From Arthur L. Burnett II, M.D. and Norman Morris

 New sophisticated guidelines to detect prostate cancer are coming online to reduce false positive PSA readings and measure the aggressiveness of detected cancer cells.In line with late research revelations at the recent American Urological Association symposium in San Diego, the medical organization has dialed back its long held screening recommendations and reset new ones to reduce the number of unnecessary treatments and determine which cases are serious enough to consider medical intervention. 

Some of the new genetic tests are aimed at reducing false alarms and anxiety caused by elevated PSA readings. Others are directed at distinguishing dangerous tumors needing treatment from ones that might be slow growing and left alone.  These genetic tests, which are in place or will be shortly, may provide a way out of the ongoing debates over whether healthy men should be screened for prostate cancer or not.

  In May, 2012 an independent medical panel, the U.S. Preventive Services Task Force (USPST) issued guidelines that recommended that healthy men should not routinely be screened with a PSA test. Their statements set off an uproar among urologists and the AUA claimed that many men who should be tested (those at high risk, including African American men) would be turned off when they should be turned on to testing.  Opponents of USPST also objected to the panel not having representation by urologists and specialists in prostate cancer.

 More than a dozen companies are working on these tests that are based on using advanced techniques to measure multiple genes called molecular markers rather than looking at a single protein like PSA (prostate specific antigen).

 The new guidelines say that routine annual testing is no longer recommended for men 40 to 54 years old who are at average risk of getting prostate cancer.The guidelines say men 55 to 69 should discuss the benefits and harms of screening with their doctors. If they do choose screening, an interval of two years is suggested rather than an annual screening.  Screening is not recommend for men 70 years or older.

 Men at high risk—those with a history of prostate cancer in their families and all African American men—should consult with their doctors about having screening earlier than at age 55.  The new guidelines do not eliminate PSA tests but suggest they be used more moderately.

 Dr. Burnett says the new guidelines “put us on the road to better precision medicine and this will help define who is at threat for prostate cancer progression and who is not.” Dr. Burnett’s colleague at Johns Hopkins, Dr. H. Ballentine Carter, professor of urology and oncology agrees. “There is general agreement that early detection, including prostate specific antigen screening has played a part in decreasing mortality from prostate cancer. It’s time to take a more selective approach in order to maximize benefit and minimize harms.”

  Dr. Philip W. Kantoff, prostate cancer specialist at the Dana-Farber Cancer Institute in Boston helped shape the guidelines. “There should be a more reasonable approach to the use of the PSA,” he said.

 Genomic Health, developer of a genetic test it calls Oncotype DX, believes it could triple the number of men who could confidently monitor their tumors rather than undergo surgery or radiation treatments. Myriad Genetics, known for its test for genetic mutations that raise a woman’s rick of breast cancer, says its tests provide better information than the Gleason score, the main tool that is now used to assess tumor aggressiveness, based on how cells appear to a pathologist under a microscope. The idea is to reduce the guessing game in human interpretation with more precise measurements.

  Researchers at Genomic Health say that their Oncotype DX test predicted unfavorable pathology more accurately than existing (human) methods—26 percent of the samples were classified as very low risk by its test, compared to only 5 to 10 percent for existing methods.  In some cases, the new tst showed the cancer to be more aggressive than existing methods.

Some experts caution it is too early to tell  how well most of the tests will perform over time.  Initially, they could cost up to $3,800.  Jan Manarite, who runs the help line for the patient advocate group Prostate Cancer Research Institute in Los Angeles says, “It’s a little tricky to find out which (test) applies to you and whether it will be paid for by insurance.

Dr. H Ballentine Carter, urologist and oncologist at Johns Hopkins Medicine in Baltimore chaired the panel that developed the AUA’s panel that developed the new screening guidelines for prostate cancer.  He is shown here in an interview at the AUA symposium explaining the new recommendations.

 http://www.youtube.com/watch?v=JX232cwiEpU

You’ve made your decision.  Surgery.  But should it be open radical, laparoscopic or robotic? Your doctor may favor one over the other or perhaps offer you the option. You really don’t know anything about any of them. Your inclination may be to go with the latest high tech procedure under the assumption that newer is obviously better. The question though is: Is it?

We are not dealing with flavors of ice cream here. To use the analogy, will Peanut Apple Danish or Wicked Caramel Sudae drive out chocolate and vanilla because they are newer flavors? In the end, what we are dealing with is satisfaction.  Let us explain.

