Tuesday, November 17, 2009

New mammography advice follows PSA changes

News that a federal advisory panel recommends women don't start breast screening until age 50 comes from a government advisory group that changed the recommendations for PSA testing last year.

Just last month the chief medical officer of the American Cancer Society said the advantages of cancer screening had been exaggerated, especially for breast and prostate cancers. He told the New York Times that screening for those diseases had led to overtreating small cancers while missing others that are more deadly.

Now the U.S. Preventative Services Task Force recommends women in their 40s should stop having routine mammograms, relying instead on self-examination.

Although the American Cancer Society doctor gave us a preview of this decision, that group and the American College of Radiology, among others, are officially disputing the recommendation.

Livestrong president Doug Ulman said:
"We must break down the barriers to screening and early detection, not create new ones. We must empower women to be well-informed about their health, not send them conflicting signals."
Fortunately, the decision on whether to get a mammogram is the decision of a woman, advised by her doctor.

One danger mentioned in the New York Times, however, is that insurance companies may one day adjust their coverage of mammograms based on the new recommendations.

Last year, the task force changed the guidelines for prostate cancer screening. It stopped endorsing universal screenings and recommended against them for men over 75 years old.

Generally speaking the American Cancer Society does not support routine testing of prostate cancer. However, the group does recommend that doctors should discuss screening with men who are of average risk for prostate cancer at age 50; earlier for men with close relatives who suffered prostate cancer.

Here's the full language of the American Cancer Society recommendation for prostate cancer screening [it's part of the ACS discussion of early prostate cancer detection]:

The American Cancer Society (ACS) does not support routine testing for prostate cancer at this time. The ACS does believe that health care professionals should discuss the potential benefits and limitations of prostate cancer early detection testing with men before any testing begins. This discussion should include an offer for testing with the prostate-specific antigen (PSA) blood test and digital rectal exam (DRE) yearly, beginning at age 50, to men who are at average risk of prostate cancer and have at least a 10-year life expectancy. Following this discussion, those men who favor testing should be tested. Men should actively take part in this decision by learning about prostate cancer and the pros and cons of early detection and treatment of prostate cancer

This discussion should take place starting at age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65).

This discussion should take place at age 40 for men at even higher risk (those with several first-degree relatives who had prostate cancer at an early age).

If, after this discussion, a man asks his health care professional to make the decision for him, he should be tested (unless there is a specific reason not to test).

Monday, November 16, 2009

Canada study says watchful waiting can be safe

Men with slow-growing prostate cancer tumors don't necessarily need to rush into surgery or radiation -- treatments that can have severe side effects.

Such is the result of a study performed by the Odette Cancer Centre at Sunnybrook Health Sciences Centre in Toronto.

It finds that "watchful waiting" is a low-risk option for patients with early stage, slow-growing prostate cancers.

Of 450 prostate cancer patients whose tumors were considered slow-growing and non-aggressive, the report found a 97.2 percent survival rate.

After 10 years, the study found that men in the watchful-waiting group were 18 times more likely to die of causes other than prostate cancer, says the CTV news website.

"Watchful waiting" is an active medical program that entails regular PSA screenings and biopsies for men diagnosed with prostate cancer. If this method of surveillance discovers a cancer tumor is becoming larger and more aggressive, a more radical form of treatment is proscribed.

In the Canada study, 30 percent of the patients were reclassified during the study period for surgery or radiation. That still leaves 70 percent who didn't take aggressive action against their cancer tumors early on and survived the term of the study.

Watchful waiting is certainly a viable alternative, especially if the doctors consider it. The side effects of surgery and radiation -- incontinence and erectile dysfunction -- can be long-lasting and sometimes permanent.

That's why it's important to get a second or third opinion of your diagnosis, even if it seems cut and dried.

The report is in the latest issue of the Journal of Clinical Oncology.

Friday, November 13, 2009

"Mary Tyler Moore" writer dies of prostate cancer

Even with all the treatments and cures for prostate cancer, the disease still kills at an alarming rate. In fact, the National Cancer Institute estimates that 27,360 men will die of prostate cancer this year.

One of those is "Mary Tyler Moore" and "Cheers" TV sitcom writer David Lloyd who died Tuesday. He was 75.

