Surgery Offers Prostate Cancer Patients Better Survival Odds

Prostate cancer patients with clinically localized tumors are more likely to die if they undergo radiotherapy rather than radical prostatectomy.

Radiotherapy for clinically-localized prostate cancer (PCa) is associated with an increased risk of overall and PCa-specific mortality compared with radical prostatectomy, according to a new systematic review and meta-analysis.

Dr. Nam’s group stated that, to their knowledge, their study represents the most comprehensive and up-to-date review of the literature comparing survival outcomes associated with radiotherapy and surgery.

Source: Surgery Offers Prostate Cancer Patients Better Survival Odds


This issue is frequently asked by patients.  In the short run, surgery and radiation are both effective at controlling prostate cancer.  Over time, most studies have shown that prostate cancer surgery is more effective than radiation at curing cancer.

Exercise Training May Delay PCa Progression – Renal and Urology News

PSA doubling time, a marker of cancer progression, increased from 28 to 76 months in prostate cancer patients performing exercise training.

“The exercise intervention resulted in marked physiological adaptations that aided weight regulation and increased fitness levels,” Dr. Hojman told Renal & Urology News. “PSA doubling time correlated with improved fitness, but not with weight loss. These findings suggest there is a fitness component that plays a role in the control of prostate cancer that is not related to weight.”

Source: Exercise Training May Delay PCa Progression – Renal and Urology News

I have been recommending exercise for my prostate cancer patients for many years.  I usually recommend 30 minutes of aerobic exercise 3 times a week.  In this study, 45 minutes of exercise 3 times a week led to the PSA going up slowly for patients that had regular exercise.

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.

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.

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.

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.

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.

1 2 3 7