Robotic prostatectomy: new studies out

A surgical procedure called robot-assisted radical prostatectomy offers prostate cancer patients another option over open radical prostatectomy (standard surgical prostate removal).  Most studies show the robot procedure results in less side effects and quicker recovery. The surgery’s success at removing cancer cells can typically be determined within several weeks, based on a PSA blood test.

 

How it’s done

Surgeons work with assistance of a robot (da Vinci system), making five small incisions (one-quarter to one-half inch each) in the lower abdomen. Robotic arms are passed into the abdomen and directly controlled by the surgeon at a remote console. The arms extend to otherwise hard-to-reach places and allow for very precise movements.  A special camera allows the surgeon to view the images in 3D, magnified 10 times.

“There are several ways to manage prostate cancer and in many cases, one option is just as good as another.  The choice of whether or not to treat the cancer, or how to treat it, will be different for each patient and requires a thorough discussion between doctor and patient.   For my patients who choose radical prostatectomy to cure their cancer, a robotic procedure offers many advantages.  It allows me to keep blood loss low, recovery time short, and patients can achieve excellent functional results,” says James Borin, MD, Director, Robotic Surgery, Greenebaum Cancer Center, University of Maryland. http://www.umgcc.org/

Several large studies were published in August 2012, which compared robotic vs. open prostatectomy in thousands of patients.  Here are specifics:

 

• Less blood loss and fewer transfusions 

Novarra, Ficarra, Rosen et al. Systematic Review and Meta-analysis of Perioperative Outcomes and Complications After Robot-assisted Radical Prostatectomy. European Urology 2012; 62:431.  http://www.europeanurology.com/article/S0302-2838(12)00628-8/abstract.  Other studies have shown fewer complications, shorter hospitalization, fewer days with a catheter, and a faster recovery.

 

• Similar rates of cancer control 

Novarra, Ficarra, Mocellin et al. Systematic Review and Meta-analysis of Studies Reporting Oncologic Outcome After Robot-assisted Radical Prostatectomy. European Urology 2012; 62:382.  http://www.europeanurology.com/article/S0302-2838(12)00631-8/abstract

 

• Better 12-month potency rates 

Ficarra, Novarra, Ahlering et al. Systematic Review and Meta-analysis of Studies Reporting Potency Rates After Robot-assisted Radical Prostatectomy. European Urology 2012; 62:418. http://www.journals.elsevierhealth.com/periodicals/eururo/article/PIIS0302283812006306/abstract

 

• Faster return to continence and better overall continence rates 

Novarra, Ficarra, Rosen et al. Systematic Review and Meta-analysis of Studies Reporting Urinary Continence Recovery after Robot-assisted Radical Prostatectomy. European Urology 2012; 62:405. http://www.europeanurology.com/article/S0302-2838(12)00629-X/abstract

  

Other treatment options

Options to robotic prostatectomy are radiation (external beam and brachytherapy), cryotherapy, and active surveillance. Talk to your doctor to determine your best decision.

 

Additional information:

General information on robotic prostatectomy

http://www.umm.edu/urology/rp.htm

Clinical data outcomes

http://www.davinciprostatectomy.com/evidence/studies.html

Find a daVinci surgeon

http://www.davinciprostatectomy.com/locator/

 

 

Metformin for prostate cancer

A small study has found that prostate cancer responds well to a diabetes drug called metformin when it is given in a neoadjuvant setting—meaning before prostatectomy, chemotherapy, radiation, or hormone therapy. And there were no side effects at a low dose (daily dose but less than prescribed to diabetics). (Princess Margaret Hospital, University Health Network in Toronto, Ontario, Canada and reported in American Association for Cancer Research Annual Meeting.  Spring 2012).

The phase 2 study included 24 men with a median prostate-specific antigen (PSA) level of 6 ng/mL.  

 

Just how effective was metformin?

Men who took the diabetes drug, used to lower glucose, had a 32 percent reduction in tKi67, a tumor marker tied to increased cancer cell growth and cell division. The researchers also found that metformin significantly reduced serum insulin-like growth factor-1, fasting glucose levels, body mass index, and PSA, also all tied to cancer growth.

