NY Times editor blogs about prostate cancer

The battle against prostate cancer is a very public ordeal for Dana Jennings.

The New York Times editor has chosen to blog about his experiences with the disease as he undergoes treatment. Find it at Well.

Although I had the best intentions to do the same with this blog, it has fallen into the occasional update of some cancer treatment news. I really don't have the desire to go into sharing all the trials and tribulations of prostate cancer recovery after surgery. Maybe one day I will.

Jennings also had surgery for prostate cancer, but that's where our stories diverge. My post-surgery pathology report and tri-monthly PSAs come back clean. His didn't.

What followed were hormone injections and now radiation treatments.

He tells very eloquently what it's like to lose his sex drive from the drugs and how he deals with the anger that wells from within.

Statin use may hide prostate cancer

My prostate cancer was discovered because of a spike in my PSA level that was noted during a routine annual doctor's visit. Others are first diagnosed for prostate cancer when their PSA level reaches a certain threshold.
In both cases, a biopsy usually follows.
What's a concern is that a report at Urology Today finds the use of statins lowers PSA levels, thereby giving inaccurate numbers that needed to give an accurate diagnosis of prostate cancer.
Statins are a class of drug used to lower cholesterol levels in people at risk for heart disease. Lipitor, Zocor and Crestor are among the brand names of these drugs.
In a retrospective study of 1,214 men who used statins, researchers found that as LDL (bad cholesterol) dropped so did PSA levels.

"PSA decline was linearly associated with a decline in LDL and for every 10% LDL
decline there was a PSA decline of 1.64%."

Often, a threshold PSA level triggers the need for a biopsy. The reseachers found that the drop in PSA in as many 39% of the cases would have resulted in no biopsy being performed.

As is so often the case, there's a lot of uncertainty regarding statins and prostate cancer. Obviously more study needs to be done.
For instance:
-- A report earlier this summer found that the use of statins for the long term could raise the risk of prostate cancer among obese men.
-- A report in January found that men who were taking statins to lower their cholesterol had a 10 percent greater chance of being cured of prostate cancer by radiation therapy 10 years after diagnosis

Vote yellow on election day

Being an ardent bicyclist, as well as a cancer survivor, I always pay special attention when I hear from the Lance Armstrong Foundation.
The foundation is reminding the LiveStrong Army to get out and Vote Yellow on election day.
That means wear yellow when you vote to make the impression that those committed to battling cancer come out to vote on election day.
Both Obama and McCain pledged on the record that they would fight cancer if elected president. Wearing yellow should remind them of their pledge.
Find out more about Vote Yellow here.

Experimental drug shrinks prostate tumors

An experimental drug that shrinks tumors in the most aggressive, and almost always fatal, type of prostate cancer is being tested, according to the Journal of Clinical Oncology.

The drug, abiraterone, is designed to block testosterone from being formed. While other drugs do this with some success, in some forms of prostate cancer the tumor cells themselves produce testosterone.

This test drug is said to block testosterone production everywhere in the body, including the tumor cells.

The initial test involved only 21 men, but a larger study involving 250 men is underway. If approved, Cougar Biotechnology of Los Angeles says the new drug could be available by 2011.

More at the LATimes.

Masturbation reduces risk of prostate cancer

....And we always thought it was the low-fat diet in some cultures that gave them a lower risk of prostate cancer.

An Australian study that was reported by the BBC back in 2003 found that cancer-causing chemicals could build up in the prostate if men do not ejaculate regularly.

The study went on to suggest that sexual intercourse may not have the same benefit because of the possibility of contracting a sexually transmitted disease, which could increase chance of getting cancer.

The Australian researchers questioned 1,000 men who had prostate cancer and 1,250 who didn't about their sexual habits. Those who ejaculated the most between 20 and 50 were less likely to develop prostate cancer.

Men who ejaculated more than five times a week were a third less likely to develop prostate cancer later in life.