Since 1982 Dr. Patrick C. Walsh at the Johns Hopkins Brady Urological Institute in Baltimore introduced the open radical surgical procedure and was responsible for constant improvements beginning with nerve-sparing that enabled patients to retain sexual function. This surgical procedure has been widely accepted throughout the country as the “gold standard” in prostatectomy.

In the early 90’s Dr. W.W.Schuessler in San Antonio performed the first successful laparoscopic radical prostatectomies.  Laparoscopy allows the surgeon to look inside the abdomen with a special camera (scope). While open surgery requires a longer incision down the center of the abdomen, laparoscopy involves five small incisions, one below the belly button and two each on each of both sides of the lower abdomen.  Carbon dioxide is passed into the abdominal cavity and the gas lifts the abdominal wall to give the surgeon a better view of the abdominal cavity. Once the camera is in place, it guides the doctor by transmitting a picture of the prostate onto a video monitor.

Laparoscopic surgeons say their surgical technique can shorten a hospital stay to one or two days. They say there is much less bleeding during the operation and claim 90% of their patients can resume full activity in two to three weeksYou are eligible for laparoscopic surgery if your prostate cancer has not spread outside the prostate and is not very aggressive (PSA less than 10).  But not so.  If you have had previous open radical or laparoscopic surgery.

Robotic surgery represents the latest approach to less invasive prostatectomy approach. The robotic approach is said to build on the laparoscopic technique. Both procedures use carbon dioxide to inflate the abdomen. Intuitive Surgical Company introduced the da Vinci System in 2003 and it has since gained wide usage here in the United States and abroad.

The da Vinci comprises three components: the surgeon’s computer console off to a side, a robotic cart bedside with 4 arms that are manipulated by the surgeon and a high def 3D vision system. The doctor can control the camera and the 3 arms that perform the actual surgery. The big difference between the robot and the laparoscopic procedure is that the robot has better rotating hand movements. It filters out any hand tremors a surgeon might have. And the camera provides a true stereoscopic picture that is transmitted to the surgeon’s console.  The da Vinci System is cleared not only for prostatectomies but for a variety of other procedures  including hysterectomies and mitral valve repairs.

Intuitive says that the role of the robotic surgeon requires less laparoscopic skill. And so they tell prospective clients that the procedure is accessible to experienced open procedure surgeons with minimal or no laparoscopic experience.  Intuitive says candidates for robotic radical prostatectomy can not have had prior BPH (benign prostatic hyperplasia) surgery because they would pose technical challenges and increase operative times as well as blood loss during the robotic procedure.

 Comparison and Controversy

 One of the leading proponents of robotic radical prostatectomy is Dr. David Samadi, vice chairman of the Department of Urology and chief of Robotics at the Mount Sinai School of Medicine in New York.  Dr. Samadi says he uses a robotic nerve-sparing technique that physically sets aside the prostate gland from the nerve bundle surrounding the prostate in an effort to preserve urinary and sexual function. He suggests that the tactile method of “feeling” for cancer in the tiny nerve tissue is ‘old school.’  Old school or not, proponents of open radical like Johns Hopkins urology professor Arthur Burnett, believe that the surgeon’s hands using tactile sensation are still the only and best way to detect the presence of cancer cells if they are in the nerve bundle. You have to remove the bundle, he says, if you detect cancer there.The growing acceptance of the da Vinci procedure is not without its critics.  Claims that the da Vinci means shorter hospital stays, faster recoveries, better outcomes (faster return to sexual function and urinary continence) are widely disputed.

A report in the New York Times March 26, 2013 suggests the sales force employed by da Vinci manufacturer Intuitive has allegedly been engaged in the practice of aggressive tactics to market high-tech (high priced—nearly $2 million per machine) medical devices. It raises the question about the quality of training provided doctors before they use the equipment on patients.

The story tells of a suit filed by a woman whose husband died of a “cascade of complications” following a da Vinci operation performed by a doctor said to have been inexperienced and improperly trained. The case against Intuitive is set go on trial shortly.

According to Intuitive, nearly 1,400 hospitals in the U.S. have purchased the da Vinci system—some two.  Nearly half a million procedures using the system worldwide have been performed—including prostatectomies hysterectomies and other kinds of surgeries.  The case against Intuitive asserts that in order to sell more and more of these highly priced machines the company has drastically cut down on training and has been interfering in hospital procedures.  Hospitals are responsible for credentializing surgeons and it is charged that Intuitive sales personnel have been mired in taking part in medical procedures.

