Myth Number One: Everyone that gets prostate cancer will die of the disease.

Fact: Checking for prostate cancer is incredibly important, but patients with prostate cancer are likely live to an old age and/or die of some other cause. Detecting prostate cancer early and working with expert doctors like Dr. Gaertner and Dr. Knoedler on a treatment plan is crucial.

Myth Number Two: If you have high PSA score that you definitely have prostate cancer.

Fact: Some high PSA scores can be due to an inflammation in the prostate or an enlarged prostate. The PSA score is a guideline to help Dr. Knoedler or Dr. Gaertner decide if you need more tests to check for prostate cancer. The doctors are interested in your PSA score over time. If it continues to increase it could be a sign of a problem. If it decreases after cancer treatment that is great.

Patients at Metro Urology now have access to UroNav, which is an MRI assisted, ultrasound-guided biopsy technique which provides a new level of accuracy to the detection of prostate cancer. Because it can detect prostate cancers in hard to find areas of the prostate, UroNav can reduce the need for multiple biopsies and find cancers in men with previous negative biopsies but high/rising PSA scores.

UroNav is a new high tech approach to the diagnosis of prostate cancer and Metro Urology is the only private urology practice in the Twin Cities to have this technology. UroNav testing has already found aggressive prostate cancers in men with previous negative biopsies.

Myth Three: Prostate cancer surgery will ultimately end your sex life and cause urine leakage.

Fact; Sex Life: Using the highest tech equipment to perform robotic surgery with the da Vinci system, Dr. Knoedler and Dr. Gaertner work to spare the nerves that help trigger erections. Because of their combined talents they have a great success rate with patients that are able to have an erection strong enough for sex again. Depending on the patient, recovery can take from 4 to 24 months, maybe longer and in general younger men usually recover sooner.

Fact; Urine Leakage: While urine leakage is common immediately after surgery it is almost always temporary. Dr. Gaertner and Dr. Knoedler have an excellent success rate in this area and within a year, approximately 95% of men have as much bladder control as they did before surgery.

Myth Four: The only men at risk of prostate cancer are elderly.

Fact: Although prostate cancer is fairly rare for men under 40 some men should be tested earlier. Age is not the only risk factor for the disease. Others include:

• Family history. For patients whose father or brother had prostate cancer, their own risk doubles or triples. The more relatives a patient has with the disease, the greater their chances of getting it.
• Race. African-American men have a higher risk of prostate cancer than men of other races, the reason is still unknown.

Talk to Dr. Gaertner and Dr. Knoedler about when you should start PSA testing.

Myth Five: Patients must have all prostate cancers treated.

Fact: In some cases patients and their doctors may decide not to treat prostate cancer. Reasons include:

• If the cancer is at an early stage and is growing very slowly.
• If the patient is elderly and has other illnesses. In cases like these the treatment for prostate cancer may not prolong life and may actually complicate care for other health problems.

In such cases Dr. Gaertner and Dr. Knoedler may suggest “active surveillance.” This means that they will regularly check the patient to make sure the cancer does not worsen. If the situation changes, the doctors may decide to start treatment.

One of the best ways to fight cancer is to catch it in the early stages, when it’s more treatable. The problem is that the warning signs for many kinds of cancer can seem pretty mild.

Take a look at these 15 signs and symptoms. Some are linked more strongly to cancer than others, but all are worth knowing about — and even talking over with your doctor.

1. Problems When You Pee

Many men have some problems peeing as they get older, like:

• A need to pee more often, especially at night
• Dribbling, leaking, or an urgent need to go
• Trouble starting to pee, or a weak stream

An enlarged prostate gland usually causes these symptoms, but so can prostate cancer. See your doctor to check on the cause of the problem. He’ll give you an exam to look for an enlarged prostate, and he may talk to you about a blood test (called a PSA test) for prostate cancer.

2. Changes in Your Testicles

If you notice a lump, heaviness, or any other change in your testicle, never delay having it looked at. Unlike prostate cancer, which grows slowly, testicular cancer can take off overnight. Your doctor will look for any problems with a physical exam, blood tests, and an ultrasound of your scrotum.