While preliminary results are promising, it is not yet known if there will be long-term benefits.

 

What next?

Investigators’ plan moving forward is to see if metformin is more effective in combination with other drugs. Some members of the PI3-kinase family (proteins) have been tied to multiple cancers, including prostate cancer. PI3 kinase fuels the disease by causing insulin to spike—so the theory is that combining P13-kinase with metformin may prove quite beneficial.

 “[Metformin’s exact role against cancer] will depend on the results of another analysis currently being completed by our study team and others worldwide,” said lead investigator and oncologist Anthony M. Joshua, M.B.B.S., Ph.D..

The investigators’  focus moving forward is on defining metformin’s specific mechanism of action and determining exactly which patients will most likely respond well.

Early studies have also found the diabetes drug effective against breast and pancreatic cancers.

Brand names for metformin are Glucophage, Glucophage XR, Glumetza, Fortamet, and Riomet.

More resources:

http://www.sciencedaily.com/releases/2012/03/120331151126.htm

Metformin and prostate and pancreatic cancers

http://www.webmd.com/prostate-cancer/news/20120403/common-diabetes-drug-may-fight-cancer

 

 

Sex After Prostate Cancer

If prostate cancer has hugely changed your sex life and your thoughts on intimacy, know that you’re among one of 200,000-plus men who step into that boat each year (in the United States alone). But you have options to stay sexually active and feeling whole.

 

First, there’s the medical model. Hormone replacement and erectile pumps fall in this category.

Hormone replacement therapy involves prescription topical creams. Or else implantation of hormone pellets in the gluteus maximus muscles (butt). It’s a quick outpatient procedure to maintain hormone levels for several months. There’s been a debate over whether hormone replacement therapy is safe after prostate cancer, but many oncologists believe it will not increase risk for recurrence once your PSA is .1 or less for a year or more.

Then there are penile implants. There are several models; none are visible from the outside. An inflatable implant has a pump you squeeze that is hidden in your scrotum. When the pump is activated, saltwater fills a cylinder that inflates the penis. After intercourse, the man “deflates” his erection by pressing a valve. You are in full control of when and how long you have an erection.

There are also semi-rigid implants with a metal or plastic rod. This non-inflatable device is bent outward to have sex, then back toward the body to conceal it under clothing.

“While ejaculation is no longer possible for at least half of prostate cancer survivors after treatment, they have dry orgasms that can still be immensely satisfying to both survivors and their partners,” says Ed Weinsberg, a certified sexuality counselor who also happens to be a prostate cancer survivor and rabbi.

“Penile implantation is usually a simple hour and a half procedure; typically there’s a little soreness for a couple of weeks, and then you’re ready to go.”

Weinsberg talks to men about all their options.

“I got a call from a guy who is divorced and now totally in love with his new partner. He had complete sexual satisfaction except for intercourse. She insisted he fulfills her in every way. Which is to say she came and came again through kissing and touching. But he was extremely depressed and wanted more. So we discussed implants.”

But Weinsberg discusses other components for better sex after cancer.

 

Sex is all about how you frame it

“Many men who now face erectile dysfunction think of themselves as impotent, which is so far from the truth,” says Weinsberg.

In helping to clear up misconceptions, he points out the broad range of what impotency is, from some difficulty maintaining an erection, to complete inability. But physical impotence is one thing; impotence beyond that is another, and avoidable. He suggests men refrain from using the “I” word; rather than say “impotent,” he suggests different language to help them see their challenges are not as pervasive as they may feel.

“I advocate using the word ED (erectile dysfunction), which can be occasional dysfunction, or frequent or total. Even if it’s complete, for a man to call himself impotent is dangerous because he can incorrectly see himself as an impotent person rather than someone whose body just doesn’t work like it used to. So I ask men to consider the distinction between what has happened to their genital functioning versus who they still are.”