Graham Giles of the Cancer Council Victoria in Melbourne said ejaculating may prevent carcinogens accumulating in the prostate gland. Fewer ejaculations may cause those carcinogens to build up.

"It's a prostatic stagnation hypothesis. The more you flush the ducts out, the
less there is to hang around and damage the cells that line them."

Here's a link to that BBC story, "Masturbation cuts cancer risk."

In spite of it being five years old, the story got a second wind this week when it was reported in PlanetOut on Monday, attributing it to a BBC story on Wednesday (yeah, Wednesday five years ago). The US News & World Report science blog called them out for drudging up this old news.

Old news or not, it's an interesting theory. Sure it's a ha-ha, wink-wink kind of story, but if valid, it certainly deserves to be pursued.

Prostate cancer treatments all have side effects

The many treatments for prostate cancer all have something in common, they all cause side effects that are sometimes long-lasting or even permanent.

Technological and medical advances try to reduce these the side effects, but a study published in the New England Journal of Medicine found that men suffered varying rates of incontinence, impotency and bowel problems after various treatments.

That's why men often take the side effects into account as often as the cure rates for prostate cancer treatments.

The methods studied: radiation beam, brachytherapy (radioactive seeds), surgical removal and hormone therapy.

According to the AP:

"No procedure was clearly best or worst."

That doesn't help making a decision any easier, does it.

The onset of side effects sometimes depend on the individual. Age, the size of the prostate, and previous urinary problems all can play a part in recovery.

In general, hormone therapy had a big effect on sexuality. It suppresses the production of testosterone.

Bracytherapy sometimes led to sexual problems, but more often caused discomfort with urination.

The surgical group reported a higher levels of urinary incontinence. The bracytherapy group had the highest levels of all urinary problems, however, which included pain and increased frequency. Those undergoing surgery and nerve sparing had a reduced risk of impotency, although it was not eliminated.

The beam radiation and radioactive seed group both reported bowel problems a year after surgery.

More at Science Daily and USA Today.

Prostate cancer forecasts for 2008

Prostate cancer will continue to be the leading type of cancer diagnosed among men in 2008 and will rank second, behind lung cancer, as the most deadly for men.

The forecasts are in the 2008 Cancer Facts and Figures Guide published by the American Cancer Society.

The success of detecting prostate cancer through the use of PSA tests, biopsies and digital rectal exams is probably the reason that one-quarter of all cancers detected in men are in the prostate. The rate was higher from 1988 to 1992, when the PSA tests first came into common use.

The American Cancer Society expects 186,320 men will be diagnosed with prostate cancer in 2008 and 28,660 will die from it.

Like they always say, early detection is often the key to survival.

About 1 in 6 men will be diagnosed with prostate cancer at some point in their lifetimes; nearly half of all men will be diagnosed with cancer at some point in their lives.

The report finds that the rate of prostate cancer is significantly higher among African-American men; the death rate from prostate cancer is nearly double in African-Americans.

As bad as those rates are, prostate cancer has the highest potential for survival over five years. According to the stats, 98.4% of all men diagnosed with prostate cancer survive for at least five years. Before PSA tests came into use, the rate of survival after diagnosis for prostate cancer was only 69% in 1975-1977 and 76% in 1984-1986.

Relatively high survival rates are posted for cancer of the thyroid (96.7%), testes (95.4%) and melanoma (91.1%). Breast cancer has a 88.6% survival rate for 5 years.

The relative success in treating prostate cancer in its early stages is probably the reason why the American Cancer Society recommends annual PSAs and digital rectal exams in more over 50; age 45 for African-American males and men with a family history of the disease.

Don't be like the men in this UK study, which found that 1 in 5 were too "scared" to see the general practitioner regarding prostate problems and 16% feared a rectal exam.

Five reasons to join a prostate cancer support group

When I was diagnosed with prostate cancer, I immediately started researching the disease on the web and ordered a half-dozen books about my condition. But I did not seek out a prostate cancer support group. I wish I had.

