POST BY DR. ANDRES BODEWIG: GREAT ARTICLE BY DR. BERT VORSTMAN

left: Andres Bodewig, M.D.
This is a great article by Dr. Bert Vorstman clearly outlining the facts about prostate cancer diagnosis and the essential need for a biopsy. Needle tracking or spread has never been documented by any urologist or pathologist in the world. There may be the rare single physician that may be an advocate if this concept. But there is no science merit to this. This concept just is not true. The reason that a biopsy is essential is that it provides hugely valuable information as to the Gleason score and the aggressiveness of the cancer. We as urologist depend on this information for planing the appropriate treatment for that individual. As well as obtaining additional information on the prognosis of the cancer. Unfortunately, there are no imaging (x-ray studies) with capabilities to determine the presence or absence of prostate cancer without a biopsy. Similar to breast cancer, no women would have their breast removed by a diagnosis based on a mammogram without having confirmation by biopsy. Like wise, no man should undergo treatment of his prostate without a biopsy.
Dr. Vorstman makes a very valid point in that the one or two urologist in America that relay on MRI, as opposed to a biopsy, are the same doctor's recommending post treatment MRI's. As well as the same physicians' that have a personal interest and ownership in the MRI equipment. As pointed out by Dr. Vorstman, there is no scientific proof or merit for a post treatment MRI. The best parameter to measure the clinical outcome of prostate cancer treatment is by periodically following the PSA.
There are three elements that are important in selecting a physician: 1) Is he board certified in his specialty?, 2) How often has he performed the recommended procedure? 3) How will the information will the test he is recommending impact on the proposed treatment? And if he is recommending a prostate MRI over a biopsy, ask for medical peer review literature to confirm that this has scientific merit,
I welcome the comments of my colleagues that treat prostate cancer on a regular basis. Can anyone them really say that they can diagnose prostate cancer with an MRI ?Can anyone of them in their professional conduct recommend an MRI over a biopsy and treat prostate cancer as such...without biopsy?

Do Prostate Needle Biopsies Spread Cancer Cells? – NO THEY DO NOT!
Posted by admin in Uncategorized on September 20, 2010 no responses
Prostate needle biopsies and needle tracking marks DO NOT spread cancer cells. Furthermore,the inflammation that brings about healing of the needle track DOES NOT cause cancer.
There are purveyors of pseudo science even in the world of urology who repeatedly offer false science that is peppered with irrelevant references and non sequitur arguments to present their case.
The sole purpose for perpetuating these untruths is to confound a vulnerable target (men who have or are at risk of having prostate cancer) and steering them towards evaluations that are self serving. Invariably,this disordered rhetoric is generated and encouraged by those physicians and organizations that have most to gain. In this regard,in-house imaging equipment such as MRI’s are well known to be potential instruments for financial abuse. Therefore, at risk patients are easily encouraged to undergo needless and expensive in-house MRI studies. This convenient arrangement and investment by owner physicians, represents a huge potential conflict of interest in managing prostate cancer patients.
There simply is NO reliable evidence to support the notion that MRI with or without spectroscopy will ever dispense with needle biopsies of the prostate.
Imaging studies are unable to definitively diagnose a prostate cancer let alone make determinations on a Gleason grade and score.
No man should ever consider treatment of his alleged prostate cancer based solely on the dubious images generated by an MRI.
Even benign lesions may mimic a prostate cancer and the only reliable method for detecting a prostate cancer is based upon a needle biopsy.
Similarly,there is no evidence that “scientific” targeted biopsies of suspicious areas provides any benefits over the standard needle biopsy without the expensive MRI. In fact,using the targeted MRI approach to the prostate may detect very early low grade,low volume cancers that are usually clinically insignificant and can be managed by active surveillance.
In addition,the questionable practice of recommending routine post HIFU MRI studies on the pretext of early recognition of incompletely treated men simply represents a further shameless and unadulterated assault on the wallets of patients and insurance companies.
Only a well designed and executed trans rectal ultrasound and needle biopsy of the prostate by an experienced urologist can answer all of the questions as to the true nature of a man’s prostate cancer.
The unabashed, pseudo intellectual and illogical recycling of these myths about prostate needle biopsies spreading cancer cells
by physicians is unfounded,unconscionable and malicious.
Certainly,those urologists that are board certified are required to practice by an ethical and scientific standard. Others,however,appear to practice the peddling of half truths and this non Hippocratic behavior taints all physicians and may be considered malpractice.