3. Blood in Your Pee or Stool

These can be among the first signs of cancer of the bladder, kidneys, or colon. It’s a good idea to see your doctor for any bleeding that’s not normal, even if you don’t have other symptoms. Although you’re more likely to have a problem that’s not cancer, like hemorrhoids or a urinary infection, it’s important to find and treat the cause.

4. Skin Changes

When you notice a change in the size, shape, or color of a mole or other spot on your skin, see your doctor as soon as you can. Spots that are new or look different are top signs of skin cancer. You’ll need an exam and perhaps a biopsy, which means doctors remove a small piece of tissue for testing. With skin cancer, you don’t want to wait.

5. Changes in Lymph Nodes

Swollen lymph nodes, small bean-shaped glands found in your neck, armpits, and other places, often signal that something’s going on in your body. Usually, they mean your immune system is fighting a sore throat or cold, but certain cancers also can make them change. Have your doctor check any swelling that doesn’t get better in 2 to 4 weeks.

6. Trouble Swallowing

Some people have trouble swallowing from time to time. But if your problems don’t go away and you’re also losing weight or vomiting, your doctor may want to check you for throat or stomach cancer. He’ll start with a throat exam and barium X-ray. During a barium test, you drink a special liquid that makes your throat stand out on the X-ray.

7. Heartburn

You can take care of most cases of heartburn with changes to your diet, drinking habits, and stress levels. If that doesn’t help, ask your doctor to look into your symptoms. Heartburn that doesn’t go away or gets worse could mean stomach or throat cancer.

8. Mouth Changes

If you smoke or chew tobacco, you have a higher risk of mouth cancer. Keep an eye out for white or red patches inside your mouth or on your lips. Talk to your doctor or dentist about tests and treatments.

9. Weight Loss Without Trying

Pants fitting a little looser? If you haven’t changed your diet or exercise habits, it could mean that stress or a thyroid problem is taking a toll. But losing 10 pounds or more without trying isn’t normal. Although most unintended weight loss is not cancer, it’s one of the signs of cancer of the pancreas, stomach, or lungs. Your doctor can find out more with blood tests and tools that make detailed pictures of the inside of your body, like a CT or PET scan.

10. Fever

A fever is usually not a bad thing — it means your body is fighting an infection. But one that won’t go away and doesn’t have an explanation could signal leukemia or another blood cancer. Your doctor should take your medical history and give you a physical exam to check on the cause.

11. Breast Changes

Men tend to ignore breast lumps because breast cancer isn’t on their radar. But 1% of all breast cancers occur in men, although they’re usually diagnosed much later. Don’t take any chances. If you find a lump, tell your doctor and have it checked.

12. Fatigue

Many types of cancer cause a bone-deep tiredness that never gets better, no matter how much rest you get. It’s different from the exhaustion you feel after a hectic week or a lot of activity. If fatigue is affecting your daily life, talk to your doctor who can help you find the cause and let you know if there are ways to treat it.

13. Cough

In nonsmokers, a nagging cough is almost never cancer. Most go away after 3 to 4 weeks. If yours doesn’t, and you’re short of breath or cough up blood, don’t delay a visit to your doctor, especially if you smoke. A cough is the most common sign of lung cancer. Your doctor can test mucus from your lungs to see if you have an infection. He may also give you a chest X-ray to check for another problem.

14. Pain

Cancer doesn’t cause most aches and pains, but if you’re hurting for more than a month, don’t just grin and bear it. Ongoing pain can be a signal of many types of cancer, especially those that have spread.

15. Belly Pain and Depression

It’s rare, but depression along with stomach pain can be a sign of cancer of the pancreas. Should you worry? Not unless this cancer runs in your family. Then you need to see your doctor.

When you have prostate cancer surgery or radiation therapy the muscles that help you control your urine flow may be weakened. When this happens you may have incontinence. Incontinence is when you leak or pass urine when you do not want to. This is a very common side effect or unwanted change of prostate cancer treatment. The good news is that there is a simple exercise, called a Kegel (Keygul) exercise which you can do to help strengthen your muscles. This exercise will help you have more control over your urine flow after your prostate cancer treatment. In this article you will learn:

• What a Kegel exercise is
• Why you should do Kegel exercises
• How to find your pelvic floor muscles
• How often you should do your Kegel exercises

It is important for you to think about and plan how you will take care of yourself before and after your prostate cancer treatment so that you can keep doing as many of your normal activities as possible.

