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

A RUSH TO OPERATING ROOMS THAT ALTERS MEN'S LIVES

August 30, 2010, 5:00 pm A Rush to Operating Rooms That Alters Men’s Lives
By DANA JENNINGS

Jeanette Ortiz-Burnett/The New York TimesAs I scuffed through the stations of the prostate-cancer cross these past two years, I sometimes wondered whether I wasn’t a dupe caught up in a Robin Cook medical thriller.

Sure, the biopsy (so I was told) showed that my prostate was cancerous. And after it was removed, the pathology report revealed that the cancer was unexpectedly aggressive, thrusting me from the relative comforts of Stage 1 to the deep woods of Stage 3.

But at least on the surface, the cancer itself never did any damage. It was the treatments that razed me — the surgery, radiation and hormones producing a catalog of miseries that included impotence, incontinence and hot flashes. And a small voice kept whispering: What if this is all a lie? A dark conspiracy of the global medical-industrial complex?

And now comes “Invasion of the Prostate Snatchers,” by Ralph H. Blum and Dr. Mark Scholz, effectively confirming my whimsical paranoia.

Mr. Blum, a cultural anthropologist and writer, has lived with prostate cancer for 20 years without radical treatment, and Dr. Scholz is an oncologist who has treated the disease exclusively since 1995.

Their book, written tag-team style, is a provocative and frank look at the bewildering world of prostate cancer, from the current state of the multibillion-dollar industry to the range of available treatments.

About 200,000 cases of prostate cancer are diagnosed each year in the United States, and the authors say nearly all of them are overtreated. Most men, they persuasively argue, would be better served having their cancer managed as a chronic condition.

Why? Because most prostate cancers are lackadaisical — the fourth-class mail of their kind. The authors say “active surveillance” is an effective initial treatment for most men.

They add that only about 1 in 7 men with newly diagnosed prostate cancer are at risk for a serious form of the disease. “Out of 50,000 radical prostatectomies performed every year in the United States alone,” Dr. Scholz writes, “more than 40,000 are unnecessary. In other words, the vast majority of men with prostate cancer would have lived just as long without any operation at all. Most did not need to have their sexuality cut out.”

Send Us Your Photos
Picture Your Life After Cancer
A collage of photos and insights submitted by readers.

Upload your photo here.
.Yet radical prostatectomy is still the treatment recommended most often, even though a recent study in The New England Journal of Medicine suggested that it extended the lives of just 1 patient in 48.

And surgery, of course, is most often recommended by surgeons and urologists — who are also surgeons. Mr. Blum writes: “As one seasoned observer of the prostate cancer industry told me, ‘Your prostate is worth what Ted Turner would call serious cash money.’ ” As for patients, their rational thinking has been short-circuited by the word “cancer.” Scared, frantic and vulnerable — relying on a doctor’s insight — they are ripe to being sold on surgery as their best option. Just get it out.

Every urologist I met with after my diagnosis recommended surgery, even though it was believed then that I had a low-risk Stage 1 cancer. The best advice came from my personal urologist, who declined to do my operation because it was beyond him: “Avoid the community hospital guys who do a volume business in prostates.”

I did, but I’m still maimed. In my experience, doctors play down punishing side effects like incontinence, impotence and shrinking of the penis. Those are just words when you hear them, but beyond language when you go through them.

Despite the impression the authors give, though, judging the velocity or voraciousness of a prostate cancer can still be imprecise. I know this firsthand.

After my biopsy, it appeared that I had a Stage 1 cancer, a doddering old nag that the authors would have designated for active surveillance. As it turned out, I had an especially pure Stage 3 cancer, a real top-fuel eliminator in terms of velocity (and hunger).

I’m a wild card, the 1 man in 48 saved by surgery. Without it, my doctors wouldn’t have learned the cancer was so advanced, and wouldn’t have given me the hormones and radiation that helped keep me alive.

So yes, prostate cancer is a dark and mysterious country, and Mr. Blum and Dr. Scholz are good, levelheaded guides through these thickets. And in telling men to slow up and take a deep breath after they learn they have prostate cancer, they provide an invaluable service. I wish I had had this book back in 2008.

But all of this raises one last stark question: Was my life worth the 47 other prostatectomies that probably didn’t have to be performed?

I don’t know. I’m a man, not a statistic.

