Prostate Cancer Alert

Are they trying to confuse us? They've succeeded

2010-03-03T13:31:00.000-08:00

After years of recommending that all men get regular PSA tests and digital rectal exams, the American Cancer Society is revising its guidelines.

Now it's saying that men should discuss the benefits and risks of prostate cancer screening with their doctors.

It sounds like one of those risks of screening for prostate cancer is a positive test. That would then require some type of action, like surgery or radiation therapy.

The problem is that both of these solutions carry lots of side effects, but doctors can't be sure whether it's a fast or slow-growing tumor. If it's a slow growing tumor, then the cure might be worse than the disease.

The ACS now recommends:

"...that men with no symptoms of prostate cancer who are in relatively good health and can expect to live at least 10 more years have the opportunity to make an informed decision with their doctor about screening after learning about the uncertainties, risks, and potential benefits associated with prostate cancer screening. These talks should start at age 50. Men with no symptoms who are not expected to live more than 10 years (because of age or poor health) should not be offered prostate cancer screening. For them, the risks likely outweigh the benefits, researchers have concluded.

"As in earlier guidelines, ACS recommends men at high risk – African-American men and men who have a father, brother, or son diagnosed with prostate cancer before age 65 – begin those conversations earlier, at age 45. Men at higher risk – those with multiple family members affected by the disease before age 65 – should start even earlier, at age 40."

I'm almost glad that I'm past this phase. It makes me uneasy when my doctor doesn't really have a good answer.

New mammography advice follows PSA changes

2009-11-17T19:41:00.000-08:00

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).

Canada study says watchful waiting can be safe

2009-11-16T15:58:00.000-08:00

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.

"Mary Tyler Moore" writer dies of prostate cancer

2009-11-13T07:16:00.001-08:00

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.

Recent celebrities with prostate cancer

2009-10-30T10:12:00.000-07:00

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.

Prostate cancer screening advantage "overstated"

2009-10-21T13:41:00.000-07:00

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."

Public kept in dark about best cancer centers

2009-10-17T17:14:00.000-07:00

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."

Ask for surgeons' track record with ED and incontinence

2009-10-16T12:46:00.000-07:00

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.

More confusion about prostate cancer treatments

2009-10-13T13:38:00.000-07:00

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.

Neighbor's prostate diagnosis brings back memories

2009-02-20T10:09:00.000-08:00

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.

NY Times editor blogs about prostate cancer

2008-12-09T10:26:00.000-08:00

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

2008-11-11T17:36:00.000-08:00

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

2008-11-03T15:39:00.000-08:00

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

2008-07-23T17:57:00.000-07:00

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

2008-04-24T09:58:00.000-07:00

....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

2008-03-20T10:54:00.000-07:00

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

2008-03-10T10:15:00.000-07:00

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

2008-03-07T10:49:00.000-08:00

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

2008-03-06T06:56:00.000-08:00

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

2008-03-04T10:58:00.000-08:00

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

2008-03-04T09:42:00.000-08:00

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

2008-03-03T12:06:00.000-08:00

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

2008-02-28T12:41:00.000-08:00

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

2008-02-26T11:24:00.000-08:00

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

2008-02-21T10:18:00.000-08:00

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

2008-02-17T12:38:00.000-08:00

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.