Exercise and prostate cancer

New research adds credence for why men ought to exercise both before and after a prostate cancer diagnosis to maximize their chances of longer survival and/or improved quality of life.

Key Points: Men who regularly walked at a brisk pace of 3.5 mph or greater before any prostate cancer diagnosis, had more normally shaped blood vessels in their tumors once a cancer did develop. Malformed blood vessels in a prostate tumor have been associated with an increased risk of developing lethal cancers.

A growing body of research suggests that exercise benefits men with prostate cancer, and now a new study may have determined one of the reasons why. In findings presented by several researchers, it was determined that men with a history of brisk walking prior to a diagnosis of prostate cancer had healthier-looking, more normally shaped blood vessels in their prostate tumors after diagnosis.

The researchers had previously shown that small, irregularly shaped vessels in human prostate tumors were linked to an increased risk of death in men with prostate cancer. “We hypothesized that brisk walking and vigorous activity would be associated with larger, more regularly shaped vessels in human prostate tumors,” said the researchers.

To test their theory, they reviewed the self-reported physical activity levels of 572 men in the study prior to a diagnosis of prostate cancer. All the men in the study underwent surgery to remove their prostate gland after their cancer was diagnosed. The researchers examined post-surgical tissue samples of these men and found that those who reported the fastest walking pace (3.5 to 4.5 mph) prior to their diagnosis of prostate cancer had more normally shaped blood vessels in their tumors compared to men with the slowest walking pace (1.5 to 2.5 mph).

This may be quite important, say the researchers, because more normally shaped vessels in prostate tumors may inhibit cancer spread in the body and might also improve men’s response to anti-cancer therapies.

Interestingly, and somewhat surprising to the researchers was that while brisk walking was associated with a positive effect on the shape of a tumor’s vasculature, more vigorous levels of exercise, such as running or cycling, did not seem to have an effect of tumor vessel shape.

Top ten things you should know about PSA testing for prostate cancer

The current controversy over PSA testing is actually not about whether we should detect prostate cancer, but whether all men who receive treatment actually need treatment. Because prostate cancer is slow growing not all men need treatment; some men can simply have their cancers monitored to see if the cancer grows (called active surveillance).

We advocate for patients who choose to monitor their cancers while also being strong in our advice to patients who may be reluctant to treat their cancer when we feel that a man should have treatment.

It is important to have a thorough discussion of the risks and benefits of prostate cancer screening with your primary care physician and urologist so that you can make a decision that is right for you.

Our hope is that this article will help you understand the issue and make informed decisions about your health care.

1. What is a PSA test? A PSA test is a blood test that is used to detect prostate cancer. PSA stands for Prostate Specific Antigen, a protein made in the prostate that leaks into the blood stream and can be detected. An elevated PSA may indicate you have prostate cancer.

Prostate cancer is detected in men with a combination of two tests – a manual exam of the prostate (digital rectal exam or DRE) and the PSA blood test. PSA testing has been clearly shown to help detect and treat prostate cancer early, before it spreads. A man who is screened for prostate cancer has less chance of developing incurable prostate cancer and is less likely to die from prostate cancer.

2. What is a normal PSA? There is no such thing as “normal” when it comes to PSA. Cancer is rarely found in men with PSA values less than 1. The higher the PSA, the higher the chance that a person has cancer. It is also very important to follow the trend in the PSA value (is it climbing? how fast?).

3. Does an Abnormal PSA test mean I have prostate cancer? No. In fact most high PSA tests do not mean a man has prostate cancer. Many men with elevated numbers never do get cancer even though they are at higher risk.

4. When should I get a PSA test? We recommend that a baseline serum PSA level be obtained in men in their 40s who have made an informed decision to pursue early detection of prostate cancer.

5. How often should I get a PSA? We recommend yearly testing for men age 50 and over who have at least a 10 year life expectancy. Men who have elevated PSA levels are followed more frequently.

6. If my PSA is normal, do I still need a prostate exam? Yes. We find many prostate cancers by physical exam that do not raise the PSA level. The cancer will make the prostate feel larger or firm in the area where the cancer is.

7. What PSA is too high? At Metro Urology we believe that a PSA should be 2.5 or less for men under 60, and less than 4.0 for men over 60. But the trend of the PSA value is also important. A rapidly rising PSA could be concerning, even if the number is still less than 2.5 or 4.0.

8. What happens if my PSA is too high? A PSA test that is too high requires a discussion with one of our physicians at Metro Urology to discuss your individual risk of prostate cancer. We can help you make the decision regarding further evaluation. Most men will be advised to have a prostate biopsy to determine if their prostate contains cancer.

9. What if my PSA is high but my prostate feels “normal”? This is very common. Most cancers are found early using the PSA test, before they grow out of the prostate and spread (called metastasis). Your physician may still recommend a biopsy because, if cancer is found, it is usually very treatable.