THE FOLLOWING ARE DR. SUAREZ' COMMENTS ON THE ABOVE ARTICLE

There are so many valid points in this article and in this book. However, there is no mention of the alternative to surgical removal of the prostate. I am specifically referring to a technology known as High Intensity Focused Ultrasound (HIFU). The manufacturer of the technology is USHIFU, it is called the Sonoblate-500 and is based in Charlotte, N. C. This is a non invasive treatment for prostate cancer that has been approved in Europe and throughout the world since 1998. It is in final phase of investigation clinical trials by the FDA, and should be approved in the U.S. in the next 18-24 months. It provides an efficacy and cure rate similar to surgery and/or radiation, but it has less risks of complications such as referred in the article: impotence and urinary incontinence. It utilizes ultrasound energy that has no toxicity, and provides a precise treatment without scatter or displacement of the treatment to surrounding tissue. Therefore, less risk of collateral damage.
The U.S. is typically the last country to adopt new technology and new medical treatments. Mostly due to the rigors of FDA clinical evaluation, and this is a good thing. No one wants to be rendered a treatment that has not undergone proper evaluation for patient safety, efficacy and clinical outcomes. Once HIFU is approved, it will be the only prostate cancer therapy that would have undergone FDA approval. As all other therapies have had "grand fathered approval" by virtue that they were procedures performed prior to revision of FDA guidelines in 1976.
HIFU is an excellent alternative that merits consideration by men diagnosed with localized prostate cancer. It is available, and being performed by hundreds of American board certified urologist in countries where it is approved. In certain cases it is covered by insurance. The technology is based on similar delivery of energy used to break up kidney stones. It is called piezoelectric energy in the form of extracorporeal shock wave lithotripsy (ESWL). Before ESWL, patients underwent major surgery to remove kidney stones. With ESWL, they are now treated in an out patient setting with non invasive technology.
The advances in computer technology and imaging capabilities continue to transform the practice of medicine at fast and rapid speed. Some of these technologies may be considered disruptive by older , and less adopting physicians. But this the natural and normal course of evolution of medical care. I am convinced that HIFU will be the state of the art treatment of choice in the future.

For additional information, please visit website: www.hifumedicalexpert.com or www.ushifu.com.
George M. Suarez, M.D.
Medical Director,
The Miami Urology Center of Excellence
9195 Sunset Drive
Miami, Florida, 33173
Tel:305-595-0199. 1-877-949-5325
www.hifumedical.expert.com

PROSTATE CANCER SCREENING FOR OBESE MEN

Prostate Cancer Screening Should Be Adjusted For Overweight, Obese Men. Fact: Overweight and obese men may have diminished prostate cancer detection.
September is prostate cancer awareness month. The following was provided by the American Urologic Association, and is placed here for educational purposes.

MedWire (8/27, Guy) reported, "Overweight and obese men may have diminished prostate cancer detection owing to low prostate-specific antigen (PSA) levels," University of Texas researchers found after evaluating data on 3,697 individuals. More specifically, "potential explanations for the association between overweight/obesity and PSA is a possible hemodilution effect caused by greater blood volume, or the suppression of PSA production caused by lower testosterone levels and higher estrogen levels," according to the paper in Urology. Thus, the study authors "recommend adjusting prostate cancer screening to allow for the impact of body mass index (BMI)."

HIFU SHOWS PROMISE AS A PROSTATE CANCER THERAPY

AMSTERDAM—High-intensity focused ultrasound (HIFU) shows promise as a treatment for early-stage prostate cancer, according to interim study results presented here at the 7th Meeting of the European Association of Urology's Section of Oncological Urology.
The study included 20 men with stage T1c-T2b, N0, and M0 unilateral prostate cancer. All subjects had a PSA of 15 ng/mL or lower, a Gleason score of 7 or less, and a prostate size of 40 cc or less. Six months after treatment with HIFU, 95% of men were able to achieve erections and had pad-free urinary continence. Also six months post-procedure, 55% of men had wet ejaculations and no patient had rectal toxicity. One man refused a biopsy at six months. Of the 19 men who underwent biopsy, two (10.5%) had cancer recurrence. One patient was switched to active surveillance and the other underwent another HIFU treatment. Six months later, magnetic resonance imaging and biopsy revealed no evidence of disease.
“By treating the disease using focal therapy we avoid the morbidity associated with radical therapy, while restoring men to a position in which they can have access to active surveillance,” said lead investigator Mark Emberton, MD, Consultant Urologist at University College London Hospital in London. “It's controversial, but it's definitely exciting—focal therapy is currently the only strategy on the table that might lead to significant and important reductions in treatment-related harms.”
From the June 2010 Issue of Renal And Urology News

HEALTHDAY NEWS

MONDAY, Aug. 23 (HealthDay News) -- The initial treatment given to prostate cancer patients has a major impact on short- and long-term costs of care, a new study has found.
For example, while some may opt for an initial treatment that is less expensive in the short-term, the long-term costs of that treatment may actually be higher, the study authors explained.