Bottom Line

 On what basis, then, should a patient make his decision?  Are we back to deciding on the flavor of ice cream?  Not exactly. After studying the pros and cons of surgical treatments, it comes down to the ingredients.  Our best advice is to understand that it is not so much the kind of surgery you undergo. It is the skill and experience of the surgeon. The patient is entitled to know the depth of the surgeon’s skills and his or her previous patient’s outcomes.  Do your research!  Ask the surgeon for a list of patients and find out from them how their experience was and what their outcomes were. Word of mouth is your best bet. Do your homework and be safe, not sorry!

“The time has come,” the Walrus said,
“To talk of many things:
Of shoes—and ships—and sealing-wax—
Of cabbages—and kings—
And why the sea is boiling hot—
And whether pigs have wings.”

—Through the Looking-Glass

And the time has come to see how goes the War on Cancer. How far have we come in defeating this dreaded enemy that still claims far too many lives despite the rapid development of armamentarium?  Let us give you a headline before we delve into the details wherein the devil likes to hide.  We have made it past first and second base, and yea, we are rounding third—but alas, we have yet to make it home!  A plethora of metaphors, to be sure, so pick the one you like and we’ll go from there.

Since the 90’s we have managed to advance the treatment of prostate cancer and drop the number of deaths a year.  And yet nearly 200,000 cases are diagnosed a year in this country alone with fatalities nearing 28,000.  We’ve done that largely with a tool called the prostate specific antigen (PSA test), often followed up by biopsies, MRIs, and treatments (surgery and different forms of radiation).  Even though these procedures have helped save lives, at the same time, they have drawn criticism among detractors who have cited unnecessary treatments, pointed to cases where outcomes were unsatisfactory and charged that costs involved are often inflated.  So where does the truth lie? And when it comes to dealing with prostate cancer what should the patient believe and what should the patient do?  Perhaps more to the point, when it comes to treatment where are we heading?  Let’s take a look.

The PSA test in our view continues to be so far the best tool we have in the tool box to give us the status of the prostate. It is a simple blood test, though complicated to interpret, that doctors hope will indicate if the prostate is healthy, has an infection known as prostatitis, or is enlarged—all benign conditions.  Or, if the patient has prostate cancer!  But the problem is the PSA test is not fool-proof.  It can sometimes give false results. If the doctor suspects the results are incorrect, s/he can follow up with a biopsy procedure.  Not always, but sometimes a biopsy can be mildly uncomfortable. The biopsy is performed to determine with certainty the presence of prostate cancer. Another problem with the PSA blood test is that many of the cancers it does detect are not likely to cause harm or be life-threatening.  But there is no reliable way to identify them.  So a large majority of men with positive tests undergo surgery or radiation treatment. They just “want that cancer out of their bodies.” And many suffer aftereffects of incontinence and erectile dysfunction—needlessly.

To determine the aggressiveness of a cancer biopsy tissue samples are sent to a pathology lab where the patterns of the cancer cells are examined under a microscope.  Normal cells are well structured while cancerous ones are poorly formed and the number and irregularity of cancer cells determines the aggressiveness of the disease.  The severity of the cancer is given a graded number and referred to as a Gleason score.  The doctor will then confer with the patient and based on the Gleason score suggest treatment options.  The problem with Gleason scores is that they are determined by human eyes.  The numbers presented by the pathologist are subject to interpretation. Obviously, experience and vision can play a vital part in providing a Gleason score.  They can differ widely from one lab to another and from one pathologist to another. That is the weakness of the test and physicians are then left with having to reflect on treatment options to offer the patient.

Two things then are perfectly clear. First, with regard to the PSA test, its weakness is that it does not point to the absolute presence of prostate cancer.  What is needed is a fault-proof biomarker that indicates without a doubt the presence of prostate cancer. Second, once prostate cancer is discovered, a better test must be found to indicate the aggressive behavior of the cancer—one established by a standardized procedure and not dependent on human interpretation that can vary from one individual to another.  Research in both areas has been underway for some time.