What could I learn from a bunch of men that I couldn't learn from experts in the field? Lots.

As the date for my radical prostatectomy drew nearer, I began thinking that the voice of experience was as worthwhile as the voice of experts. I frantically called around to several groups in my area.

None of them had a meeting until after my surgery date. I made plans to attend the most convenient one, catheter and all.

Jump ahead six months and I still attend those monthly meetings.

This is a very easy and friendly way to learn about the disease. About a dozen men from the overall group of 80 or so show up every month. Although guys aren't known for opening up about themselves, these prostate survivors bare their souls.

1. Learn about treatments
Just about every month there's a new member who has just received "the word" from his doctor and he's looking for answers. We usually go around the table and tell our individual stories. The guy hears personal anecdotes about all the treatments. I hear about things I never read in the books.

So, you join to learn about treatments. But why keep going month after month?

2. Emotional support
Some guys have to live with prostate cancer. It's too far spread to treat by removing the prostate. These guys come for the emotional support.

3. Recovery issues
All the treatments -- surgery, radiation therapy, hormonal -- have side effects. Impotence and erectile dysfunction are two consequences that can be long-lasting. Hormonal treatment results in a loss of sex drive. Surgery and radiation therapy can also cause incontinence for weeks or months. You learn about what works or doesn't work in these support groups. Guys are comforable talking about these issues that they probably wouldn't broach anywhere else.

4. Information source
One in six men will get prostate cancer. You'll find that other men come to you for information. You owe it to them to be able to give the best advice possible. You'll get that in the support group.

5. You're not alone
I'll be frank. What doctors write in books or on the web won't always apply to you. The biopsy, I was told, is "nothing." Well, it was very uncomforable. My doctor told me that he had guys go "back to work four days" after the surgery. I had no energy and could just walk around the block. Sitting around and shooting the bull with other prostate cancer survivors, you learn that none of them were back to work four days later and one of the good things about treatment was that they wouldn't have to go back for a biopsy.

Where to look
UsToo International Prostate Cancer and Support

Man to Man

Cancermatch.com

Out With Cancer

Saving the blood vessels along with the nerves

When undergoing a radical prostatectomy to remove a cancerous prostate, surgeons commonly take a "nerve-sparing" approach to preserve the bundles of nerves that are necessary for erections.

Recent studies show that perhaps that isn't enough. A paper by doctors at the Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center in New York says the concept of "artery sparing" radical prostatectomies should be advanced.

This is certainly something you'll want to talk about with your surgeon if you're planning a regular or laproscopic operation for prostate cancer.

The paper -- Artery Sparing Radical Prostatectomy - Myth or Reality? -- notes that not all men whose nerves are spared during prostate surgery ever recover full erections.

While there's no question that preservation of the cavernous nerves is necessary for men to get erections, the paper notes:

"In addition, it is believed that erectile tissue requires oxygenation to
maintain its integrity, which can be significantly affected if the arteries
irrigating the cavernous bodies are damaged intraoperatively, such as the
accessory pudendal arteries."

While informing the urological community about the potential need to spare the
accessory pudendal arteries, the researchers say further study is needed. "The
crux of the difficulty," they say, "is deciding which arteries should be
preserved and which may be sacrified."

A copy of this abstract is posted online at PubMed.gov.

Prostate cancer on schedule for Phils' coach Davey Lopes

The Philadelphia Phillies' first base coach Davey Lopes, 62, learned he's "one in six" as he's been diagnosed with prostate cancer.

News reports say he's expected to undergo surgery and make a full recovery.

Although there aren't a lot of details, the team said that a routine medical exam at the beginning of spring training detected the cancer. Lopes is expected to undergo surgery at Morton Plant Hospital in Clearwater, Florida.

He's expected to return to his job at first base in about six weeks.

About one in six men are diagnosed with prostate cancer. Lopes, however, is the only man who led the National League in stolen bases in 1975 and 1976 to be diagnosed.

