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.

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.

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