Meantime, many prostate support groups have formed throughout the country urging men to be screened for prostate cancer using the PSA test.  Millions of men in the country have followed the call. In 2011 a government health advisory group ( the U.S. Preventive Task Services Force ) called for an end to widespread screening.  They said healthy men at low risk to prostate cancer should not be tested and it claimed millions were treated unnecessarily and subjected to great physical and psychological harm ( incontinence and sexual dysfunction).  A storm of controversy broke out. The American Urological Association, cancer hospitals and urologists cried foul.  They pointed out that no urologists or prostate cancer specialists were included on the panel of the task force. They expressed fear that those at high risk, including African American men, would no longer line up for screening.  Their fear was in fact born out.  There has been a dramatic decline in the number of high risk patients participating in screening in the country.

The position taken by the vast majority of urologists and major prostate cancer centers as well as the American Urological Association is that screening of high risk patients is a necessity to prevent them from acquiring cancer at an advanced stage when intervention is as yet, not possible.  Their recommendation with regard to treatment is that men diagnosed with prostate cancer consult with their physicians and decide whether they should be treated or follow a course of Expectant Management (surveillance with periodic testing. )

Now the extraordinary good news. Research has been making rapid strides.  Sophisticated new prostate cancer tests are coming to market that may well supplement the PSA test.  Potentially, they can save tens of thousands of men every year from unnecessary biopsies, operations and radiation treatments. Some of these tests are aimed at reducing false alarms.  If proven successful, they could help reduce anxiety brought on by elevated PSA readings.  Another group of tests aims to substantiate or theoretically even replace Gleason scores. They examine genetic workings of cancer to distinguish dangerous tumors that need treatment from the slow-growing kind that can well be left alone. The idea is that these genetic findings would no longer be based solely on human visual interpretations.

What has been hailed as the “single biggest leap forward” in understanding genetic causes of prostate cancer has just been reported in the British newspaper The Guardian.  The announcement says the huge study involved more than a thousand scientists.   The newspaper reports that the study was “one of the largest ever conducted to look into faulty DNA that drives cancer.” Doctors say genetic biomarkers they have uncovered could provide patients with a personalized ‘risk profile’ for diseases, paving the way for individually tailored screening for those at risk having regular health checks.

What are the implications here? The suggestion is that a test based on genetic markers for prostate cancer “could identify men whose lifetime risk is a staggering 50%. “ The authors say men could be routinely screened for prostate cancer by doctors within five years using a simple saliva test to detect the smallest genetic mutations that collectively increase the risk of developing the potentially fatal illness.  They also believe that advances in detecting the many dozens of DNA mutations linked with a range of cancers, including ovarian and breast cancers, will lead to a revolution in the early diagnosis and treatment of tumors that would otherwise go undetected.   In Britain, more than 40,000 men are diagnosed with prostate cancer and nearly 11,000 die from the disease.

Back in this country, a response to the Preventive Services Task Force’s assertion that “healthy men” need not be screened comes from Dr. Mathew Cooperberg, an assistant professor of urology at UC, San Francisco.  He says, “it’s not that screening doesn’t work; it’s that we haven’t done a great job of targeting treatments for the tumors that need it.”  Dr. Cooperberg is one of the consultants working with companies that have been working on new testing procedures.  More than a dozen companies are introducing or planning to introduce new tests based on genetic discoveries.  Instead of looking at a single protein like the PSA, they are investigating multiple genes and other mechanisms they call molecular markers.

It is important to emphasize here that although these new tests are intended to help men make smarter treatment decisions, the fact is that because so many companies are producing so many different tests the plain fact is the multitude of claimed results is apt to cause more confusion until a general consensus is established by medical peer review.   For now among medical experts there is an air of optimism that one or more of these new tests will perform and make a difference in treating patients.  They caution, however, that it could be tricky to figure out which tests apply to individual patients.  Another question that comes to mind is will insurers be reluctant to pay for the new tests without evidence that men will trust results enough to forgo treatment if that is indicated.  And to be sure there will always be men who don’t want to live with cancer no matter how slight some test says their risk is.