RESEARCH ON UNINSURED PROSTATE CANCER PATIENTS

Uninsured Prostate Cancer Patients Tend To Have More Severe Disease At Diagnosis.
HealthDay (9/17, Preidt) reported that, according to a paper in Cancer Epidemiology Biomarkers and Prevention, "prostate cancer patients who are uninsured or on Medicaid at the time of their diagnosis tend to have more severe disease, likely because they have less access to medical care." In fact, "compared to patients with private insurance, those who were uninsured or Medicare-insured had higher PSA levels and Gleason scores, and were more likely to be diagnosed with advanced cancer." Before reaching those conclusions, investigators "analyzed National Cancer Database records of 312,339 prostate cancer patients diagnosed between 2004 and 2006."

Emory researchers eventually discovered that "uninsured and Medicaid-insured patients had approximately 4 ng/ml higher PSA levels than their privately insured counterparts," MedWire (9/17, Guy) reported. "Furthermore, being uninsured was clearly associated with having an advanced Gleason score, with odds ratios (ORs) of 1.97 and 1.67 for uninsured and Medicaid insured men, respectively, compared with privately insured patients. Being Black, Asian, or Hispanic also increased the risk for poor Gleason score compared with being White," while "being uninsured and Medicaid-insured...increased the risk for being diagnosed with advanced-stage disease, 1.85 and 1.49 times, respectively, compared with being privately insured."

PSA SCREENING IN MEN WITH SPECIFIC GENETIC MUTATIONS

New Research Provides Support For Continued PSA Screening In Men With Specific Genetic Mutations.
BBC News (9/10) reports, "PSA screening has been contentious in the past because of concerns about over-diagnosis," and the medical community also remains at odds about "how effective it was at reducing mortality." Aiming to clarify the issue, UK scientists set about analyzing preliminary data culled from the "first large international prostate cancer screening study," which is "targeted at men with a known genetic predisposition to the disease." Investigators eventually concluded that "it appears that PSA screening is reasonably accurate at predicting potentially aggressive prostate cancer among men at higher risk of the disease due to a genetic predisposition." In other words, their work "provides support for continued screening in men with genetic mutations." Reuters (9/10, Kelland) also covers the study.


George M. Suarez, M.D.

