be the case since the neurovascualr bundle is a series of small microscopic nerves, not a large nerve that you can see.

Regrets After Prostate Surgery

Source: Tara Parker-Pope – Health – New York Times Blog

One in five men who undergoes prostate surgery to treat cancer later regrets the decision, a new study shows. And surprisingly, regret is highest among men who opt for robotic prostatectomy, a minimally invasive surgery that is growing in popularity as a treatment.

The research, published in the medical journal European Urology, is the latest to suggest that technological advances in prostate surgery haven’t necessarily translated to better results for the men on which it is performed. It also adds to growing concerns that men are being misled about the real risks and benefits of robotic surgical procedures used to treat prostate cancer.

This was an interesting article about prostate cancer satisfaction rates. The important point was that patients who underwent robotic prostatectomy were not as satisfied as patients that underwent conventionally surgery. It is interesting to read the comments as well.

The important things that I have done that I believe give me a higher satisfaction rate is to better explain how the procedure is still a major surgery. I know that my patients expect less problems and I believe they do have less problems. The important thing is to have them understand it is still a major surgery that is similar to open surgery in what we are trying to accomplish.

That being said, once expectations are realistic, most patienst are satisfied. I do notice that the satisfaction rate is often higher in patients that have worse than expected incontinence. After several weeks to months, once the urinary control is back to normal people have a much higher satisfaction rate.

Organ-confined disease more common in screen-detected prostate cancer

Source: MedWire News

Prostate cancers detected by screening have a higher rate of organ-confined disease and a lower rate of extracapsular extension and positive surgical margins than non-screen-detected cancers, say researchers.
The widespread use of prostate cancer screening had led to stage migration, with more cancers detected at a lower stage, which has led to a reduction in the age-adjusted mortality rate. However, it is not clear whether some men are being treated unnecessarily, says the team.


Another study that shows men that are screened for prostate cancer with PSA bloodwork have cancers that are more likely to be contained to the prostate.

Best of AUA Orlando 2008 for Prostate Cancer

Source: Urology Times
Robotic Surgery
Presented by Ashutosh K. Tewari, MD,
Weill-Cornell Medical College, New York.


* Robot-assisted laparoscopic partial nephrectomy is associated with shorter hospital stay and less bleeding, but the warm ischemia time is still around 30 minutes.

* Studies comparing robot-assisted laparoscopic cystectomy and open radical cystectomy show similar oncologic outcomes. At a high-volume tertiary care center, the robotic technique was more cost-efficient, but that finding needs to be confirmed at other centers. Other remaining issues regarding the robotic procedure include the need to define how the reconstruction should be performed, the extent of the lymphadenectomy, and ensuring clear margins at lateral areas.

* A study of almost 4,000 patients reaffirms the safety of robotic-assisted laparoscopic prostatectomy (RALP). Rates of major surgical, major medical, and minor medical complications were all ≤0.7%, and the rate of minor surgical complications was 3.3%.

* Studies comparing open and RALP show the surgeon is the most important variable in determining outcome.

* Extended lymph node dissection should be performed in high-risk prostate cancer patients, and can be done with RALP.

* A total reconstruction procedure including anterior and posterior restoration of the vesicourethral junction is associated with early return to continence and improvement in overall continence rates.

Some of the highlights from the AUA
Of interest is the growing application of robotic surgery for smaller kidney cancers (partial nephrectomy) and bladder cancer, which I have been performing since 2005 myself.

The other very important adaption is the posterior and anterior reconstruction of the urinary tract during robotic prostatectomy, which I have performing for over a year after attending Dr Tewari’s conference.

Surgeon and hospital volume linked to radical prostatectomy outcomes

Source: MedWire News

“Briefly, higher hospital and surgeon volumes are associated with a decreased risk of most in-hospital complications after RP,” the team concludes.

They add: “These associations are statistically significant and likely to be clinically important, especially if doubling hospital or surgical volume can lead to an 8% to 9% decrease in the rate of any complication.”


