News that an influential panel of experts is advising healthy men not to be screened for prostate cancer with a widely used test is certain to cause confusion and anxiety among men and their doctors, and reignites a debate about the benefits and risks of screening tests.

The recommendations, to be officially announced on Tuesday by the United States Preventive Services Task Force, affect more than 44 million men age 50 and older who typically are candidates for a simple blood screen call the prostate-specific antigen (P.S.A.) test.

The panel, which already recommends against P.S.A. screening for men age 75 and older, will cite recent research suggesting that the testing does not save lives but does lead to unnecessary treatments that can cause impotence, incontinence and a number of other complications.

Here are some answers to common questions about P.S.A. testing and what the task force recommendations mean for men.

Will the new recommendations prevent me from getting a P.S.A. test if I want one?

No. Whether to be screened for prostate cancer is still a decision that each man must make for himself with the advice of a doctor he trusts. But now that the independent panel has taken a stand, many doctors who were ambivalent or opposed to P.S.A. testing may be more willing to express their own doubts about the test and to advise patients against it.

What if I have a family history of prostate cancer or worrisome symptoms? Should I still be checked for cancer?

The panel’s advice is based on studies of healthy men. Men who have symptoms related to prostate health should always be seen by a doctor; the task force did not address whether P.S.A. testing is appropriate for them. And men with a strong family history of prostate cancer may have more to gain from screening than men at low risk, so they also should discuss the issue with their physician.

In addition, a man who already has prostate cancer that has been diagnosed or treated is likely to continue to undergo P.S.A. testing, which can help doctors determine whether cancer has returned or is spreading.

What do other groups say about P.S.A. testing?

Most major medical groups have not taken a stand against routine P.S.A. screening and say it is a decision a man should discuss with his doctor. The American Cancer Society suggests that the conversation start at age 50 for most men, earlier for African-Americans and men with a strong family history of prostate cancer.

The American Urological Association recommends that P.S.A. screening be offered to men 40 or older. Most organizations discourage prostate cancer screening for men with less than 10 years life expectancy.

Why not get screened? Isn’t it always better to find cancer early?

The argument against P.S.A. testing is that prostate cancer is typically so slow growing that most men would be just fine if they never knew it was there. But once cancer is detected, it is psychologically difficult for a man to do nothing.

As a result, tens of thousands of men each year are left impotent and incontinent as a result of aggressive treatment for a cancer that would never have caused them harm. But it is impossible to tell which men have comparatively benign cancer and which men have aggressive cancer. As a result, many doctors believe the overall benefits of screening outweigh the negatives.

How much weight do the task force recommendations carry?

The task force is an independent panel of experts in prevention and primary care appointed by the federal Department of Health and Human Services. While the group only makes recommendations, a change by the task force often prompts other organizations to review their guidelines and can influence how insurance companies reimburse for certain services.

But the influence of the panel is often determined by how controversial its recommendations are. Two years ago, for instance, the task force concluded that healthy women under age 50 should no longer get annual mammograms. That recommendation was met with strong resistance by many cancer organizations, women and their doctors, many of whom continue to ignore it.

And even though the panel has already recommended that men over age 75 not undergo P.S.A. testing, many men and their doctors continue the practice. Earlier this year, The Journal of Clinical Oncology reported that men ages 80 to 85 are being screened as often as those 30 years younger. The task force’s advice is not necessarily the final word.

There are a number of significant benefits associated with Pro-Vas aside from being a very reliable form of birth control without the associated pain and irreversibility of a traditional vasectomy. There is little to no post-procedural pain associated with Pro-Vas and it is a much quicker procedure than a vasectomy. It is very non-invasive as there is no general anesthesia involved and men can leave same day. There are no associated complications like vasectomy and the recovery time is much quicker, allowing men to return to their normal everyday activities a lot quicker. Unlike a vasectomy, Pro-Vas can be reversible through a standard procedure known as a vasovasostomy.

Prior to electing to undergo the Pro-Vas procedure, men should first speak to their loved ones as it is a very important decision. If men no longer want to worry about unplanned pregnancies and want to stop dealing with temporary methods of birth control, the Pro-Vas procedure can be extremely beneficial. Pro-vas does not affect erections, sex drive, climax sensation, quality of sperm, the scrotum, or the testicles. Many men state that by undergoing the Pro-Vas procedure, they have been able to increase the spontaneity in their sexual relationship, something they were unable to do beforehand.

One thing that men need to keep in mind is that they will not be sterile as soon as the Pro-Vas procedure is done. Therefore, they will need to continue using an alternative type of birth control. Many doctors that perform this procedure say that men need to wait up to three months after the device is implanted as the body still needs to get rid of the sperm that is still in the system, namely the prostate. Many medical professionals will offer to do a sperm check at weeks six and twelve post procedure. These checks see if there is still any sperm left and if the device is working and will remain a viable form of contraceptive

Numerous physicians are now recommending HIFU to their prostate cancer patients due to the limited number of harmful side effects associated with the procedure. HIFU offers patients a procedure that is controlled and precise, thereby limiting side effects, such as erectile dysfunction and incontinence, which are common with other treatments for prostate cancer. A prostate cancer patient only needs to devote up to three hours for this procedure and may leave mere hours after the procedure it done. They just have to wait for the anesthesia used to minimize discomfort to wear off. HIFU is non-ionizing and does not utilize radiation. Therefore, HIFU treatment can be used on a number of occasions without damaging healthy tissue. Due to this, physicians use HIFU when they do not see successful results using other prostate cancer treatments.