In his book, Reigniting Intimacy and Sexuality after You’re Ill Weinsberg discusses a mind-body approach he calls the Intimacy Development System (IDS). IDS involves ten strategies to reverse survivors’ tendency to distance themselves from their partners due to anxiety about sexual dysfunction. And he goes into the whole range of what sex is, with penetration just being one aspect.

 

It’s a whole-body experience. Kissing, hugging, embracing, and massaging are all parts of it.

Communication between partners is key, too, stress sexuality therapists.

“The conversations start slowly because you need to grieve your loss. But when men and women open up to each other, I see them grow closer through the crises they face together,” says Weinsberg.

 

“There definitely is some difference between what was and what is. But if you love each other enough, and with sober, adult thinking, in the long run the changes don’t make a difference. Actually, you can become open to a slew of richer sexual experiences that you may never have had before your cancer.”

-Ed Weinsberg, PhD

Certified Sexuality Therapist and Author

 

Related information:

http://www.urologicalcare.com/advanced-ed-treatments/types-penile-implants/

http://www.upmccancercenters.com/cancer/prostate/erectiledysfunction.html

http://www.pcf.org/site/c.leJRIROrEpH/b.5836625/k.75D7/Erectile_Dysfunction.htm

http://greatsexaftercancer.typepad.com/blog/

 

 

 

New prostate cancer procedure cuts side effects

There’s a new, fairly noninvasive technique for treating prostate cancer that appears as effective as radical surgery and or radiation, but carries much less risk for impotence or incontinence. And five-year follow up studies suggest the procedure is as effective at managing the cancer. 

 Actually,  high intensity focus ultrasound (HIFU) has been done since 1996 in other countries, but is slated for FDA approval in the United States as early as 2012, according to George M. Suarez, M.D., a urologist who has performed the procedure for ten years overseas and who was the first to do HIFU in the United States.

The way it works is that ultrasound is converted to heat, which can destroy tissue deep in the body. So it’s done without openly operating on the patient.

“I first saw HIFU done in Europe in the late 1990‘s. And I thought If this is nearly as good as they are claiming, it’s  going to revolutionize prostate cancer treatment and hopefully encourage more patients to manage their condition.  So many men forgo treatment because of their fear of being impotent or incontinent. This is a fairly noninvasive, outpatient procedure. There is no blood loss and much less chance of complications with lasting lifestyle consequences.”

 

How HIFU works

HIFU is done using a computer to visualize the area being treated, and ultrasound. 

“The software gives a very clear image of the prostate, and a built in doppler picks up nerve bundles.  So the surgeon is able to avoid those nerves to preserve potency and avoid nearby tissue to preserve normal urinary continence,” says Dr. Suarez.

“But in addition, the  newest software enables us to read tissue characteristics before the HIFU energy is delivered and again after HIFU has been delivered. If you take both before and after pictures of the target, you can determine how effective the lesion has been. If doctors are not satisfied with the initial changes, they can go back and redeliver HIFU,” says Suarez.

 

The clinical data

BJU International reported that the five-year disease-free survival rate was only about 20%, but a newer machine called the Sonablate-500 VERSION 4.5 HIFU shows dramatically more promising results. 

• A study at Tokai University and Kitasato University in Japan found the following disease-free rates in all patients at one, three, and five years: 84%, 80%, and 78%, respectively. Survival rates were higher than these figures in patients whose  PSA was less than 10 ng/ml before treatment. 

• Research from the University College London and University College London Hospitals NHS Foundation, backed by US HIFU and United Kingdom partners, found the following: 

   At one-year follow-up,  95 percent of participants achieved good erections, 90 percent had no  cancer on tissue samples, and 100 percent had “no significant cancer.” 

• A ten-year follow up study shows overall disease-free survival at eight years to be 59 percent.  (Toyoaki Uchida, MD in Japan.)

 

Who’s a candidate for HIFU? 

Patients with localized prostate cancer who could otherwise be treated by radiation or radical surgery. This treatment can also be considered in patients who have received prior treatments like cryotherapy radioactive seeds implants or external beam radiation therapy (EBRT) for localized prostate cancer but who have had a local recurrence. This is possible even after surgical removal.  