A report appearing in the New York Times March 27,2013 suggests the biggest battles likely to take place among the many companies engaged in developing new tests will involve Genomic Health and Myriad Genetics.  Both companies are moving into the prostate cancer arena after successes in developing tests for breast cancer.  Both companies have come up with tests that analyze gene activity levels in the tumor samples obtained by biopsy to gauge how aggressive the cancer is.  As we’ve pointed out, these new tests would provide better information than the Gleason score that is presently used by pathologists.According to the New York Times, Noridian, the Medicare contractor for Utah, will not pay for Myriad’s test (called Polaris) because some prostate cancer specialists say the test has not yet been adequately validated. Cost of the test is said to be $3,400.  Genomic Health expects to release supporting data for its test at the upcoming American Urological Association annual meeting in May.  They plan on selling the test following the meeting. One physician, Dr. Eric A. Klein of the Cleveland Clinic who worked on the Genomic Health test told the press, “Even if we can only convince 15 to 20 percent of men that we have enough confidence that they don’t have to be treated, that will be a big step forward.”

More genetic tests are coming from an avalanche of established companies and start ups.  Hologic and MDxHealth and Mitonmics say they have tests that can reduce the number of unnecessary biopsies. Opko Heath, Beckman Coulter and Metabolon are working on tests that they believe will improve PSA screening.  Researchers at the University of Michigan are studying a test that relies on a particular fusion of two genes found in half of the prostate cancers. And at the Johns Hopkins Medical Institute work continues on development of a prostate cancer biomarker based on a simple blood test.

Meantime, what are prostate patients to do?  For now, the majority of prostate cancer experts agree the PSA is the best tool in the tool chest.  Many believe that unnecessary procedures can be reduced simply by using the PSA test less frequently. The man who helped bring the PSA to market in the 90s, Dr. William J.Catalona, director of the prostate program at Northwestern University, says of the rush of research taking place today, “This is only the start. This field is moving kind of like cellphones.”

The Cancer Research Institute in New York is in the forefront of battling advance prostate cancer.  They are providing funding and much needed support in developing new approaches to deal with this life threatening form of the disease.  Where conventional treatments fail, FDA approved immunotherapies are saving lives. Many new clinical studies are getting underway and currently in the pipeline.  The Institute is encouraging prostate cancer patients with advance prostate cancer to enter clinical trials at all stages of the disease.

To find out if you are or someone you know is eligible to take part in a clinical trial please contact the Cancer Research Institute.  Here are ways to contact them:

Phone
(800) 99-CANCER (800-992-2623)
(212) 688-7515
Monday to Friday, 9 a.m. to 5 p.m. EST

Fax
(212) 832-9376

Mail
Cancer Research Institute
National Headquarters
One Exchange Plaza
55 Broadway, Suite 1802
New York, NY 10006

- See more at: http://www.cancerresearch.org/contact-us#sthash.J7ep3OVK.dpu

Testosterone is the male hormone—also called androgen—that is essential for sex drive and fertility. It is also responsible for such “manly” characteristics as body hair post puberty and deepening the male voice.  That’s the good news. The bad news is that if a man develops prostate cancer testosterone is the fuel that sets the house on fire and causes the cancer to spread. Cutting off the supply is akin to dousing the fire retardant and keeps the prostate cancer from spreading through the rest of the body.  This is what we mean by hormone deprivation.  Other terms for the same thing are androgen deprivation therapy  (ADT) and androgen suppression therapy (AST).

Androgens (male hormones) are made mainly in the testicles.  Lowering androgen levels or stopping them from reaching prostate cancer can make the prostate cancers shrink or grow more slowly for a time.  But hormone treatment alone does not cure prostate cancer.

Who needs hormone therapy?  You may opt for it if you’re not able to have surgery or radiation. If your cancer remains—or comes back after surgery or radiation therapy. If your doctor thinks you’re at higher risk of the cancer recurring after treatment. And sometimes before radiation to try to shrink the cancer or make the treatment more effective.

There is a surgery called orchiectomy that involves removal of the testicles to remove the source of testosterone. But most men are turned off by the very thought. So hormone therapy can be used to accomplish the same end.  In this case the usual procedure is to be injected or have small implants under the skin that release estrogen periodically.  The newest research has turned to patches, as explained in a previous story (UK: Estrogen Patches for Advanced Prostate Cancer).

What are the possible side effects of hormone therapy?Side effects can include the following, but it should be noted that not every patient experiences the same effects and some don’t experience any or all of them.  All patients can expect to feel extremely fatigued. But men may experience one or more of the following—or with luck none of these:

Reduced or absent libido (sexual drive); impotence (erectile dysfunction; hot flashes, which may get better or even go away with time; breast tenderness or growth of breast tissue; osteoporosis (bone thinning); anemia (lower red blood cell counts); depressed mental sharpness; loss of muscle mass; weight gain; increased cholesterol; depression.

