April 18, 2012

Buffett’s Prostate Cancer
Is Not a Death Knell

Louis Kavoussi, MD

Warren Buffett has announced to shareholders that he has the most common cancer in men, Stage 1 prostate cancer.

The information he released is insufficient to determine prognosis let alone what treatment is needed, if any. However, statistics are generally on Mr. Buttett’s side.
 
Autopsy studies show that most men will eventually present with prostate cancer. The good news is that the vast majority of them don't succumb to the disease--even without treatment.
 
Visit our main Web site to find a hospital in New York close to you or visit our Find a Physician tool to find a doctor best suited to your needs.
Full Post - to Detail View

March 23, 2012

Controversy Persists About Prostate Cancer Screening

Manish Vira, MD

In 2009, the publication of the results of two large screening studies ignited the controversy over prostate-specific antigen (PSA) testing and prostate cancer screening. Now, both studies have been updated and the debate continues.

This month, the New England Journal of Medicine published an update of the European Randomized Study of Screening for Prostate Cancer (ERSPC) with two additional years of follow-up. The study reported a 21 percent reduction in prostate cancer mortality for participants screened with PSA testing. In the 10th and 11th year of follow-up, the mortality reduction in the screened cohort improved to 38 percent.
 
On the other hand, an update from the National Cancer Institute’s original report of the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial now with follow up of 13 years continued to find no difference in prostate cancer mortality in study participants who were screened.
 
So we have conflicting recommendations from the two largest prostate cancer screening trials. While the debate about the overall benefit of screenings may continue, we can still draw helpful conclusions from these two trial updates.
 
First, it appears that patients can derive the potential benefits from PSA testing by getting screened every two years rather than annually. Second, it takes at least 10 years of follow-up to show the potential benefits of screening. This means that screening will probably not help older men with other significant medical issues. In fact, PSA testing may even cause significant harm from prostate biopsy complications and overtreatment of prostate cancer.
 
Still, given that the overwhelming majority of patients believe that cancer screening is important to good health, PSA testing is unlikely to diminish. Therefore, physicians should try to reduce the burden of overtreatment by increasing active surveillance in men with low-risk prostate cancer. Full Post - to Detail View

November 02, 2011

Radiation Increases Survival of ADT-Treated Prostate Patients

Louis Potters, MD

The latest Lancet outlines the results of a large Phase III clinical trial that shows that men with locally advanced prostate cancer (that has not spread elsewhere) who receive radiation therapy on top of their androgen deprivation therapy (ADT) have greater overall survival compared to men on ADT alone.

Data suggests that the use of hormones without radiation therapy to manage men with high-risk prostate cancer has increased in the past several years. The results of the Warde study tell us that radiation therapy needs to be added as a component of care for these men.

Using newer technology such as intensity modulated radiation and image guidance, higher doses of radiation therapy can safely be delivered in high-risk patients. Yet using older technology and lower radiation doses than today’s standards, the authors demonstrated a remarkable 90 percent disease-specific survival for men with very high risk disease. Plus, these survival gains were achieved without any clear decrease in overall quality of life.

Based on high-level evidence, radiation therapy is saving lives of men with prostate cancer. Though other methods of treating high-risk prostate cancer exist, a radiation-based approach remains the standard against which other modalities needed to be measured. Randomized trials comparing different treatments are required to test if these other methods will be equally efficacious to radiation therapy.

Full Post - to Detail View

October 14, 2011

Prostate Cancer and Supplements

Louis Potters, MD, Chair of Radiation Medicine
Louis Kavoussi, MD, Chair of Urology

Prostate Cancer and Supplements

Last week, results from the SELECT Trial were released. This randomized study of 35,533 men tested the hypothesis that Vitamin E and selenium could prevent prostate cancer. Surprisingly, the results just published in the Journal of the American Medical Association not only found that the supplements had no effect on the development of prostate cancer, but also that there was a 17 percent increased incidence of cancer in men taking the supplements. Full Post - to Detail View

October 05, 2011

Prostate Treatment and Sexual Function

Louis Kavoussi, MD

An article published in this month’s Journal of the American Medical Association (JAMA) looks at factors that put men at risk for loss of erections. The authors studied the sexual function in 1,027 men who had treatment for prostate cancer and were followed for 2 years. The authors found that only 48 percent of all patients who had sexual function before treatment had erections sufficient for intercourse after treatment.

Several factors were found to result in problems. Patients with any degree of difficulty with erections prior to treatment had more difficulty afterwards. Also, older patients or those patients who had a higher PSA level (blood test that detects prostate cancer), were overweight or were Caucasian had a lower rate of recovery. In best case scenarios where men had positive risk factors (young, thin, normal function, minimal disease), sexual function was preserved 70 percent of the time. Those with poor factors only had a 10 percent rate of recovery of sexual function.

This study is important in helping physicians set expectations for patients considering any treatment for prostate cancer. Any treatment of prostate cancer, be it surgery, external beam radiation or radioactive seeds, has the potential to affect sexual function. Although the ability to be aroused and climax are not affected, loss of erections sufficient for penetration can occur. This is because nerves responsible for erections lie directly upon the prostate. So any trauma--whether manipulation during surgery or scatter of energy from irradiation--can injure the nerves and cause difficulty with erections. Even modern therapies such as nerve-sparing prostatectomy and conformal irradiation do not guarantee preservation of normal erections.
 

Full Post - to Detail View