 

History on HIFU

The first clinical applications for prostate cancer were in the late 1990s, with the technology  based on methods used to break up kidney stones.  In 2002 the American Urological Association reported on the procedure when it was in early trial phases in the United States. HIFU is now in final trial stages, awaiting FDA approval.

More on prostate cancer and HIFU:

 http://www.internationalhifu.com/frequently-asked-questions-hfiuforprostate-69.html

www.HIFUmedicalexpert.com

http://adsabs.harvard.edu/abs/2010AIPC.1215..216U

 

More clinical data on  HIFU:

http://www.internationalhifu.com/hifu-results-aamp-clinical-data-whatishifu-48.html

 

To find clinical trials:

http://www.clinicaltrials.gov/ct2/search/browse?brwse=cond_cat_BC04

http://www.prostatecancertrial.org/

 

 

Fish-filled diet improves outcome of prostate cancer

A fish-filled diet may help fight prostate cancer in men who already have the disease according to a recent study at McGill University of Health in Montreal. In fact the data suggests that eating a lot of fish reduces risk of death from prostate cancer by 50 percent.

The lead researcher took his studies further, analyzing 31 large-scale studies and reported consistent findings in the American Journal of Clinical Nutrition. While there has been no evidence that eating fish can reduce the chance for prostate cancer, there was an overall 44 percent  reduction in metastasis in men who already had the disease. And there were 63 percent less deaths from it.

Researchers believe fish’s ability to reduce inflammation is the key to its cancer-fighting properties. The omega 3 fatty acids in oily fish are also credited for fighting prostate and other cancers. There is no research to indicate how many servings or what size servings are optimal, but if you have prostate cancer, it’s looking like stocking up on fish, especially oily, non-farm raised fish is a good idea. Fresh fish, particularly cold water salmon, sardines, mackerel, and trout are the healthiest. They should be grilled, baked, or poached.

While there is debate over whether diet can make a dramatic impact on advanced prostate cancer (spread beyond the prostate), studies show the following diet choices do help against early stage cancer:

 

Foods to fight prostate cancer

• Foods high in Vitamin C. You can get Vitamin C from citrus fruits, dark green leafy vegetables, sweet peppers, especially red peppers, and tea; green tea and white tea, in particular are known to have cancer-fighting properties

 

• Eat berries and red grapes, and drink red grape juice, or red wine regularly

 

• Foods high in Vitamin E such as nuts, seeds, olive oil, avocado oil, wheat germ, peas, and nonfat milk

 

• Foods high in selenium such as Brazil nuts, fresh fish, grains, mushrooms, wheat germ, bran, whole-wheat bread, oats, and brown rice

 

Foods to avoid:

• Trans fatty acids, found in margarine, fried foods, and commercial bakery products

 

• Preserved, pickled, or salted foods

 

• High-dose zinc and calcium supplements

 

• Go low on animal fats

 

More information on fish and prostate cancer:

http://www.msnbc.msn.com/id/39560025/ns/health-cancer/

http://www.ajcn.org/content/92/5/1223.abstract

More on diet and prostate cancer:

http://www.life123.com/health/mens-health/prostate/prostate-cancer-treatment.shtml

 

Exercise cuts incontinence after prostate surgery

After prostate cancer surgery, almost all men suffer from incontinence for at least a couple of weeks, if not up to six weeks or so. Still the frustrating effects are not permanent for the vast majority. A new finding is that if you keep your weight in  check and exercise, you’re far less likely to remain incontinent after prostatectomy. (24% to 25% of physically inactive men, whether obese or not, remained incontinent; 16% of thin, active men remained incontinent in a study reported by Journal of Urology, Feb 2010).

For years, the health care community has focused on surgical techniques to prevent incontinence, hoping to stave off the side effect by preserving nerves, muscles, and blood vessels around the prostate.

 

The buzz is that physical activity of at least an hour a day will cut the chance for incontinence

Exactly why exercise might prevent incontinence needs to be looked at further. But one theory of the researchers is that exercises that improve overall muscle tone, which may improve bladder control, are the best. These would be walking and biking, for instance.