My prostate cancer journey started with PSA test

Thanks to my wife, I'm one of those guys who goes to the doctor every year for a physical. Part of that exam is a blood test, and one the things my doctor has checked was PSA.

Until last summer, I didn't even know what PSA stood for or why I needed it. When the results started climbing, however, I quickly found out.

PSA stands for Prostate-Specific Antigen, which is a protein produced by cells in the prostate gland. It's always in the blood in men in very low levels. An elevated level of PSA can indicate prostate cancer, prostate infection or irritation, such as that from a digital rectal exam.

Normal
Generally, a PSA test of 4 or below has been considered normal. I had a string of three annual PSA tests that were all under 4.0. But my general practitioner noticed a troubling trend last spring -- the results continued to climb.

My first test in 2003 was 2.7; in 2004 it was 2.77; in 2006 it was 3.81; and in 2007 it climbed to 4.29.

My doc never detected anything in the digital rectal exams, the common way of checking for prostate cancer until the PSA tests came along in the late 1980s. Although the 4.29 was considered only slightly outside the normal range, I went in for a follow up PSA.

Abstain
A follow-up PSA was still in the same range, and I was referred to a urologist at University of Washington hospital.

Because there are other factors that can influence PSA, I was told to abstain from sex for a week and stop bicycling for two weeks. Both of these activities have been found, at times, to slightly elevate PSA.

My third PSA test of 2007 dropped slightly, to 4.02. That wasn't far enough for my doctors though, and they scheduled a biopsy for me. I'll write more about that later.

What is normal
Researchers are still wrestling over what PSA level should trigger a biopsy. The 4.0 nanograms per milliliter (ng/mL) level in general has dropped. The National Cancer Institute published the following ranges:

• 0 to 2.5 ng/mL - low
• 2.6 to 10 ng/mL is slightly to moderately elevated
• 10 to 19.9 ng/mL is moderately elevated
• 20 ng/mL or more is significantly elevated

Velocity
The point I want to make here is the importance of the PSA test in detecting prostate cancer.

As with any test, it is not foolproof. Occasionally it gives a false positive, sometimes a false negative. There's a debate over whether the 4.0 level for action should be lowered.

For me, and for many men I talk to at my cancer support group, it wasn't so much a one-time PSA test that triggered action. It was velocity, and rate at which the PSA increased. An increase from 2.7 to 4.29 might not sound that radical, but consider that rate of growth was nearly 60% over four years.

Based on my experience, and that of many other men, I'd recommend an annual PSA test. That gives doctors a baseline to check any changes in PSA over subsequent tests. If you are over 50, and your doctor is still relying on just a digital rectal exam to check for prostate cancer, I'd suggest you ask him to include the PSA as well.

More reading at National Cancer Institute: PSA Q&A; WebMd: Prostate-Specific Antigen

New target for prostate cancer treatment

Researchers have successfully killed prostate cancer cells by targeting a protein that is critical for the cancer's spread.

The finding is significant because it would give doctors another tool to battle advanced prostate cancers that are resistant to hormone therapy.

Scientists at Kimmel Cancer Center in Philadelphia killed cancer cells in the laboratory cell cultures and experimental animals by blocking Stat5, a protein that keeps the cancer cells healthy.

The researchers blocked the protein in a number of different ways, all of which were successful in killing the cancer cells.

The team was headed by Marja Nevalainen, M.D., Ph.D., associate professor of Cancer Biology at Jefferson Medical College of Thomas Jefferson University, determined that the Stat5 protein was "switched on" in nearly all recurrent prostate cancers.

More details at Science Daily or Thomas Jefferson University.

New method to test spread of prostate cancer

One of the big questions after a confirmed diagnosis of prostate cancer is whether the tumor has spread outside the walls of the prostate.

This is often difficult to predict, because the spread is sometimes at the microscopic level and therefore not visible on CT scans or other imaging tests. Often the patient doesn't know for sure until the prostate and adjacent lymph nodes are removed and examined in the lab.

