Urology Care

A new study just published by Michael Barry of Harvard Medical School and the Massachusetts General Hospital in the Journal of Clinical Oncology reports that radical prostatectomy carries a high risk of post-op adverse effects, most notably incontinence and erectile dysfunction.  He surveyed 685 patients who had radical prostatectomies, 406 robotically and 220 open surgeries.  Dr. Barry reports that “men should not expect fewer adverse effects following robotic prostatectomy”.  The incidence of incontinence and ED were about the same with slightly more problems among patients having robotic surgeries.  This is just one more study demonstrating that better results claimed by robotic prostatectomies may be overstated.

Prostate Cancer

Screening for prostate cancer has again made the news largely because the new chief medical officer of the American Cancer Society, Dr. Otis Brawly interprets the data as not showing enough benefit for screening.  A few personal observations and opinions on the subject: Read more…

PSA, Prostate Cancer, Screening

The June 2011 Journal of Urology has published the findings of Catalona, et al, which report a significantly worse outcome when radical prostatectomy is delayed 6 months or more even among patients diagnosed with clinical low risk (D’Amico criteria) prostate cancer.   They found more pathologic upgrading and a higher rate of biochemical progression after delay.

Prostate Cancer

Researchers from the MD Anderson Cancer Center in Houston studied the effect of stress management on patients immune system function in prostate cancer.  Men facing treatment decisions for prostate cancer experience profound stress no matter how well they appear to manage it outwardly.  The results of this study showed that men who learned stress management had evidence of better immune system function 48 hours after surgery compared to controls.

Prostate Cancer

A study presented at the ACS meeting showed a higher primary treatment failure rate with cryoablation (freezing) of renal cell cancer as opposed to surgical excision.  Tumor persistence/recurrence was observed in 1.7% of patients who underwent a partial nephrectomy compared to 7.8% after cryoablation.  The study concluded that “Open partial nephrectomy is the gold-standard treatment for small renal masses…”

Cancer

Prostate cancer incidence within families, referred to as familial prostate cancer, has been increasingly studied.  Most prostate cancer occurs sporadically, however observation of prostate cancer clustering within families has led to the study of how certain genes may be the cause in these families.  About 25% of all prostate cancers are considered familial based on evidence of a genetic component.  Only about 5% of all prostate cancers have strong genetic factors and these cases are referred to as hereditary prostate cancer.  Hereditary prostate cancer (HPC) refers to a family with three generations affected, or three first-degree relatives affected, or two relatives affected before age 55.  HPC is marked by a pattern consistent with passage of a susceptibility gene via Mendelian inheritance.  Early age at diagnosis is a recognized marker of genetic susceptibility for hereditary cancers.

The consensus from expert panels is that men with a family history of prostate cancer should consider PSA testing and digital rectal examination at age 40 years or 10 years younger than the youngest prostate cancer case in a family.

Prostate Cancer

Dr. William Catalona recently reports that PSA screening reduces prostate cancer mortality.  In the U.S. there has been a 75% reduction in metastatic disease at diagnosis and a 40% decrease in the age adjusted prostate cancer mortality rate during the PSA era.  That equates to more than 22,000 fewer men die of prostate cancer each year than in 1992.  Dr. Catalona was instrumental in PSA clinical research and in the FDA approval of PSA for prostate cancer screening.

PSA, Prostate Cancer, Screening

The Mayo Clinic recently presented the results of a 17 year followup study on the various treatments of BPH at their institution including medical therapy, laser procedures and traditional TURP.  The lead investigator of the study, Amy E. Krambeck, M.D., reported that TURP (transurethral resection of the prostate) showed the greatest improvement in both voiding symptoms and incontinence compared with other treatment groups.

BPH

A recent article in the Wall Street Journal investigated the use of robotic surgery and reports of patient injuries from inexperienced practitioners.

Prostate Cancer

The American Cancer Society’s (ACS) latest pronouncement on prostate cancer screening has them pulling back from their past recommendations.  They are no longer recommending yearly PSA and digital rectal examinations (DRE) but instead stressing that the patient should make an informed consent in consultation with his physician. 

ACS guideline:
Beginning at age 50, asymptomatic average-risk men with at least a 10-year life expectancy should receive information that allows them to make an informed decision, in collaboration with their healthcare providers, about prostate cancer screening

Despite the clear fact that PSA is the most accurate single cancer detection test in oncology, recent complaints about false positive test results (as occurs with all tests) and an inability to differentiate the most dangerous prostate cancers has the ACS backtracking on its prior pronouncements.  The America Urological Association (AUA) and the ACS are no longer in agreement about who should be screened.  This is a complex issue that even the experts do not agree, making it even more puzzling that the ACS is abdicating its leadership role and now wants to leave this controversy up to the patient. Read more…

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