POTENTIAL SECONDARY EFFECTS OF RADIATION THERAPY

The following is a very interesting article that appeared recently in Cancer regarding the potential secondary effects of Radiation Therapy associated with treatment for prostate cancer. Patients are often mislead into choosing radiotherapy without full informed consent of the potential side effects. As well as their fear of even greater complications associated with surgery. As HIFU continues to prove it's efficacy with decreased side effects, it is rapidly becoming the fastest growing new treatment for localized prostate cancer. For additional information on HIFU, please visit: www.hifumedicalexpaert.com.
George M. Suarez, M.D.
___________________________________________________________________________________________________
5 Common Unwanted Effects Of Radiation Therapy With Regard To Prostate Cancer
Cancer 2010-09-07
There are three techniques used in prostate cancer treatment. One of these is via radiation therapy. This kind of treatment can be delivered in two ways, outwardly and internally. Outwardly treatment methods are done in several sessions wherein the high-frequency x-ray device is used in order to destroy most cancers tissue. The internal method or medically known as brachytherapy utilizes the implantation of radioactive seed products into the prostate gland. They are efficient methods in treating cancer. Nevertheless, they can trigger some unwanted effects towards the various areas of the body.
Among the prostate cancer radiation side effects is actually tissue damage. The tissues from the body are very vulnerable to radiation. However only a small percentage of the patients undergoing this sort of treatment encounter this sort of impact. The actual tissues associated with a few organs which are near the prostate such as the skin, vesica or rectum are broken because of the contact with radioactive supplies. When this happens it can produce loss of function and may need surgery in order to cure it.
Radiation therapy with regard to cancer of the prostate may also trigger unwanted effects for example bowel problems such as diarrhea, bowel emergency as well as hemorrhoids. Since the radiation can even achieve through the bowels due to its location adjacent to the prostate, the individual undergoing the radiation can encounter this kind of problem. The radiation does not only have an effect on cancer tissue but it also kills the standard cells causing problems about the function associated with a few internal organs like that from the bowel. Drugs receive to treat these unwanted effects.
A mans individual getting radiation therapy additionally encounters urinary incontinence. This happens to about 10 percent of those who have this sort of treatment. The actual sphincter of the urinary system bladder is actually damaged that caused seapage and incontinence. Occasionally, following radiation the patient should put on a mat just to maintain him through wetting his trousers. If this situation gets worse or does not take care of, the individual will have to go through surgical treatment and make required repair about the damage of the vesica to stop this kind of healthcare issue.
Another side-effect associated with radiation therapy with regard to prostate cancer is impotence as well as inability to conceive. Because, the actual prostate gland is actually the main man reproductive system; functions associated with male sexuality are reported. There is a issue with regards to male erection and the patient will even have a issue generating sperm. Mentionened above previously, radiation therapy does not just affect most cancers cells but also those which are typical such as the semen. The patient must find out about this because it is a great issue related to his lovemaking life.
Finally, the patient will really feel weak as well as fatigue could be experienced for about a few several weeks after the process. You have to follow the related diet that will help get through with this problem. These are the common unwanted effects that a individual experiences following a radiation therapy. But the definitive goal of the remedy outweighs these minor problems. Individual education is really essential so that the individual may know what to do during the process as well as what to expect after the therapy is carried out.
Radiation therapy with regard to prostate cancer is an effective mode associated with remedy however there are certain side effects how the patient should learn and the physicians must monitor.
George M. Suarez, M.D.
Medical Director,
The Miami Urology Center of Excellence

GEORGE M. SUAREZ, M.D. IN DOCTORS HOSPITAL IN THE BAHAMAS

FROM LEFT TO RIGHT: BARRY RASSIN, PRESIDENT OF DOCTORS HOSPITAL IN THE BAHAMAS, GEORGE M. SUAREZ, M.D.,MEDICAL DIRECTOR USHIFU, BOARD CERTIFIED UROLOGIST.

Nassau, Bahamas - Doctors Hospital has been a pioneer in minimally and non-invasive surgeries in the Bahamas with the first Laparoscopic colon surgery performed locally in 2009; today high intensity focused ultrasound (HIFU) has been added to its portfolio for treatment of prostate cancer. Doctors Hospital thus joins a select group of hospitals that is offering this innovative treatment for prostate cancer and becomes the first hospital in the Bahamas to offer this technology.
HIFU delivered with the Sonablate® 500 medical device (“Sonablate HIFU”) destroys prostatic tissue with extreme heat generated from focused ultrasound waves. Initially, the Sonablate captures real-time images of the prostate gland, allowing the physician to create a customized treatment plan for each patient. The physician then uses the Sonablate to deliver the ultrasound energy to extremely small target sites, or focal points, throughout the prostate gland. The ultrasound energy is delivered in rapid-fire succession to targeted tissue throughout the gland. The tissue at each target is destroyed while surrounding tissue remains unharmed.
HIFU treatment typically is a one-time, 2-4 hour procedure performed on an out-patient basis under spinal anesthesia. Patients generally are up and walking within hours after HIFU and can return to a normal lifestyle within a couple of days.
Considered a promising technology within the non-invasive or minimally invasive therapy segments of medical technology, HIFU uses non-ionizing, or clean, energy and may be repeated if necessary should there be a recurrence and may be used as a salvage therapy if some other treatments have failed.
Men over age 50 years are still encouraged to have an annual rectal examination and a blood test called a PSA as prostate cancer is the most common non-skin cancer in men and the third leading cause of male cancer deaths worldwide.