The Sonablate 500 is possibly the most well known HIFU therapy option utilized for the treatment of prostate cancer. It is currently used in a number of hospitals and clinics around the world. It is controlled through a computer and delivers the HIFU energy directed right at the infected area via a small rectal probe. Through this action, all tissue infected by cancer is eliminated. Through the use of integrated biplanar ultrasound imaging, relating planning and monitoring is offered throughout the duration of the treatment, as well as images both before and after of the entire infected region.

To understand how the HIFU system works, think about what happens when the sun’s rays are focused through a magnifying lens. HIFU offers the same type of precision focusing through the use of ultrasound energy. By focusing this ultrasound energy on the infected area, the temperature of that area is raised, killing the tissue. At the same time, unaffected areas remain unharmed and their temperature remains unchanged. Once the procedure is complete, the physician has the ability to monitor the location of the precise lesion. The HIFU system also helps the physician determine a course of action to treat and locate the infected areas. The high imaging resolution is just one of the many reasons why many physicians utilize HIFU and the Sonablate 500 in particular. It provides the opportunity to identify all vital structures located around the prostate, including the neurovascular bundles, seminal vesicles, and rectal wall, ensuring only the targets areas are treated, preventing unnecessary damage.

The requirement of the patient before the treatment can begin is to undergo two enemas before the treatment can commence. Patients also undergo light anesthesia to ensure the patient remains still during the procedure as even small movements can cause damage. The rectal probe uses ultrasound waves to also provide-time images to the physician of the complete area, offering immediate and detailed feedback. Once the procedure is complete, patients only need a few hours to recover and in just a few days, patients are able to go back to their life.

Within a ten-year period ahead of the modification of GS, 856 patients (mean age 64.2 years) underwent radical prostatectomy (RP). The grade of agreement between GS in biopsy and definitive histology was calculated by Kappa statistics (k). Grades are in accordance with the level to which the epithelium assumes an ordinary glandular structure. A grade of 1 indicates a near-normal pattern, and grade 5 indicates the absence of any glandular pattern (less malignant to more malignant). This scheme of grading histological features greatly depends on the skill and experience of the pathologist and is subject to a few degree of character variation. Univariable and multivariable outcomes of different preoperatively available parameters on disease-free survival (DFS) were assessed. The mean follow-up period was 39 months.

Concordance amongst GS in biopsy versus RP samples was 58% (k-value 0.354) and was improved by an increased collection of biopsy cores. Undergrading in biopsy was present in 38% and never significantly enhanced by a longer time-period between biopsy and RP (threshold 90d). PSA level, clinical tumour stage, fraction of sure cores (dichotomized at 34%), cases of RP per year and establishment (dichotomized at 75), and GS alone influenced DFS. An upgrading to GS ≥ 7 was found in only 5.7% of patients presenting with GS 2-4 within the biopsy. Free from ultimate histology, patients with GS 2-4 had a significantly better prognosis in comparison to patients with a higher GS.

The present analyze shows an independent prognostic result of GS in biopsy samples categorized in response to the previous classification. The removal of GS 2-4 by the ISUP 2005 ends up in a substantial deficit of pretherapeutic prognostic facts and thus need being questioned particularly with reference to the increasing demand for active surveillance regimens. Men with PSA levels less than 10 ng/mL and low- or moderate-grade histology (Gleason score <7) with no findings or minimal findings on actual examination would possibly proceed to surgery or brachytherapy without further research. Men with PSA levels more than 10 ng/mL, high-grade histology (Gleason score ≥ 7), or physical findings that suggest stage T3 disease should possibly undergo a staging CT scanning and bone scan. The CT scanning can be used to evaluate extension into the bladder and lymph nodes to support stage the patient's cancer or to consider lymph node sampling prior to treatment.
 

To analyze the usage of high-intensity focused ultrasound (HIFU) as a salvage therapy in patients with a recurrence of localized prostate cancer after external beam radiation (EBRT), brachytherapy, or proton therapy, the charts of all patients who had undergone salvage HIFU for biopsy-proven prostate cancer after primary radiation therapy, were reviewed retrospectively. Patient characteristics and oncological effects were assessed.

