Health and Disease, Lifestyle, Uncategorized

Prostate Cancer Test Saves Lives, Risks Remain



Prostate Cancer Test Saves Lives, Risks Remain


Men who get a controversial blood test that looks for signs of prostate cancer appear to have a reduced risk of death from the malignancy, according to a new analysis by an international group of researchers.

The analysis re-examined data from two earlier studies that had led experts to recommend against routine use of the test, which measures levels of prostate-specific antigen (PSA).


“The trials taken together indicate there is an important benefit,” said Ruth Etzioni, who is the senior author of the analysis from the Fred Hutchinson Cancer Research Center in Seattle, Washington.


A flaw of the earlier trials is that some men who were assigned to a no-screening group actually did get the PSA test on their own, making it difficult to identify differences between the screening group and the no-screening group.


The unclear results – and the risk that the blood tests could lead to unnecessary biopsies and treatments – led the government-backed U.S. Preventive Services Task Force (USPSTF) to recommend against PSA screening.


The new analysis attempts to clear up the confusion by reexamining the data in computer models, to account for the men who got PSA tests when they weren’t supposed to. Etzioni’s team compared men in the two trials based on the intensity of screening they received.


In one of the trials, PSA testing was tied to a 25 percent to 31 percent reduced risk of death from prostate cancer, the researchers report in the Annals of Internal Medicine.



In the other trial, PSA testing was tied to a 27 percent to 32 percent reduced risk of death from prostate cancer, they found.


Etzioni said the new results don’t mean all men should be screened for prostate cancer.


In the U.S., about one in seven men will be diagnosed with prostate cancer, according to the American Cancer Society, but most men with the slow-growing cancer won’t die from it.


As a result, it’s often reasonable to monitor prostate cancers instead of treating them, since the side effects of treatment – which can include incontinence and impotence – may be more harmful than helpful.

In a proposed update to its recommendation, the USPSTF suggests that men ages 55 to 69 should be able to decide if they want PSA testing based on a discussion with their doctors about the possible benefits and risks, such as biopsies and unneeded treatment.


“This finding confirms or reinforces what everybody has been moving to over the last 5 to 8 years,” said Dr. Otis Brawley, chief medical officer of the American Cancer Society. “There is some benefit to prostate cancer screening and there are some harms associated with it.”


Brawley, who wasn’t involved in the new analysis, told Reuters Health that the benefits of screening are becoming more apparent as doctors move away from aggressively treating all prostate cancers and instead decide to monitor the many that will likely never advance and cause death.

In an editorial published with the new analysis, Dr. Andrew Vickers of Memorial Sloan Kettering Cancer Center in New York City identified ways to help ensure the benefits of prostate cancer screening outweigh the harms.


For example, he advises shared decision-making between doctors and patients, carefully selecting which men to biopsy and not screening elderly men, who are unlikely to benefit.


“The controversy about PSA-based screening should no longer be whether it can do good but whether we can change our behavior so that it does more good than harm,” wrote Vickers.

Health and Wellness Associates


Dr P Carrothers


Health and Disease, Lifestyle

Different Treatments for Prostate Cancer Means Different Side Effects


Treatments for Prostate Cancer Have Different Side Effects


The long-term side effects of different prostate cancer treatments vary –

and knowing that may help men decide which one is right for them.


That’s the conclusion of two new studies published March 21 in the Journal of the American Medical Association.


Both followed men who had early stage prostate cancer treated with “modern” approaches — including the latest surgical and radiation techniques. And both found that side effects sometimes persisted for up to three years.


The specifics, however, varied.


Many men had surgery to remove the prostate. Overall, they tended to have greater declines in their sexual function, versus men who chose radiation or “active surveillance.”


They were also more prone to urinary incontinence.


On the other hand, men treated with radiation typically had more problems with bowel function. If they also received hormonal therapy, they were also at risk of hormone-related symptoms — such as hot flashes and breast enlargement.

