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.