Urology Care

“Prostate-specific antigen (PSA) levels are significantly lower in aspirin users with latent prostate cancer than in similar patients who are not aspirin users,” say Vanderbilt University “scientists who caution that aspirin may affect prostate cancer detection.”

PSA, Prostate Cancer, Screening

An editorial published online in the Journal of Clinical Oncology “speculates about how oncologists should disseminate” information in clinical practice about vitamin D in light of recent research and “laboratory, ecologic, and epidemiologic studies” indicating that “higher levels of vitamin D might lower the risk for colon, breast, endometrial, and prostate cancers.” In the editorial, Pamela J. Goodwin, MD, of Mount Sinai Hospital and Princess Margaret Hospital, in Toronto, Canada, explained that “the ‘unpredictable relationship between vitamin D intake and blood levels’ makes it difficult to recommend a standard dose for supplementation.” But, “depending on age, current recommendations for vitamin D range from 200 to 600 IU per day. Given that there is sufficient evidence that vitamin D supplementation at these doses is associated with reduced mortality and improved bone health, clinicians should feel comfortable using them as a starting point,” she said.

Diet/Nutrition

 Medscape (4/2, Nelson) reported, “After a radical prostatectomy, the risk for recurrence is strongly affected by the experience of the operating surgeon,” an actuality that holds “true for both open and laparoscopic procedures.”  But, investigators at the Memorial Sloan-Kettering Cancer Center, also pointed out that the “learning curve for surgery — improvement in surgical outcomes with increasing surgeon experience — appears to accrue more slowly for laparoscopic radical prostatectomy than for open surgery.”  Lead researcher Andrew Vickers, PhD, explained, “If they are only doing a handful of radical prostatectomies a year, then [surgeons] are going to have a hard time getting up on the learning curve.  A great deal of surgical experience is required to treat prostate cancer optimally.”  Read more…

Prostate Cancer

Published data from the Prostate Cancer Prevention Trial demonstrated that there is no PSA level below which the risk of having prostate cancer is zero. For an individual patient, the significance of a PSA level should be interpreted in a broad clinical context, including age, race, family history, digital rectal exam, prostate size, results of prior prostate biopsy, and use of 5α-reductase inhibitors. Considering the high incidence of asymptomatic cancer in the general population that may not pose an ultimate risk to the patient, the decision to recommend urological evaluation or prostate biopsy should be individualized after considering all these factors.

The risk that a patient will have prostate cancer detected if a biopsy is performed at various levels of PSA is listed in the table below:

PSA Relative risk for prostate cancer

PSA, Prostate Cancer

 ABC World News (3/10, story 8, 2:15, Gibson) reported, “There is an important new medical study…that offers the latest findings about prostate cancer. Researchers now estimate as many as 42 percent of prostate cancers are over-diagnosed, meaning men may show traces of cancer, but those traces will never harm them.  Still, because of aggressive screening and diagnosis, many of those men are getting treatments they don’t need.” Read more…

Prostate Cancer

A new study from the University of Souther California published in the Journal of the National Cancer Institute suggests that men who take a daily folic acid supplement have an increased risk of developing prostate cancer, renewing skepticism about the value of supplements in the fight against cancer.  The study followed 643 men for slightly more than a decade who were taking either a placebo or 1mg of folic acid a day, which is more than twice the amount in the typcial multivitamin.  Participants taking the suppliment had 2.6 times the risk of developing prostate cancer than those given a placebo.

Diet/Nutrition, Prostate Cancer

The American Urological Association will publish in March its new guideline which recommends that “healthy men over 55 who are concerned enough about the risk of prostate cancer to undergo annual PSA screening should consider taking the drug finasteride daily to redue their risk of developing the disease”.  They are not advising it but only suggesting they should consider it.  This is based on the results of a large studiy involving over 18,000 men which reported that finasteride can reduce the risk of developing prostate cancer by as much as 25 percent.

Finasteride (brand name Proscar) is an antiandrogen medication which has been used to help shrink the prostate for over 15 years.  This new indication is significant.  Although the drug is now in generic form, it still costs about $1000 per year to take daily.

Prostate Cancer

Prostate Cancer

A study from the National Cancer Institute in Paris reports that as little as a half glass of wine per day increases the risk of colon cancer by nine percent and the risk of mouth cancer by 168 percent.  This study confirms other studies that found alcohol increases the risk of some cancers.  Drinking alcohol and smoking increases the risk even further they report.  (Dr. Mac notes - It doesn’t seem anything is safe these days.)

Uncategorized

New research just published in the British Journal of Urology (BJU) International compared patients who had a radical prostatectomy alone with those who had external beam radiation therapy following surgery.  They report no significant difference in overall or cause-specific survival.

Prostate Cancer