Help for side effects:

Hot flashes can often be helped by treatment with antidepressants;

Meds are available for osteoporosis

Depression can be treated  with antidepressants and/or counseling

Exercise can help reduce many side effects, including fatigue,weight gain, loss of bone and muscle mass.

Treatment options:

Nearly all prostate cancers treated with hormone therapy become resistant to hormone treatment over a period of months or years.  Some doctors believe that constant androgen suppression may not be needed, so they advise intermittent –which means on and off again treatments.  The advantage of intermittent treatments that for a while some men can avoid the side effects of hormonal therapy, such as decreased energy, impotence, or hot flashes and loss of sex drive.

Which Prostate Cancer Treatment is Right For You Or Your Loved One?

A diagnosis of prostate cancer is traumatic for any individual and his loved ones, regardless of age or social status. Cancer is not necessarily a life-threatening challenge and it can be a crushing blow. However, there have been many advances in prostate cancer treatments. It is important for patients to ask questions, research their options, and get a second opinion to find the best possible plan of attack in order to successfully overcome the disease.

Radical Prostatectomy

A radical prostatectomy involves the complete removal of the prostate gland. The surgeon may also remove other tissues surrounding the prostate if the cancer has spread. Lymph nodes in the area are often removed as well to be tested for the presence of cancer. This procedure can be performed in traditional, open surgery, or through laparoscopy. Laparoscopic surgery involves small incisions and a faster healing time.

Robotic Prostatectomy

Robotic technology is being applied to many areas in healthcare and prostate surgery is no exception. Minor incisions are made in the abdomen through the use of robotic equipment. This equipment allows specially trained doctors to be more precise in their procedures, leaving less room for human error. Removal of the prostate gland is a delicate operation in which surgeons must take great care not to disturb nerves which control the ability to have erections.

Expectant Management and Surveillance

As doctors perform tests for prostate cancer, some individuals are candidates for monitoring the situation. They may recommend regular check ups concerning the progress of the disease. In some cases, the cancer may not be aggressive and the age of the patient does not merit rigorous treatments. Hormone therapy is another form of treatment that is effective in managing the disease for many patients.

Chemotherapy, Radiation, and Other Non-Surgical Prostate Cancer Treatments

Some patients may opt for rigorous chemotherapy and radiation treatments to combat the disease. This may be for personal preference or because the disease is in its earliest stages. On the other hand, when the disease is more advanced and has spread to other areas of the body, a comprehensive treatment plan may be necessary to tackle the disease and slow its progress. Cryotherapy is another treatment option that actually involves freezing cancer cells, with the purpose of killing them with liquid nitrogen or argon gas. Ultrasound treatments take the opposite approach, directing intense heat at cancer cells through the use of ultrasound waves. Death of cancer cells is the end result. When a diagnosis has been received, patients need to discover the stage of the disease and discuss the arguments for surgery or other treatment methods to combat the growth of cancer cells. Men need to choose the option that will have the greatest success rate.

By Selina Gough, Health Advocate, Brisbane, Queensland, Australia

Guest OP-ED contributor views represent independent perspectives and do not necessarily represent the views of the authors of Prostate Cancer Survivors Speak Their Minds: Advice on Options, Treatments and Aftereffects.

There are those among us whose lives have been completely shattered by unspeakable calamity.  Whether through war, disease, accident.  Resulting physical and psychological pain can be beyond one’s ability to express. We were moved by the way some courageous souls have found solace in dealing with their ordeals.  Writing in the Well section of the New York Times (February 5, 2013), Tara Parker-Pope describes how cancer patients are grappling with their complex emotions by expressing their fears and hopes in poetry.  She quotes a 41 year old breast cancer patient, Kyle Potvin, who discovered poetry to be an extraordinary resource and outlet for her emotions.

How I feared chemo, afraid

It would change me.

It did.

Something dissolved inside me.

Tears began a slow drip;

I cried at the news story

Of a lost boy found in the woods…

At the surprising beauty

Of a bright leaf falling

Like the last strand of hair from my head

Consider this from a collection of poems by Ted Kooser he calls “At the Cancer Clinic”  A nurse holds open the door for a slow moving patient.

 How patient she is in the crisp white sails

of  her clothes.  The sick woman

peers from under her funny knit cap

to watch each foot swing scuffing

forward

and take its turn under her weight.

