California HIFU Blog

Low Risk Prostate Cancer in Men Under 65

admin — Wed, 22 Jun 2011 04:46:14 +0000

Reported in AUA Daily Scope (5/5/11) From Swedish Cancer Study: Now with 15 year follow-up. Of 700 men under 65 who volunteered to be randomized into Surgery vs Surveillance, the Surgery group had 38% fewer cancer deaths, and 41% lower risk of cancer spread to other parts of their bodies.

If a man is under 65 with Low Risk prostate cancer, he should strongly consider treatment rather than surveillance.

Radiation Therapy and Loss of Ejaculation

admin — Wed, 22 Jun 2011 04:34:34 +0000

From Memorial Sloan-Kettering reported at the 2010 AUA Meeting: Men treated with radiation reported loss of ejaculation over time: At 1 year—16%, 3 years—69%, 5 years—89%.

Hip Fractures and Radiation Therapy

admin — Wed, 22 Jun 2011 04:29:05 +0000

It has long been known that Proton Beam Therapy is associated with hip fractures due to the delivery of the beam through the hips, and subsequent weakening of the bones.

At the 2010 American Urology Ass’n Meeting (5/10), Bankhead reported a 70% increased risk of hip fractures in men treated with External Beam Radiation Therapy. The fractures occurred only in areas of the hips exposed to the radiation, not in unradiated bones.

Worse Outcomes With Laparoscopic Radical Prostatectomy

admin — Wed, 22 Jun 2011 04:19:47 +0000

From Cleveland Clinic (4/11) reported in AUA Daily Scope: Men with Intermediate Risk prostate cancer had significantly worse 5 year survival rates, higher PSA failures, and more need of additional therapies (Salvage) when treated with Laparoscopic (including DaVinci Robot) Radical Prostatectomy than men treated with Brachytherapy, External Beam Radiation, or Radical Retropubic Prostatectomy.

Active Surveillance and Eventual Need for Treatment

admin — Wed, 22 Jun 2011 04:07:12 +0000

Approximately 40% of men with “low risk” prostate cancer (as now defined) managed with A.S. currently go on to require treatment. Studies from Northwestern U and Johns-Hopkins show better outcomes if these men are treated early (before 6 months) rather than after 6 months from time of diagnosis.

Hence, it would be desirable to identify who really will not need treatment. From University of Miami (8/10): Changing the “Low risk” criteria to PSA < 10, Gleason 6 only, tumor volume <20% in one or 2 biopsy cores only resulted in very few men ultimately needing treatment.

Older Men With Prostate Cancer

admin — Wed, 22 Jun 2011 03:56:14 +0000

Journal of Clinical Oncology (3/11): U of Conn—Over 65 with localized low grade prostate cancer less likely to die from it over next 10 years if untreated.

Agrees with 5/11 report from Swedish National Healthcare stats supporting Active Surveillance in this age group.

NOTE: These findings differ from those in men under 65.

Prostate Swelling After Brachytherapy and Seed Migration

admin — Tue, 07 Dec 2010 06:09:14 +0000

From Medwire 11/30/10: The Japanese Journal of Clinical Oncology reports that 69.4% of men experienced seed migration within 30 days of implantation. They believe it may be related to the swelling occurring after implantation. Obviously this would result in intense radiation exposure of organs to which the seeds migrated, as the seeds are very potent for months.

Hormone Therapy in Prostate Cancer Linked to Colon Cancer

admin — Tue, 07 Dec 2010 05:59:17 +0000

Reported in Medscape 11/10/10 from Univ. of Michigan: Over 100,000 men studied found a 30-40% increased risk for Colorectal Cancer in those getting hormone ablation therapy for Prostate Cancer. The longer the men were treated with hormone therapy, the greater their risk, with the greatest risk in those whose testicles were removed. An editorial in the Journal of the Nat’l Cancer Institute suggests this risk may be an additional consideration to weigh in the “risks vs benefits” discussion. The US FDA recently mandated warnings be labeled on associated risks of heart disease and diabetes with hormone ablation drugs.
Hormone Therapy is NOT the free ride we used to think it was.

Anticoagulants and Prostate Cancer

admin — Tue, 07 Dec 2010 05:38:23 +0000

From the Oct. 29, 2010 AUA Daily Scope: Men with localized prostate cancer on anticoagulants have a 50% reduction in risk of dying from prostate cancer as compared to men not taking anticoagulants. This from the Univ. of Texas Southwestern Medical School in Dallas, lead author Kevin Choe. The medicines appear to lessen the risk of developing metastatic disease.

Understaging Prostate Cancers

admin — Tue, 08 Jun 2010 04:57:24 +0000

From the 6/1/10 AUA Daily Scope:

Quoted from the International Journal of Radiation Oncology, 60-70% of men with low stage, low grade prostate cancers, with PSA less than 10 (frequently managed with Active Surveillance), will be found at Radical Prostatectomy to instead have bilateral and higher grade disease. This implies a risk for local or distant recurrences due untreated active disease.

And, from Prostate Cancer and Prostate Diseases: Men with Gleason 3+3 cancer and PSA’s in 2-3.9 range have 32.6% chance of having Gleason 7 or higher at Radical Prostatectomy when the whole gland can be examined. If the PSA is 4-10 in these men, 44% have higher grade cancer when the gland is examined after Radical Prostatectomy.

There’s more: From Northwestern University, investigators found that men with low risk prostate cancer who waited more than 6 months for surgery had double the risk of being found to have high grade cancer, and double the risk of biochemical (PSA) recurrence than those treated before 6 months after diagnosis. They conclude men with low grade cancer should be counseled on the increased risks of worse outcomes if they wait longer than 6 months for treatment.

May make us think twice on the safety of the Active Surveillance approach.