What Are Pelvic Floor Muscles?

Your pelvic floor muscles are a network of muscles that support your bladder and help you control your urine flow. There are three pelvic muscles:

1. The bladder. Your bladder is a muscle shaped like a balloon and holds your urine.
2. The sphincter muscles. These muscles help you open and close your urethra, the tube that drains urine from your bladder. And,
3. The pelvic floor muscle [also known as the pubococcygeus (pu-bo-kak-sije- us) or PC muscle] supports your bladder and rectum and helps control your urine flow.

What are Kegel Exercises?

Kegel exercises are easy exercises you can do before and after your prostate cancer treatment to help strengthen your pelvic floor muscles. These muscles help control your urine flow. Kegel exercises are one of the most effective ways of controlling incontinence without medication or surgery.

Why Should I Do Kegel Exercises?

The prostate is a gland, about the size of a walnut, located under the bladder surrounding the upper part of the urethra. The urethra is a tube that carries urine through the penis to the outside of the body. There are many muscles that surround the prostate gland. These muscles may be weakened during your prostate cancer treatment. This may cause you to have urine leakage also known as incontinence. Building up the strength in your pelvic floor muscles can help you gain better control of your bladder and urine flow. Remember, that just as it takes time to build your biceps and strengthen any other muscle in your body, it takes time to strengthen muscles in your pelvic floor.

How Do I Find My Pelvic Floor Muscles?

In order to help strengthen you pelvic floor muscles, it is important that you take time to make sure you are exercising the right muscles. It may take you several tries to find your pelvic muscles. So, take your time.

There are several ways that you can find your pelvic floor muscles. One way is to:

Try to stop and start your urine stream while you stand at your toilet to urinate (pee). Try to do this two or three times.

Another way to find your pelvic floor muscles is to:

1. Imagine that someone walks in to your bathroom while you are urinating (peeing) and you need to stop your urine flow.
2. Try to stop your urine flow.

The muscles you use to stop your urine flow are your pelvic floor muscles. These are the muscles you want to strengthen before and after your prostate cancer treatment.

How Do I Do A Kegel Exercise?

Now that you have located your pelvic floor muscles, you can exercise them even when you do not have to urinate by following these simple steps:

1. Tighten and hold your pelvic floor muscles for five seconds (count 1 one thousand, 2 one thousand, 3 one thousand, 4 one thousand, 5 one thousand).
2. Relax your pelvic muscles. You have just done one Kegel exercise. You should plan to do 10 to 20 Kegel exercises three to four times each day.

Another way to tighten your pelvic floor muscles is to:

1. Squeeze the muscles in your anus (like you are holding a bowel movement).
2. Relax your pelvic floor muscles after each attempt.
3. Repeat this exercise 10 to 20 times.

When you do your Kegel exercises, remember

• Do not hold your breath.
• Do not push down. Squeeze your muscles together tightly and imagine that you are trying to lift this muscle up.
• Do not tighten the muscles in your stomach, buttocks, or thighs.
• Relax your pelvic floor muscles between each squeeze.

How Often Should I Do My Kegel Exercises?

When you first start doing your Kegel exercises, you may not be able to repeat the exercise 10 to 20 times. This is ok. It is much better for you to do fewer Kegel exercises that make your pelvic floor muscles stronger, than to do more exercises that do not work the muscle in the right way. As you get better at doing your Kegel exercises, slowly increase the number of times you repeat the exercise until you reach 20. Your goal should be to do 20 Kegel exercises three to four times each day.

The great thing about Kegel exercises is that you can do them anytime you want to do them. No one can tell that you are doing these exercises. You do not need any special equipment to do Kegel exercises. You can do your Kegel exercises before you get up in the morning, at lunchtime, at suppertime, and at bedtime. You can do them while you are watching TV or reading. Some men put notes on their refrigerator or on their bathroom mirror to remind them to do their Kegel exercises. The more you do them, the stronger your pelvic floor muscles will become.

When Should I Do The Kegel Exercises?