Current methods of combining the results of PSA tests, staging, and rectal exams is accurate in predicting spread of the cancer in 89% of cases. Knowing whether the cancer has spread would give doctors and patients a better idea how to proceed with treatment.

Now researchers say a blood test for endoglin, a plasma biomarker, can increase the accuracy of predicting the spread of prostate cancer to 97.8%. Endoglin is used to predict the spread of colon and breast cancer.

The results of the study were published in Clinical Cancer Research, a journal of the American Association for Cancer Research, and summarized at Science Daily.

In spite of the results of this study, researchers say there were limits to the study and more work needs to be done before it can be used clinically.

If the endoglin test can be successfully used, however, then not only will patients have a better idea how to proceed with treatment but it may be unnecessary to remove pelvic lymph nodes in the future.

No single treatment preferred for prostate cancer

It comes as no surprise to many of us who have been diagnosed with prostate cancer that there is no single treatment accepted by the medical community as the best.

There's surgical removal, radiation, and hormone therapy. There's even watchful waiting, which is really no treatment at all but a way of monitoring the tumor for signs of growing.

A report by the Agency for Healthcare Research and Quality reviewed all the treatments and could not recommend one over the others because of a lack of research in prostate cancer.

When I researched what type of treatment I should undergo for protate cancer, I came to my conclusion partly based on the stage of the tumor. It's troubling that the actual reason that men have so many options is because there isn't the clinical data available for better treatment decisions.

"Information is really lacking to determine whether overall one treatment is more effective and preferred," Dr. Timothy Wilt of from the Minneapolis Veterans Affairs Center for Chronic Disease Outcomes Research is quoted.

The reason for this lack of data:

• Lack of financing
• Lack of advocacy
• Reluctance of men to participate in clinical trials
• A long time for tumors to turn deadly

The International Herald Tribune notes that US government spending on prostate cancer lags behind breast cancer research. The National Cancer Institute funded $305.6 million for prostate cancer compared to $551.1 million for breast cancer in 2007.

I'm not crying foul that prostate cancer is more deserving than breast cancer. They both should be adequately funded so men and women can both make the best choices about their cancer treatment.

Thousands of biopsy results faulty in New Brunswick

After blood tests confirmed that my PSA levels were on the rise last summer, I had to undergo a prostate biopsy. This procedure shouldn't be taken lightly, as it determines whether there is actually a tumor present in the prostate gland.

Regardless of what PSA tests and digital rectal examinations find, the biopsy helps you and your doctor decide on a course of action regarding treatment.

So imagine the chaos that's been created in New Brunswick where the Miramichi Regional Health Authority is reevaluating biopsies of more than 23,000 patients taken over the past 12 years.

Misdiagnose

The health authority is re-examining the biopsies after an independent review of a former pathologist found 18% of his prostate and breast cancer cases in 2004 and 2005 had incomplete results and 3 percent were misdiagnosed, reports CBCNews.

A 97% success might seem pretty good, until you do the math and realize that if the rate holds true for all 23,000 cases, that's nearly 700 incorrect diagnoses.

The most recent cases are being reviewed first, as they have the most "clinical significance," CBC reports. The health department is seeking help from pathology labs across North America.

What this prostate cancer blog is all about

It's been six months since I learned that I had prostate cancer. Needless to say, it was a real shock.

I was 57 years old at the time and felt that I was in pretty good health. When the doctor told me I had a tumor in my prostate gland, I remember blurting out, "But I feel fine."

Sure I felt fine, but things were happening inside my body that only blood tests and other methods of early detection could uncover.

That's how cancer works. The silent killer. By the time you know something's wrong, it's often too late to do anything about it.

I've written about some of my experiences with prostate cancer at my bicycling blog, but I have a lot of information and insight to share with men who might be going through this.

On Prostate Cancer Alert, I'll be writing about my own personal decisions regarding prostate cancer and what I've learned along the way. Also, I'll report on new and alternative treatments and other issues involving prostate cancer.

I hope you find this information helpful.