STUDY ON FINASTERIDE

Study Suggests Finasteride May Not Be Widely Prescribed For The Prevention Of Prostate Cancer.

Bloomberg News (8/11, Fridson) reports, "Researchers urged doctors to discuss with patients the benefits of Merck & Co.'s Proscar for preventing prostate cancer, after a study found that prescribing of the product didn't increase when a 2003 trial showed the medicine wards off tumors." The "drug, also sold generically as finasteride, was shown to reduce some men's risk of developing prostate cancer by a quarter, to 18 percent from 24 percent," according to the 2003 paper in the New England Journal of Medicine.
Thus, the "American Society of Clinical Oncology and the American Urological Association issued a joint guideline in 2009 recommending that 5-alpha reductase inhibitors be considered for prostate cancer prevention in healthy asymptomatic men with a prostate-specific antigen (PSA) level of 3.0 ng/mL or less who receive regular screening for prostate cancer," Medscape (8/10, Nelson) reported. "But, according to the new survey, 64% of urologists and 80% of primary care physicians never prescribe finasteride for prostate cancer chemoprevention." In the study published in Cancer Epidemiology, Biomarkers & Prevention, "55% of urologists expressed concern about inducing high-grade tumors, and 52% of primary care doctors were unaware that finasteride could be used as a chemopreventive agent."

DOCTORS HOSPITAL OFFERS NEW CANCER TREATMENT

PICTURED BELOW IS GEORGE M. SUAREZ, M.D., FACS, FAAP, MEDICAL DIRECTOR, USHIFU, INTERNATIONAL HIFU, BOARD CERTIFIED UROLOGIST



Doctors Hospital has been a pioneer in minimally and non-invasive surgeries in the Bahamas with the first Laparoscopic colon surgery performed locally in 2009; today high intensity focused ultrasound (HIFU) has been added to its portfolio for treatment of prostate cancer. Doctors Hospital thus joins a select group of hospitals that is offering this innovative treatment for prostate cancer and becomes the first hospital in the Bahamas to offer this technology.

HIFU delivered with the Sonablate® 500 medical device (“Sonablate HIFU”) destroys prostatic tissue with extreme heat generated from focused ultrasound waves. Initially, the Sonablate captures real-time images of the prostate gland, allowing the physician to create a customized treatment plan for each patient. The physician then uses the Sonablate to deliver the ultrasound energy to extremely small target sites, or focal points, throughout the prostate gland. The ultrasound energy is delivered in rapid-fire succession to targeted tissue throughout the gland. The tissue at each target is destroyed while surrounding tissue remains unharmed.

HIFU treatment typically is a one-time, 2-4 hour procedure performed on an out-patient basis under spinal anesthesia. Patients generally are up and walking within hours after HIFU and can return to a normal lifestyle within a couple of days.

Considered a promising technology within the non-invasive or minimally invasive therapy segments of medical technology, HIFU uses non-ionizing, or clean, energy and may be repeated if necessary should there be a recurrence and may be used as a salvage therapy if some other treatments have failed.

Men over age 50 years are still encouraged to have an annual rectal examination and a blood test called a PSA as prostate cancer is the most common non-skin cancer in men and the third leading cause of male cancer deaths worldwide.