Lloyd won an Emmy for his script for the Mary Tyler Moore Show episode entitled "Chuckles Bites the Dust," often considered one of the best TV sitcom scripts ever written. That's the final minutes of the episode above, when the news staff visits the funeral for the TV clown.

After writing jokes for Jack Paar in 1962, Lloyd went on to work on the "The Bob Newhart Show," "Phyllis," "Rhoda," "Lou Grant," and "Taxi."

The family asks that donations be sent to the USC Westside Prostate Cancer Center.

More on Lloyd's work and reactions to his death at the LA Times.

Friday, October 30, 2009

Recent celebrities with prostate cancer

Just saw that news that Hollywood actor Dennis Hopper has been diagnosed with prostate cancer.

He was one of the "outlaws" in the movie Easy Rider and went on to become a director and actor in scores of movies.

His manager said 73-year-old Hopper was being treated through a "special program" at the University of Southern California. I'm sure we'd like to know what that "special program" is.

Meanwhile, it was announced in the past couple of weeks that composer Andrew Lloyd Webber, 61, has been diagnosed with prostate cancer as well.

The composer of Phantom of the Opera and other musicals also is currently undergoing treatment, although there's been no word on what treatment he chose either.

I'm sorry to hear about these men falling victim to cancer, but maybe it will help raise awareness of the disease among men.

Wednesday, October 21, 2009

Prostate cancer screening advantage "overstated"

The chief medical officer of the American Cancer Society might have dropped a bomb when he told the New York Times in a story ("Cancer Society, in shift, has concerns on screening") on Wednesday:

"We don’t want people to panic. But I’m admitting that American medicine has overpromised when it comes to screening. The advantages to screening have been exaggerated.”

That's not great comfort to all of use who carefully watched PSA tests and took action when the levels started to rise.

Dr. Otis Brawley was responding to a report that the American Cancer Society is working on a message that screening for prostate, breast and other cancers can result it overtreating small cancers while missing other cancers that are deadly.

Clarifying his statement later regarding prostate cancer, Brawley said:

"Since 1997 the American Cancer Society has recommended that men talk to their doctor and make an informed decision about whether or not prostate cancer early detection testing is right for them. This recommendation also still stands."

ABC News sought out Dr. William Catalona, director of the Clinical Prostate Cancer Program at Northwestern Memorial Hospital in Chicago, for his reaction:

"In the U.S. there has been an 85 percent decrease in the percentage of prostate cancer cases that present with advanced-stage disease and a 40 percent reduction in the age-specific prostate cancer mortality rate during the PSA screening era... I continue to recommend PSA screening to my patients."

Saturday, October 17, 2009

Public kept in dark about best cancer centers

Newsweek magazine makes a case for more transparency in cancer treatment won-loss scorecards among doctors and hospitals.

The article, "What You Don't Know Might Kill You," says there can be a wide disparity in success of treatments of cancer, for instance, depending on where the patient goes.

" ... at Fox Chase Cancer Center in Philadelphia, to pick one top site, the five-year survival rate for patients with stage II prostate cancer is 93 percent, compared with 88 percent nationwide."
A 5 percent difference doesn't sound like much, unless you are one of the 5 percent.

The Newsweek investigation found wide differences between the results of top cancer centers and community settings (local hospitals and private practice oncologists) where 90 percent of cancer patients are treated.

"Five years after surgery for prostate cancer, for instance, 72 percent of men treated at leading hospitals are alive, compared with 62 percent of those treated elsewhere. Scrutinizing data from specific cancer centers reveals even greater gaps. Five-year survival for stage IV prostate cancer is 71 percent at Fox Chase, for instance, but 38 percent nationally."
Often the issue isn't which hospital has the best machines, it's which hospitals have the best doctors. Those are usually found at the major cancer centers.

But good luck finding out the track records for particular cancers at various cancer treatment centers. They usually don't release this data. So if you want to find the best cancer center for treatment of prostate cancer, you can't find out.

In fact, according to Newsweek,
"And although the National Comprehensive Cancer Network (NCCN) of the nation's 21 top cancer hospitals collects data on how well its members adhere to treatment guidelines, it will not release the information on specific centers."

Friday, October 16, 2009

Ask for surgeons' track record with ED and incontinence

Media blogger Jeff Jarvis has written a detailed and insightful piece about the aftermath of his prostatectomy -- "Small c: the penis post."

Warning readers that this might qualify as too much information, Jarvis goes into some of the specifics of incontinence and erectile dysfunction.