Another study, this one from Canada, showing that hospital and surgeon volume are both related to lower rates of complications for prostate cancer surgery.

I am pleased to say that I am close to 500 robotic prostatectomies and my partner and I have combined for over 600.

Prostate Cancer-Specific Survival Following Salvage Radiotherapy vs Observation in Men With Biochemical Recurrence After Radical Prostatectomy: Abstract

Source: JAMA
Prostate Cancer-Specific Survival Following Salvage Radiotherapy vs Observation in Men With Biochemical Recurrence After Radical Prostatectomy
Bruce J. Trock, PhD; Misop Han, MD; Stephen J. Freedland, MD; Elizabeth B. Humphreys, MS; Theodore L. DeWeese, MD; Alan W. Partin, MD, PhD; Patrick C. Walsh, MD
JAMA. 2008;299(23):2760-2769.

Context Biochemical disease recurrence after radical prostatectomy often prompts salvage radiotherapy, but no studies to date have had sufficient numbers of patients or follow-up to determine whether radiotherapy improves survival, and if so, the subgroup of men most likely to benefit.
Objectives To quantify the relative improvement in prostate cancer-specific survival of salvage radiotherapy vs no therapy after biochemical recurrence following prostatectomy, and to identify subgroups for whom salvage treatment is most beneficial.
Design, Setting, and Patients Retrospective analysis of a cohort of 635 US men undergoing prostatectomy from 1982-2004, followed up through December 28, 2007, who experienced biochemical and/or local recurrence and received no salvage treatment (n = 397), salvage radiotherapy alone (n = 160), or salvage radiotherapy combined with hormonal therapy (n = 78).
Main Outcome Measure Prostate cancer-specific survival defined from time of recurrence until death from disease.
Results With a median follow-up of 6 years after recurrence and 9 years after prostatectomy, 116 men (18%) died from prostate cancer, including 89 (22%) who received no salvage treatment, 18 (11%) who received salvage radiotherapy alone, and 9 (12%) who received salvage radiotherapy and hormonal therapy. Salvage radiotherapy alone was associated with a significant 3-fold increase in prostate cancer-specific survival relative to those who received no salvage treatment (hazard ratio [HR], 0.32 [95% confidence interval {CI}, 0.19-0.54]; P<.001). Addition of hormonal therapy to salvage radiotherapy was not associated with any additional increase in prostate cancer-specific survival (HR, 0.34 [95% CI, 0.17-0.69]; P = .003). The increase in prostate cancer-specific survival associated with salvage radiotherapy was limited to men with a prostate-specific antigen doubling time of less than 6 months and remained after adjustment for pathological stage and other established prognostic factors. Salvage radiotherapy initiated more than 2 years after recurrence provided no significant increase in prostate cancer-specific survival. Men whose prostate-specific antigen level never became undetectable after salvage radiotherapy did not experience a significant increase in prostate cancer-specific survival. Salvage radiotherapy also was associated with a significant increase in overall survival.
Conclusions Salvage radiotherapy administered within 2 years of biochemical recurrence was associated with a significant increase in prostate cancer-specific survival among men with a prostate-specific antigen doubling time of less than 6 months, independent of other prognostic features such as pathological stage or Gleason score. These preliminary findings should be validated in other settings, and ultimately, in a randomized controlled trial.

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Prostate cancer tied to inactivity

Source: UPI

Men who work at desk jobs are more likely to develop prostate cancer than manual workers, a study indicates.
Researchers found low levels of physical activity in the workplace can significantly raise the risk of cancer, the Daily Mail reported Saturday.
The study determined men who worked as teachers or in office jobs were much more likely to get cancer than those who spend much of their day on their feet, such as laborers, bakers and barbers.
Specifically, men who spend their day working at a desk are 30 percent more likely to develop prostate cancer than manual workers, the study found.


This study shows that men with sedentery jobs are at increased risk or prostate cancer. I wouldn’t advise changing careers, but adding exercise to your daily regimen should help prevent illnesses and probably helps prevent recurrences and delays progression in men who have cancer.

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