But if you haven’t been exercising regularly, please talk to your doctor before lacing up your walking or jogging shoes or “heave hoeing” those dumbbells. Here’s to your health!

For more information:

http://tinyurl.com/

 

Aspirin against prostate cancer

Aspirin may cut death from prostate cancer by more than 50 percent and may have multiple other benefits for people living wiith this disease according to a recent study.

The drug’s cancer-fighting powers are in its ability to stave off risk of blood  clots, which has researchers’ attention, as people with blood clots carry a higher risk for  cancer. Lab work on rats actually suggests that aspirin slows the growth and spread of cancer.

 

Study results

The trial, done at the University of Texas Southeastern Medical School, Dallas, involved 5,275 men with localized prostate cancer.  Here are highlights of study findings:

• Cancer had spread in 3% of the men taking the anti-clotting medications, vs. in 7% who had not taken the medications.
• Recurrence was 33% in those on the medication and 43% in the remaining men
• Ten years after diagnosis, 10% of the men who had not taken the medication had died from cancer while 4% who took the medication had died.

Professionals in oncology are not advising men with prostate cancer to begin randomly popping aspirin. Further research is needed to determine optimal dose, when and for how long you should take aspirin, especially since too much aspirin can cause bleeding. But you may want to talk to your doctor about possibly beginning on a baby aspirin.

Studies also suggest aspirin’s benefits extend to fighting colon cancer and breast cancer.

For more information:

http://tinyurl.com

http://tinyurl.com

 

New therapy translates to better sex and other benefits

A very targeted form of radiation seems to dramatically reduce the risk of impotence in men with prostate cancer, and is coming with other benefits.

By 12 and 18 months after receiving proton therapy, 95%, and 94% of men were still enjoying healthy sex lives, as was reported in a follow up on 100 men participating in a study at Florida Proton Therapy Institute in Jacksonville. And after 18 months, just one man experienced a rising PSA level.

 

Study results

The Florida study, and others of even a larger scale have shown similar results, including  that proton therapy reduces risk for recurrence and side effects.

A study of 643 men with local early and late stage prostate cancer found that disease-free survival rate was 89 percent after five years. (Proton Treatment Center at Loma Linda University Medical Center in southern, California). This number translated to as many or more patients free of disease as those cited who underwent conventional treatments

Instead of conventional x-ray, which may cause more damage to healthy tissues, proton therapy uses powerful, more precisely guided protons, sparing healthy tissue. When it’s used for prostate cancer, treatments are usually five days a week for eight weeks.

More information:

http://www.proton-therapy.org/prostate.htm

http://www.protons.com/; 1-800-PROTONS

 

 

Pomegranate juice slows climbing PSA levels

You’ve probably been told at some time in your life, “Drink your prune juice.” But there’s a new one from the University of California for the millions of men with early stage prostate cancer: pomegranate juice may slow the disease.

The Journal of Urology (2009, issue 4) reported  on a University of  California study involving 48 men with prostate cancer who drank eight ounces a day of pomegranate juice; it took twice as long for their PSA’s to double. Rising PSA (prostate-specific antigen) is often an indicator that prostate cancer is growing.

The ingredient in the juice believed to be behind the slowed PSA’s is ellagitannins, which get digested into chemicals called urolithins.

The study is not the first of its kind to produce such intriguing results. In 2006, UCLA researchers found that PSA doubling time increased from an average of 15 months to 54 months for men drinking the pomegranate juice.

The 2009 report, from a phase two trial, will be followed by a phase 3 trial involving a placebo control group.

For more study details:

www.nutraingredients.com/Research/Pomegranate-juice-may-slow-prostate-cancer-recurrence-Study

 

 

First cancer vaccine available

If you’re living with advanced prostate cancer (spread beyond your prostate) and you aren’t getting promising results from hormone therapy, this may be the best news you’ve heard in a while … the FDA just approved a vaccine that you may be a candidate for. It’s called Provenge—and unlike vaccines designed to prevent illnesses in the first place –Provenge fights advanced prostate cancer after a man has been diagnosed.