On the brighter side, the issues with radiation were mainly limited to the first year after treatment, said Dr. Daniel Barocas, the lead researcher on one of the studies.


Not surprisingly, both studies found, men who opted for surgery or radiation had more long-term symptoms than those who chose active surveillance.


With that approach, men put off treatment in favor of having their cancer monitored with periodic blood tests and biopsies.


Active surveillance is an option for prostate cancer because the disease is often slow-growing and may never progress to the point where it threatens a man’s life.


But that doesn’t necessarily mean active surveillance is the best option for any one man, said Barocas. He’s an associate professor of urologic surgery at Vanderbilt University in Nashville.


Much depends on whether the cancer is “low-risk” or not, he explained. Low-risk prostate cancers have characteristics that mark them as less aggressive.


“If you’re in that low-risk group,” Barocas said, “active surveillance might be the best choice, to avoid treatment side effects.”


But for men with more aggressive prostate tumors, treatment is typically advised to boost their long-term survival.

For those patients, Barocas said, “it’s pretty clear that treatment is better than no treatment.”


Dr. Freddie Hamdy is a professor of surgery at the University of Oxford in England.


In general, he said, research suggests that when men with low-risk prostate cancer are carefully selected for active surveillance, they have “very low” death rates from the disease.


For some men, active surveillance might be anxiety-provoking, said Hamdy, who wrote an editorial published with the studies.


But, he added, his own research has found that men on active surveillance do not have higher rates of anxiety or depression than prostate cancer patients who choose immediate treatment.


“The anxiety generated in many of these patients is more likely to be related to the diagnosis of cancer, and the fact that [they] have to live with its consequences, irrespective of the treatment that they receive,” Hamdy said.


For their study, Barocas and his colleagues followed 2,550 men diagnosed with prostate cancer between 2011 and 2012. All had tumors that were confined to the prostate. Almost 60 percent had surgery; another 23.5 percent had external radiation; and 17 percent chose active surveillance.


Three years later, men who’d had surgery gave lower ratings to their sexual function, versus the two other groups. They also had more trouble with urinary incontinence: 14 percent said they had a “moderate or big problem” with urine leakage, compared with 5 to 6 percent of men in the other groups.


Radiation, meanwhile, carried the biggest risks of bowel problems and hormonal side effects. But that faded by year three.


The second study — of more than 1,100 men with early stage cancer — had similar findings.


Surgery carried higher risks of sexual dysfunction and urine leakage. For instance, of men with normal sexual function before surgery, 57 percent reported “poor” function two years later, the University of North Carolina researchers found.


External radiation, again, caused more short-term bowel problems. The study also included men who’d undergone brachytherapy — a type of internal radiation that implants radioactive “seeds” in the prostate. Those patients had more issues with urinary tract obstruction and irritation.


So what’s a man to do with that information? According to Barocas, patients can talk to their doctor about the types of side effects that might occur with each treatment — then decide what they can personally live with.


“If, for example, you already have poor sexual function — as many patients in our study did — that side effect might not mean as much to you,” Barocas said.


For a man with low-risk prostate cancer, he noted, the risk of any treatment side effect might not be “acceptable.”


Hamdy made another point: While robot-assisted surgery has become the go-to approach, it has the same types of side effects that traditional open surgery always had. They are also finding that there are parts of the robotic surgery equipment that can not be sterilized and thus various bacteria have been found in surgical rooms, that are not being addressed yet.


What should you do?


Stop your sedentary lifestyle!   Men who develop prostate cancer are usually less active than they have been in their past.  Change that. Get up walk.


Also, stop the depression.  Stop sitting around and feeling sorry for yourself.   This has been a common thread in men who develop prostate problems.


Eat right!   Stop eating out, stop snacking throughout the day on garbage foods!


If you need help in turning this problem around, call us!


Health and Wellness Associates


P Carrothers