Those are two big problems for men who undergo prostate surgery or radiation treatments. It seems we're so intent of getting rid of this cancer -- be it slow or fast growing -- that we don't worry about the side-effects until after we start to heal and things ain't what they used to be.

Everything I read leading up to my surgery suggested that patients should find out the doctor's success rate at curing the cancer. In a recent report on minimally invasive surgery, a researcher suggested that patients who choose the da Vinci robotic method ask the surgeon how many he's performed. Apparently the success rate improves with "hands-on" experience.

While those are good ideas, something else patients should ask is the surgeon's success rate regarding incontinence and erectile dysfunction following the operation.

Based on experiences of men in a prostate support group I joined, too few surgeons pay much attention to those statistics for their patients.

They should. Removing the cancer is only half the battle. Ensuring the prostate cancer survivors can live full lives is an important part of the cancer cure.

If your surgeon doesn't seem to know how his patients fared with incontinence and ED after the surgery, it's time to start looking for a new surgeon.

Tuesday, October 13, 2009

More confusion about prostate cancer treatments

A new study raises more questions than it answers about the serious, long-term after-effects of surgery for prostate cancer.

The study finds that men who undergo the less invasive, laparoscopic surgery tend to have a greater chance of impotence and incontinence than those who have surgery by traditional methods.

Published this week in the Journal of the American Medical Association, the prostate surgery report finds that men who choose minimally invasive surgery had a lower rate of blood transfusions and internal scarring, as well as shorter hospital stays.

After 18 months, however, the men who had minimally invasive surgeries reported a high incidence of incontinence and erectile dysfunction.

The minimally invasive surgery includes, but is not limited to, the da Vinci robotic system that is gaining widespread support. Other types of laparoscopic surgery is performed by hand.

It's unfortunate that the researchers lumped all types of minimally invasive surgery together in the report, rendering it totally useless for anyone trying to make an informed decision about what route to take for cancer treatment.

Many doctors tout the da Vinci system as superior to other forms of hands-on laprascopic surgery; this study does nothing to prove or disprove that.

The study by Dr. Jim Hu of Brigham and Women's Hospital in Boston also did not take into account the several forms of radiation or hormone therapies that are used in cancer treatments.

According to the AP, Hu analyzed the Medicare data for nearly 9,000 prostate cancer patients who had surgical treatment from 2003-07. Of those, 1,938 patients had minimally invasive surgery and 6,899 patients had standard surgery. Note that since these were Medicare cases, the age of the men involved was probably older than the average age of men who undergo prostatectomies.

Among the results, diagnoses of incontinence was 15.9 (minimally invasive) vs. 12.2 (standard) per 100 person years and erectile dysfunction was 26.8 (minimally invasive) vs. 19.2 (standard) per 100 person years. (The rate of "100 person years" is primarily for comparison. It's the rate for 100 people for 1 year, or 1 person for 100 years, or however else you want to divide it.)

Said Hu:

"The take-home message for men is they need to dig deeper than simply the message they might be getting from planted stories from device manufacturers or radio ads or billboards."

Unfortunately, this study itself doesn't dig deep enough.

Friday, February 20, 2009

Neighbor's prostate diagnosis brings back memories

My wife brought home the news yesterday from her bus commute that one of our neighbors has been diagnosed with prostate cancer.
I immediately asked my wife to see if the guy wants to talk with someone about it. I can imagine the shell-shock he must have felt at getting the news.
It has been nearly two years since I got the first hint that I may have prostate cancer. An MD first noticed a spike in my PSA at an annual check up in April 2007. By August it had been confirmed by follow-up tests and a biopsy, and I had my robotic laproscopic surgery in September.
My first reaction was surprise, then shock (my father and a close relative had both died of cancer).
Even though the diagnosis was scary for me, I had a lot of support from my family and medical community. I got busy reading about prostate cancer and its treatment. Luckily, I was "healthy" enough to get surgery that would take the bastard out of there for good.
So what I'll suggest to our neighbor is to listen to his doctor, get a second opinion, read up on the disease, contact a prostate cancer support group and make a decision.
Then I'll warn him that even when the cancer is gone, the side effects of treatment can linger. Men suffer varying degrees of incontinence or erectile dysfunction, but there are ways to deal with those problems too.
The important thing is to take action and not passively accept fate.