It can take six weeks or longer to strengthen your pelvic floor muscles so it is best to start doing your Kegel exercises before you have prostate cancer treatment. This will help you become better at doing the Kegel exercises and strengthen your pelvic floor muscles before your treatment starts. Remember, your pelvic floor muscles are like any other muscle in your body. It takes regular exercise and time to strengthen them.

Can I do Kegel Exercises If I Have A Catheter?

A catheter is a thin rubber tube placed in your body to drain urine from your bladder out through your penis. Do not do any Kegel exercises if you have a catheter in your penis.

Start doing your Kegel exercises according to the instructions above as soon as the catheter is taken out of your penis. After your catheter is removed you may experience some urine leakage (incontinence) when you stand up, cough, sneeze, laugh, or lift something. You will probably need to use incontinence pads for a while. However, doing Kegel exercises may help you control your urine flow sooner. If you have urine leakage when you stand up, cough, sneeze, laugh, or lift something, try doing a Kegel exercise. This may keep you from leaking urine.

Will My Urine Leakage Stop if I Do The Kegel Exercises?

Most men gain control of their urine leakage (incontinence) within nine to 12 months after their surgery. Studies with men show that Kegel exercises help lessen urine leakage. However, each man’s healing time is different.

Do not become discouraged if you have urine leakage. If you do your Kegel exercises on a daily basis, you can expect to see some results. You may have a great improvement or you may help keep your urine leakage from getting worse. You will need to continue doing your Kegel exercises each day so that your pelvic floor muscles stay strong.

If you have any questions or concerns about urine leakage (incontinence), how to do a Kegel exercise, or if you would like to know about other things that may help with urine leakage, please talk to Dr. Gaertner or Dr. Knoedler.

Patients with newly diagnosed low-risk prostate cancer—and their urologists—need to know the aggressiveness of their tumor. The Oncotype DX Prostate Cancer Assay can help. This genomic test performed on a patient’s needle biopsy provides essential insight into the underlying biology of that patient’s prostate cancer. The result is reported as the Genomic Prostate Score or GPS, and provides a more precise, accurate, and individualized risk assessment that can help a patient and his urologist make a confident choice between active surveillance and immediate treatment.
Visit http://prostate-cancer.oncotypedx.com/ for more information on test.

Congratulations, Drs Knoedler and Gaertner, on the 10 year anniversary of performing the first private practice robotic prostatectomy in Minnesota and the five state area. Since May 17th, 2004 they have completed over 3000 robotic cases establishing themselves as one of the leading robotic prostatectomy teams in the United States.

Drs Knoedler and Gaertner continue to perfect their technique and share them with visiting surgeons. Their best source of referrals is from their own patients and other urologist. They strive to make the next 10 years as successful as the first 10 years.

Meir J. Stampfer, Jaquelyn L. Jahn and Peter H. Gann
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Author Affiliations
Affiliations of authors: Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA (MJS, JJ); Departments of Epidemiology and Nutrition, Harvard School of Public Health, Boston, MA (MJS); Department of Pathology, University of Illinois at Chicago, Chicago, IL (PG).
Correspondence to: Meir J. Stampfer, MD, DrPH, Harvard School of Public Health and Brigham and Women’s Hospital, Departments of Epidemiology and Nutrition, Channing Division of Network Medicine, 677 Huntington Ave, 3rd Fl, Boston, MA 02115 (e-mail: stampfer@hsph.harvard.edu).

Prostate-specific antigen (PSA) screening remains a focus of intense controversy, despite decades of clinical experience and several randomized trials. In this issue of the Journal, Stattin et al. (1) take advantage of a natural experiment in Sweden and use sophisticated statistical modeling techniques to provide further persuasive evidence for the benefits of PSA-based detection to reduce prostate cancer–specific mortality. Sweden has not endorsed a PSA screening program, but considerable “opportunistic” PSA screening has caused an apparent increase in rate of overall prostate cancer detection. This increase, of course, is primarily due to the identification of latent tumors, which are age-related, and in autopsy studies, are prevalent in about 36% of US and European men aged 70 to 79 years (2). Stattin et al. (1) used this effect of PSA screening to identify counties in Sweden with higher rates of PSA screening by categorizing the counties according to the increase in overall prostate cancer rates in recent decades after introduction of the PSA test. As expected, these high-incidence counties had greater usage of PSA testing, and the case patients had characteristics tending to be slightly more typical of screened populations, with somewhat lower levels of PSA at diagnosis and earlier-stage disease (3). Over the time period studied, the authors noted a 19% reduction in prostate cancer–specific mortality in the counties with more PSA screening as compared with less.
The authors note that this is not a randomized trial, and the conclusions, as in any observational study, rest on the assumption that the control counties with lower screening are truly comparable and represent the counterfactual—what would …

Nagging back pain. Indigestion. Frequent urination. You may assume these are minor health issues that don’t need a doctor visit. But think again.

