Tuesday, March 6, 2012

What is the answer for prostate surgery?

Robotic surgeries for prostate cancer don't appear to have a better track record than open surgeries for avoiding the side effects of incontinence or sexual problems.

A study reported in the Journal of Clinical Oncology compared the rate of side effects for Medicare--age men who had robotic prostate removal compared to those who underwent open surgery.

The report's conclusions:

"Risks of problems with continence and sexual function are high after both procedures. Medicare-age men should not expect fewer adverse effects following robotic prostatectomy."

That's bad news for men who were sold on the robotic surgery to reduce the chance of side effects later on.

Of the men who responded to the survey, 31% reported a problem with incontinence and 88% of men reported having a moderate to major problem with sexual function. There didn't appear to be a significant difference between men who had robotic or open surgery.

A newsletter for the Oncology Nursing Society says the experience of the doctor may be more important than the method used:

"... the outcome of any type of procedure is based not only on the technology but also on the skill and experience of the provider and the hospital system. The researchers recommended that each man should know that the type of surgery he chooses is not as important as his surgeon's experience with that particular procedure..."

The report didn't compare the short-term recovery times comparing robotic and open surgeries.

In the long-term, it doesn't sound like there are any good choices between the two types of surgery. Finding the right surgeon might be the answer.

Wednesday, March 3, 2010

Are they trying to confuse us? They've succeeded

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.

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."