The newest facility to become a part of the US HIFU international treatment program, Doctors Hospital joins more than one hundred (100) centers in thirty-plus countries to offer the innovative treatment. The program provides patients from the United States access to the Sonablate technology in international facilities. Just a forty-five minute flight from Florida, this high- tech procedure can now be offered close to home for some US patients and in a beautiful island setting.

According to an article published in one of the local dailies, there is a sizeable medical tourism market for the Bahamas to tap into. In 2007, some seven hundred and fifty thousand (750,000) Americans traveled abroad for overseas medical services, spending approximately $2.1 billion. The former number is predicted to swell to within six million by the end of this year.

Poised to take advantage of the door the medical tourism opens, Doctors Hospital recently accredited by Joint Commission International (JCI), Doctors Hospital joins an elite group of few hospitals worldwide, which have passed JCI’s stringent clinical quality standards. Joint Commission International (JCI) is the global arm of the US-based Joint Commission on the Accreditation of Healthcare Organizations (JCAHO); The distinction certifies that the hospital’s programs meet international standards and follow the latest US clinical guidelines establishing it as a facility with exceptionally high standards, and as part of a high-quality network offering highly-skilled doctors, state-of-the-art equipment and innovative treatment.

Source: Doctors Hospital

SOME MEN MAY EXPERIENCE URINARY PROBLEMS, TEMPORARY ED AFTER PROSTATE BIOPSY

Some Men May Experience Urinary Problems, Temporary ED After Prostate Biopsy.

Reuters (8/31, Norton) reports that some men may experience urinary problems or temporary erectile dysfunction after undergoing a prostate biopsy, according to a German study published in the Journal of Urology. After randomizing 198 men to one of three types of biopsies, investigators discovered that those who were subjected to saturation biopsies were more likely to visit the bathroom during the night or find it difficult to pass urine. As for ED, that group, as well as those who underwent standard and 10-sample biopsies, had issues.

SEXUAL DYSFUNCTION AFTER CURIETHERAPY

Sexual dysfunction after curietherapy and external radiotherapy of the prostate for localized prostate cancer]
[Article in French]
Huyghe E, Bachaud JM, Achard JL, Bossi A, Droupy S; les membres du comité d'andrologie de l'AFU.
Service d'urologie CHU de Toulouse, Hôpital de Rangueil, 1 avenue du Professeur Jean Poulhès, Toulouse cedex 9, France. huyghe.e@chu-toulouse.fr
Abstract
OBJECTIVES: Knowing the importance of sexuality items in the choice by the patient of the modality of treatment of localized prostate cancer, we aimed at reviewing and updating the effects of prostate radiotherapy and brachytherapy on sexual functions.
METHOD: A PubMed search was done using the keywords: prostate cancer, erectile dysfunction, radiotherapy, brachytherapy, ejaculation and orgasm.
RESULTS: After both radiotherapy and brachytherapy, sexual troubles occur progressively, the onset of occurrence of erectile dysfunction being 12-18 months after both treatments. Even though the pathophysiological pathways by which radiotherapy and brachytherapy result in erectile dysfunction have not yet been fully clarified, arterial damage and exposure of neurovascular bundle to high levels of radiation seem to be two main causes of erectile dysfunction after radiotherapy and brachytherapy. The radiation dose received by the corpora cavernosa at the crurae of the penis may also be important in the etiology of erectile dysfunction. Another important factor following radiotherapy is the treatment modality. Not many data about ejaculation and orgasm after radiation treatments have been published yet. Recent data show that most of the population treated by brachytherapy conserves ejaculation and orgasm after treatment, even if a majority describe reduction of volume and deterioration of orgasm. Patients need to be correctly informed on the possible sequela of radiotherapy and brachytherapy on their sexual well-being while planning their treatment. Patients should also be informed about the possible treatment modalities for erectile dysfunction.
George M. Suarez, M.D.
Medical Director,
The Miami Urology Center of Excellence
Cell: 305-310-8238