Cancer symptoms are often vague. In fact, prostate cancer — the most common cancer in men — has some of the least obvious symptoms.

“Men shouldn’t ignore their health,” says Therese Bevers, M.D., medical director of MD Anderson’s Cancer Prevention Center. “It’s vital to stay informed, pay attention to changes in your body and report unusual symptoms to your doctor right away.”

Knowing what symptoms to look for can help your doctor find cancer early when it’s most treatable.

Bevers shares some of the most common cancer symptoms in men.

Abnormal lump. Have you recently felt a mass or lump right below your skin? This may be a sign of cancer. Lumps normally show up in the breast, testicles, lymph nodes and soft tissues, like tendons and ligaments. Here’s what to do: Report it to your doctor immediately, especially if you just found it, or it has grown in size.
Changes in your testicles. Have you noticed changes in the size of your testicles, like one or both have gotten bigger? Maybe you’ve found a lump, or your testicles feel swollen or extra heavy. Any of these signs should send you straight to your doctor. Testicular cancer is most common in young and middle-aged men.
Changes in your restroom habits. Suddenly need to use the restroom all the time? Or have pain when you go? This may be a sign of bladder or prostate cancer. Other signs to look out for are blood in your urine or stool. Changes in your bowel habits, like constipation or diarrhea that won’t go away, matter too.
Changes in your skin. If you work long hours outside or have a history of blistering sun burns, check your skin more closely. What you think are signs of hard work might actually be skin cancer. Look for unusual bleeding, scaling or sores that do not heal. Other signs include warts as well as moles and freckles that change in color, size or shape. Bottom line: If you’ve got a strange spot on your skin, call your dermatologist.
Indigestion or trouble swallowing. A prolonged painful burning sensation in your throat or chest shouldn’t be ignored – even if you suspect it’s from eating spicy food. Don’t think that regular indigestion or trouble swallowing is a normal part of aging either. It can be a sign of esophageal, stomach or throat cancer.
Persistent cough or hoarseness. Do you have a nagging cough? If it lasts more than three weeks, it’s a sign that something’s wrong. And whether you smoke or not, a cough that doesn’t go away can be a sign of lung cancer. Persistent hoarseness, wheezing, shortness of breath or coughing up blood are also signs to call your doctor right away.
Changes in your mouth. If you smoke, chew, dip or spit tobacco, you need to pay close attention to changes inside your mouth. White patches inside your mouth or white patches on your tongue may be pre-cancers. Left untreated, these areas can turn into oral cancer. Sores, unexplained bleeding, numbness or tenderness in the area around your mouth – like your tongue, lips and cheeks – should tell you that it’s time for a check-up.
Unexplained weight loss. Are you dropping pounds without changing your diet or exercise habits? Call your doctor – even if you think they’re pounds you need to lose. Losing ten or more pounds for no known reason can be a sign of pancreatic, stomach, esophageal or lung cancer.
Constant fatigue. Are you too tired to play with your kids? Or hang out with the guys after work? Are you constantly tired no matter how much rest you get? Don’t brush it off. Constant fatigue can be a sign of leukemia as well as some colon and stomach cancers.
Persistent pain. Nagging back pain, a headache that won’t go away, abdominal or stomach pains – your doctor needs to know. “No pain, no gain” doesn’t apply to cancer. And, persistent pain, no matter the location, can be the first sign that something’s wrong.
Remember, having one or more of these symptoms doesn’t mean you have cancer. But if they’re persistent, you need to go in for a checkup.

“See your doctor and get your cancer risk assessed,” Bevers says. This assessment can help you understand whether or not you’re more likely to get cancer. That way you can make better choices to keep your body healthy and cancer-free.

by Brittany Cordeiro