There is no restlessness or impatience

or anger anywhere in sight. Grace

fills the clean mold of this moment

and all  the shuffling magazines grow

still.

 Dr.Rafael Campo, an associate professor of medicine at Harvard says he uses poetry  in his practice to aid his patients. “It’s striking  to me how they want to talk about the poems …and not the  other stuff I give them…It’s such a visceral mode of expression.  When our bodies betray us in such a profound way, it can be all the more powerful for patients to make sense of what is happening in their bodies”

The New York Times invites readers to submit their own poems about cancer.  nytimes.com/well

In our book, Prostate Cancer Survivors Speak Their Minds: advice on Options, Treatments and Aftereffects our aim was to provide readers with sufficient information to enable them to make informed and personal decisions. We regard our work as a companion piece to a good medical text book. A kind of portable support group.  But to be sure, advances in research and medical techniques are taking place at a rapid pace. And while the basic tenets in our work are sustainable, we want our readers to be apprised of the latest information as it becomes available.  These advances may alter options and decisions a patient may want to make. In our Blog, you will find reports  on the latest advances and research on fighting prostate cancer.  We scour the scientific world to bring it to you as soon as possible. At the same time, from now and then, we can’t help injecting our opinions here and there if we think they may be helpful. We clearly mark them “opinions” in full disclosure.

We began our Blog when the book was first published in 2010 and you will find the Blog has been updated ever since.  Just so you get an idea of the contents, we will provide here a list of the more recent postings. You can always find older posts at the bottom of each Blog page marked “older entries.”  We hope you will find these useful.  Let us know if we can answer any questions you may have by filling out the Contact portion of our website.

BLOG ENTRIES

 FDA approves Mayo Clinic’s new imaging agent for advanced prostate cancer

Clinical trials begin for advanced prostate cancer

Erections after prostate cancer surgery

PSA screening: Johns Hopkins vs U.S.Preventive Services Task Force

New drug to fight advanced prostate cancer: cabazidtaxel

“Blood signatures” point to aggressive prostate cancer

Mystery of erections

Advanced prostate cancer: more options now

Risk markers found for ED after radiation

MD Anderson unveils broad program to fight multiple cancers

“Wait and See” No longer cool

FDA approves Xtandi for advanced cancer

Aspirin: life saver for prostate cancer as well as heart attacks

Breast cancer drug helps men with gynecomastia

Opinion: Who should make the decisions?

PSA test gets new boost

Advanced prostate cancer treatment makes more strides

Opinion: When nothing is something

PSA and new drugs search for prostate cancer cells

U.S.Preventive Service Task Force under new fire

Opinion: Should I get treatment or do nothing?

A chip that finds prostate cancer cells

Upgrading the PSA test

New Hormone blocker pill for advanced prostate cancer

American Society of Clinical Oncology reports advances fighting advanced PC

PSA game changer?  Says Who?

Birth control pills do not cause prostate cancer

Beehive glue checks prostate cancer in mice

New universal cancer vaccine developed to be tested

Antibody shrinks tumors in 7 cancers

New surgical tool aids doctors

Circumcision and prostate cancer

Insurance Issues and prostate cancer

New cancer statistics and old cowboy hats

Link between heart disease and prostate cancer?

Robotic surgery and outcomes

Not long ago the United States Preventive Task Force (USPSTF) trumpeted this message to men: “ No need to get screened for prostate cancer. If you do get it you probably won’t die of it.”  It was a message that went round the world and many listened. Many took it to heart. Many were confused. Many still are.

Who were the experts who made the pronouncement? Certainly not the medical community who had been dedicating themselves for years to treating and curing prostate cancer. They were stunned and outraged at the USPSTF recommendations.

Despite the fact that PSA screening has saved tens of thousands of lives, a group of so-called “independent scientists” were winding the clock backwards, blacking out years of progress in controlling prostate cancer. The “independent scientists”, we were told, could more objectively evaluate the literature without bias. With not a single urologist or prostate cancer specialist on the panel?  

Prostate cancer specialists and researchers at Johns Hopkins Brady Urological Institute immediately called the USPSTF message dangerous and setting a disastrous course. The American Society of Clinical Oncology rejected the recommendations outright, calling instead for a sensible approach to screening: discouraging PSA screening in men with a life expectancy of less than 10 years, but advising men who are expected to live more than 10 years to discuss the benefits and harms of screening with their physicians.