Treatments options for early-stage prostate cancer include surgery, radiation therapy, hormonal treatment, watchful waiting, or combinations of those methods. Decisions about which treatment to use are based on a variety of factors, including cost, according to background information in the study, published online Aug. 23 in the journal Cancer.
In the study, U.S. researchers analyzed data from 13,769 prostate cancer patients, aged 66 and older, who were diagnosed in 2000 and followed-up for a period of five years. The data came from the Surveillance, Epidemiology and End Results (SEER)-Medicare database.
The men were divided into groups based on the treatment they received during the first nine months after being diagnosed with prostate cancer: watchful waiting, radiation, hormonal therapy, hormonal therapy plus radiation, and surgery. The men in the surgery group may also have received hormones and/or radiation therapy.
For most of these cases, treatment costs were highest in the first year and then declined sharply and remained steady over the next several years. According to the report, watchful waiting had the lowest initial ($4,270) and five-year total costs ($9,130), and hormonal therapy had the second lowest initial cost but the highest five-year total cost ($26,896).
The highest initial treatment costs were observed among those receiving hormonal therapy plus radiation ($17,474), and those undergoing surgery ($15,197), the investigators noted.
Over five years, total costs for hormonal therapy plus radiation were $25,097, and $19,214 for surgery.
When the researchers took into account that costs of treatment in the last 12 months of life are different than other treatment years and excluded the costs for that year, they found that total costs were highest for hormonal therapy plus radiation ($23,488) and hormonal therapy only ($23,199).
"This demonstrates that treatments that may be less expensive in the short term may have higher long-term costs," study leader Claire Snyder, of the Johns Hopkins School of Medicine and the Johns Hopkins Bloomberg School of Public Health in Baltimore, said in a journal news release.
More information
The U.S. National Cancer Institute has more about prostate cancer.

CONSIDERING RADIATION THERAPY FOR PROSTATE CANCER...GET THE FACTS

If you are considering radiation therapy for prostate cancer, including the highly marketed concept of radioactive seeds. Get the facts before making a decision.The fact is that radioactive seeds are nothing more than another form of radiation. It is not much different than External Beam Radiotherapy, Image guided Modulated Radiotherapy (IMRT) or Proton radiotherapy. With all forms of radiation comes the toxic side effects of radiation. Anyone considering radiation should look into High Intensity Focused Ultrasound (HIFU) . There no radiation and no surgery. HIFU is truly totally non- invasive outpatient procedure. For further information, visit: www.hifumedicalexpert.com. If you want to get the facts on the secondary effects from radiation exposure in the treatment of prostate cancer, click on the link below and read the comments that follow.

Please see the recent article in Urology Times in the link below commenting on clinical outcomes of radiation therapy being similar to HIFU in treating prostate cancer.

http://digital.healthcaregroup.advanstar.com/nxtbooks/advanstar/ut_201008/index.php?startid=24


"Although this is another important article in the fast gaining popularity of HIFU as a treatment option for localized prostate cancer, and the efficacy in clinical outcomes. The fact is that as a slow growing cancer, it seems to respond to almost any type of treatment when it is diagnosed early and has favorable PSA and Gleason score. However, Radiation has additional toxic side effects that are not often discussed with the patients. Yet, it remains the most common form of treatment for prostate cancer. Mostly because of men's fear of undergoing surgery and the collateral damage associated with it. Even with radiation there is still high degree of side effects. These include erectile dysfunction and urinary incontinence and high degree of irritable or "bother symptoms" (bladder and bowel). What is seldom mentioned is the increased risk of developing a secondary malignancy. Particularly bladder and rectal cancer, reported as high as 70 % greater than men treated with alternatives other than radiation. (1) Furthermore, a recent study from the CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor) database has revealed that PSA recurrence after radiotherapy occurred in 63 % of men with 93 % being treated with Androgen deprivation therapy for salvage of PSA failure. (2) The alternative to Androgen deprivation is to treat radiation failures with Salvage HIFU and saving patients from being placed on hormone therapy. That in the end Androgen deprivation is only palliative and never curative."


References:

(1) Baxter NN, Tepper JE, Durham SB. et al, Increased risk of rectal cancer after radiation: a population-based study. Gastroenterology, 2005;128:819-824.

(2) Agarwal PK, Sadestsky N, Konety BR et al: and the CaPSURE group. Treatment failure after primary and salvage therapy for prostate cancer: Likelihood, patterns of care, and outcomes. Cancer 2008;112:307-14.




Acute Toxicity Predicts Late Injury After Prostate Radiotherapy -