 

The way Provenge works is by training the immune system to recognize and attack cancer cells.

Immune system cells are removed from your blood and exposed to a substance in prostate cancer cells. Then the cells are placed in your body in a process similar to a blood transfusion.

The vaccine appears to have short-term mild to moderate side effects, though has caused strokes in a small  number of patients, so you will want to discuss the pros and cons with your doctors. So far the drug is extending patients’ lives by about four months.  It’s not a cure, but a step forward. And know that other prostate cancer vaccines are in clinical trials as you read this article …

 

“The approval of Provenge represents a significant scientific and clinical advancement for the treatment of prostate cancer. Cancer immunotherapies that use the patient’s own immune system will likely create an entirely new treatment paradigm for patients with cancer.”

-Philip Kantoff, M.D., Director of the Lank Center for Genitourinary Oncology, Chief of the Division of Solid Tumor Oncology, and Chief Clinical Research Officer at Dana-Farber Cancer Institute (Reported in Seniorjournal.com). http://seniorjournal.com/NEWS/Health/2010/20100430-ProvengeApproved.htm

 

To find clinical trials:

http://clinicaltrials.gov/ct2/search

More on Provenge:

www.cancer.org/cancer/news/news/fda-approves-prostate-cancer-vaccine

For a free Advanced Cancer Treatment Guide:

www.johnshopkinshealthalerts.com/special_reports/advanced/advanced_landing.html

 

 

New hormone therapy for advanced prostate cancer

There’s a fairly new hormone treatment called Abiraterone, showing promise for men with advanced prostate cancer that may be on the market by the end of the year.

The cancer drug works differently and often more effectively than other hormone therapies, in that it blocks testosterone production. Researchers have been studying the drug for several years.

 

Results from two recent studies

50% decline in PSA in 36% of the total 48 men who took Abiraterone.  Partial responses were seen in 18%. PSA remained stable for an average of 169 days. (The Journal of Clinical Oncology, March 2010).

In a study of 1,195 men, those taking Abiraterone lived for about four months longer than those who did not take the drug. Conducted by The Institute of Cancer Research, based out of London.

If you have heart disease, know that there are side effects that may not make this the ideal drug for you, and you’ll want to talk to your doctor. But researchers found that adding low-dose prednisone can reduce these heart-related complications.

More on Abiraterone:

www.webmd.boots.com/prostate-cancer/news/20101011/advanced-prostate-cancer-drug-shows-promise

http://jco.ascopubs.org/content/28/9/1496.short

To find clinical trials:

http://clinicaltrials.gov/ct2/search

www.mayoclinic.com/health/prostate-cancer/DS00043/DSECTION=treatments-and-drugs (also has links to additional resources)

For a free Prostate Cancer Guide:

www.johnshopkinshealthalerts.com/register_ppc_prostate/prostatesre_reg_landing.html?st=ppc&s=MSN_023027_Prostate_Cancer_-_Content&c1=MSN_CM_NW&source=PROS_7KEY&kw=Prostate_Cancer_-_Content

 

 

PSA testing

About one in six men will be diagnosed with prostate cancer in his lifetime, but by far the majority will survive the disease—thanks in large part to early screening. The Prostate Specific Antigen (PSA) test is the most common way to check for prostate cancer. It’s a blood test that detects and measures a substance made by the prostate gland. Most men have PSA levels under 4 nanograms per milliliter of blood. If your level is above 4 but less than 10, you have about a 25% chance of having prostate cancer. If it rises above 10, your chance is about 50%. Know that as you age, it is normal for your PSA to go up to some degree, even if you are healthy. But you will want to have your doctor keep an eye on it.

Related links:

www.cancer.gov/cancertopics/pdq/screening/prostate/Patient/page1

“Can Prostate Cancer Be Found Early”

www.cancer.org/docroot/CRI/content/CRI_2_4_3X_Can_prostate_cancer_be_found_early_36.asp

Cancer screening/testing

www.davinciprostatectomy.com/about-prostate-cancer/screening_testing/index.aspx