Records of 22 patients with a median (range) follow-up of 24 (5-80) months were reviewed. Patients were men with presumed organ-confined disease who were treated with salvage HIFU following recurrent disease after EBRT (fourteen patients), brachytherapy (five patients: four with high-dose brachytherapy using In (192); and one with low-dose brachytherapy applying Au (98)) or proton therapy (three patients). The median (range) age at salvage HIFU was 65 (52-80) years, with a median (range) prostate-specific antigen (PSA) level before radiation therapy of 14.3 (5.7-118) ng/mL and an average (range) PSA level of 4.0 (1.2-30.1) ng/mL before HIFU. The median (range) period to HIFU after radiation therapy was 36 (4-96) months. The biochemical disease-free survival (bDFS) rate in all patients at 5 years was 52%. Rates of bDFS in low-, intermediate- and high-risk groups were 100%, 86%, and 14%, respectively. One among the twelve patients who received post-HIFU prostate biopsy showed malignancy. Side effects included urethral stricture in four patients, grade I urinary incontinence in four patients, rectourethral fistula and epididymitis in one of each patient.

This preliminary data recommend that high intensity focused ultrasound represents a legitimate alternative treatment strategy for patients with localized prostate cancer. Salvage HIFU is often a promising treatment option for local recurrence after radiation therapy, with morbidity comparable with other types of salvage treatment. A careful choice by the patient is imperative depending upon the aforementioned prognostic factors.
 

Three-week-old male nude mice were fed either normal chow (control) or a diet deficient in vitamin D. The latter diet resulted in severe hypovitaminosis D within 6 weeks. At this point, 5×10(4) cells of the prostate cancer cell line, PC-3, were injected either into the bone marrow (tibia) or subcutaneously into soft tissues. Osteoprotegerin (OPG) was co-administered in subgroups of mice to suppress bone remodeling. Osteolytic lesions were monitored by serial X-ray, and soft tissue tumor growth was measured by caliper. All tissues were analyzed by micro-CT and histology at the end of the experiment.

It was noticed that bone turnover was significantly accelerated in vitamin D deficient mice in comparison to vitamin D sufficient mice from week 6 onwards. Intra-tibially implanted PC-3 cells resulted in mixed osteolytic and osteosclerotic lesion. In the end, osteolytic and osteosclerotic lesions, total number of tumors, and tumor mitotic activity were all significantly increased in vitamin D deficient mice compared to controls. Regardless of diet, OPG reduced bone turnover, total number of tumors, and osteosclerotic area as well as tumor mitotic activity, while promoting cell apoptosis. The findings suggest that vitamin D is effective at reducing metastasis in the progression of prostate cancer. In contrast; vitamin D deficiency did not alter tumor growth in soft tissues.

Vitamin D deficiency enhances both the growth of tumors and the tumor-induced osteosclerotic changes. Vitamin D deficiency stimulates prostate cancer growth in bone through modulating the bone microenvironment. Vitamin D promotes the differentiation of prostate cancer cells, and helps maintain the differentiated phenotype of prostate epithelial cells, and induces prostate cancer cell death
 

There is no general anesthesia required for Pro-Vas, so the procedure can be performed safely and comfortably in your doctor's office. Pro-Vas is a small unique titanium and polymer clip that effectively occludes each vas deferens, stopping the flow of sperm. The gentle pressure of the Pro-Vas clip is specially designed to block sperm without damaging the tissue. This new non-scalpel method for vasectomy requires only one or two tiny openings in the skin which cause less discomfort and infection than the traditional vasectomy method.

Men who undergo this procedure must continue to use another form of birth control for 2 to 3 months post implantation, until the body is able to eliminate all the sperm that remains in the system. A sperm check at six and twelve weeks after the procedure will make sure all sperm has been stopped and the device can be relied upon as a form of birth control. Men who have the Pro-Vas clip still produce sperm in the testes, but it is absorbed by the body since it is unable to pass through the vas tubes. The implantation of this device will not change a man’s sex drive, erections, sperm quality, climax sensation, testes, or scrotum.

"Pro-Vas is the most exciting innovation yet. When men and their doctors understand the simplicity and effectiveness of the device, I think it will completely change the way we think about male birth control. Men today have few contraception options and our culture and advertisers have placed the birth control burden largely on women. Pro-Vas offers an easy, effective alternative. I think it has the potential to change the way men and women look at birth control," said Bill Dennis, MenRx Surgical's CEO.

The Food and Drug Administration (FDA) granted approval to Pro-Vas as a vas deferens ligation clip in 2007. Unlike a vasectomy, which is considered permanent even though it can be reversed in some cases, Pro-Vas is easily reversible with a standard vasovasostomy procedure. The common complications found in this procedure are bruising of the scrotum, infection of the puncture in the scrotum, and failure by the physician to place one or both clips correctly.

Patient outlook about this procedure is positive as the results are promising. Its efficiency is greater than the traditional vasectomy, and most men resume their normal activities in less than one day after the procedure. The various benefits of this PRO VAS procedure are reduced post procedural pains, decreased potential complication in comparison with other methods, reversible with the vasovasostomy procedure, and of course the prevention of unplanned pregnancy. Other temporary birth control methods can be avoided with this unique procedure and a healthy sexual relationship.