According to the panel, “healthy men” don’t need screening. There is too much screening. “ Think of the cost-saving if we cut down on screening.” So the mantra goes.  The recommendations prompt this question:  Are they in place to promote progress or are they in place—far more likely—to save money?

 Prostate cancer is after all, the most common cancer in American men. It is also the second most common cause of cancer death.  It produces no symptoms until  it reaches an advanced stage, but by then it is too late to cure!  It can be diagnosed with a rectal exam (DRE), but it has to be large enough to be felt by a doctor.  The problem is that by the time it has grown this much it could mean it has spread beyond the confines of the prostate gland. That can spell real trouble.  What the PSA test does is signal danger before trouble begins!  That patient may appear to be “healthy” but the PSA can say otherwise.

It takes an expert to read and interpret a PSA test. To know at what level it should be in men of every age. To know if it is rising too quickly, requiring an biopsy.  It is not a perfect test but it is the best tool in the tool box—so far.  They are looking for a more perfect one all the time. Before 1991, when PSA testing became widespread, 20 percent of the men with a new diagnosis of prostate cancer had a tumor that had already spread to the bone.  Today that number is less than 4 percent!  In 1991, one out of 5 men had metastases.  Today, it is one out of 25!  Between 1994 and 2004, deaths from prostate cancer plummeted 40 percent. That was more for any other cancer in men or women.

Johns Hopkins reported the age adjusted death rate from 1990 of 39.2 per 100,000 men and applying it to 200, there would have been 59,000 deaths. Because the death rate fell to 23.5, there were 35,000 deaths.  Which means 24,000 fewer men died from prostate cancer in 2007 alone. The National Cancer Institute estimates that 40 to 70 percent of this reduction is due entirely to screening.

Critics of the USPSTF recommendations say while they used at large uncontrolled observations to look at complications of surgery, they did not discuss the number of lives saved since PSA testing was introduce in the U.S.

Important:

 USPSTF has tried to deal with the issues of over-diagnosis and over treatment. For a Johns Hopkins recommendation on these vital issues, the following link to the National Comprehensive Cancer Network (NCCN) Guidelines should be carefully read and studied.  These guidelines are approved by The American Society of Clinical Oncology as well as other national and international prostate cancer experts.

http://www.nccn.org/patients/patient_guidelines/prostate/index.html#/12/

Dr. Arthur Burnett, whose major contribution to male sexual rejuvenation has been the development of Viagra, in a new landmark discovery has just closed a major gap in understanding male potency.  For two decades scientists have known the biochemical factors that trigger penile erection. But not what’s needed to maintain one.

Now Dr. Burnett’s team of researchers at Johns Hopkins has uncovered the mystery linking the initial stimulus that produces an erection to what happens next that enables that erection to be maintained.  The team understood that the release of the chemical nitric oxide, a neurotransmitter that is produced in nerve tissue, triggers the erection by relaxing muscles that allow blood to fill the penis. What they learned from this study was that there is a complex positive feedback loop in the penile nerves that then triggers waves of nitric oxide to keep the penis erect.  Dr. Burnett says they now know that the nerve impulses that originate in the brain and from physical stimulation are in his words “ sustained by a cascade of chemicals that are generated during the erection following the initial release of the nitric oxide.”  The research was done with mice and Dr. Burnett says the basic biology of erections at the rodent level is the same as in humans.

The key finding is that after the initial release of nitric oxide, a biochemical process called phosphorylation takes place to continue its release and sustain the erection.  The study can be found in the current issue of Proceedings of the National Academy of Sciences  (PNAS).

With this latest discovery Dr. Burnett says it may be possible to develop new medical approaches to help men with erection problems caused by such factors as diabetes, vascular disease or nerve damage from surgical procedures.

One of the agents studied by the team was an herbal compound called forskolin. It’s been used to relax muscle and widen heart vessels.  They discovered that forskolin also ramps up nerves and can help keep nitric oxide flowing to maintain the erection.  Dr. Solomon S. Snyder, MD, a professor of neuroscience at Hopkins, was co-author of the current study and was also Dr. Burnett’s co-author in the original studies on nitric oxide published in Science in 1992.  Dr. Snyder says this latest research project represents a 20 year journey to complete our understanding of the complex role the nitric oxide process plays in producing erections.

Dr. Burnett is co-author of Prostate Cancer Survivors Speak Their Minds: advice on options, treatments and aftereffects. Published by John Wiley & Sons, Inc.