10. I have heard PSA testing is not accurate. Do all doctors agree on PSA testing? Recently, several prominent medical organizations have changed their recommendations regarding whether or not men should undergo prostate cancer screening. These conflicting reports lead to significant patient confusion.

Oncotype Prostate Assay

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 on 10 Years of Robotic Surgery

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.

Hounds Astound: Prostate Cancer Found 100% (Around)

ORLANDO, Florida — With an accuracy rate of nearly 100%, 2 specially trained dogs were able to detect prostate cancer with their olfactory system — by sniffing urine samples, according to a new study that is the largest of its kind.
Italian researchers tested each dog’s ability to sniff out prostate cancer in urine samples from 362 men with prostate cancer and 540 men with either non-neoplastic prostate disease or nonprostatic tumors.
The dogs, German Shepherds named Liu and Zoey, had their day, time and again.
Liu had an accuracy rate of 99.0%, with a sensitivity of 100.0% and specificity of 97.8%. Zoey had an accuracy rate of 97.0%, with a sensitivity of 98.6% and specificity of 95.9%.
“This is a real clinical opportunity,” said lead researcher Gianluigi Taverna, MD, chief of the prostatic disease unit at Humanitas Research Hospital in Milan, about the results. The opportunity includes the possibility that specially trained dogs could provide a noninvasive method of cancer detection.
He spoke during a press conference here at the American Urological Association (AUA) 2014 Annual Scientific Meeting.
The dogs were equally capable of detecting low-risk and more advanced prostate cancers. “The dog has a quality, not quantity, response,” said Dr. Taverna.
When evaluating the rare wrongly detected cases, the researchers found no differences between epidemiologic, clinical, or histopathologic characteristics.
The frozen urine samples used in the study were obtained from local Milan hospitals and then thawed for the testing.
The smell tests occurred in a small room with a video recorder mounted on one wall. A dog handler walked a single dog in a circle around a series of mesh covered bowls. The dog went around the full circle once, and then on the second go-round, stopped at specific bowls if they contained urine with prostate cancer odors.
The dogs are not any old mutts, said Dr. Taverna. They are very well-trained dogs who are also experts at detecting explosives. “They are Ferraris,” he explained, referring to the Italian high-performance cars.
 
They are Ferraris.
 
Two important questions remain.
First, what do the dogs actually smell? The answer to this is not known, Dr. Taverna said.
Second, how can a dog be used in daily clinical practice? He explained that an international center could be developed to train dogs, and then send them to other countries and medical centers.
An American urologist has a different vision. “Someone discovers what these organic compounds are and uses gas chromatography or the “electric nose” as a sensor to pick them up,” said press conference moderator Brian Stork, MD, from West Shore Urology in Muskegon, Wisconsin, who is a member of the AUA social media committee.
Electronic nose technology, first developed for the military to detect chemical warfare, analyzes odors.
In a recent proof-of-concept pilot study, one such device — the ChemPro 100 eNose (Environics) — detected prostate cancer from a urine sample with nearly 80% accuracy.
Electronic noses have also been shown to identify lung cancer with a high degree of accuracy, as reported by Medscape Medical News.
However, in commenting on the Italian study, Dr. Stork, who is a self-proclaimed dog lover, said that it would be “more beautiful” if dogs were used to detect prostate cancer.
Indeed, there is a growing body of literature on the ability of dogs to sniff out cancer. Previous studies have reported on dogs that can smell and detect lung and breast cancer from breath samples and colon cancer from stools, and there has been anecdotal evidence suggesting that dogs can detect melanoma and bladder and ovarian cancer.
There has been one other study of dogs sniffing out prostate cancer in 33 patients, according to AUA press materials.
The Italian researchers are studying the volatile organic compounds that are behind the odorous signature of prostate cancer.
Dr. Taverna and Dr. Stork have disclosed no relevant financial relationships.
American Urological Association (AUA) 2014 Annual Scientific Meeting: Abstract PD19-01. Presented May 19, 2014.

Further Evidence That Prostate-Specific Antigen Screening Reduces Prostate Cancer Mortality

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 …

10 Cancer Symptoms Men Shouldn’t Ignore

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

Selenium and Vitamin E Supplements May Increase Prostate Cancer Risk

Selenium and vitamin E supplements ‘increase prostate cancer risk”
Monday 24 February 2014 – 12am PST

A new study recently published in the Journal of the National Cancer Institute suggests that taking high doses of selenium and vitamin E supplements may increase the risk of prostate cancer, depending on a man’s selenium levels prior to taking the supplements.
The research team, including first author Dr. Alan Kristal of the Public Health Sciences Division of the Fred Hutchinson Cancer Research Center in Seattle, WA, analyzed 1,739 patients with prostate cancer and 3,117 matched controls from the Selenium and Vitamin E Cancer Prevention Trial (SELECT).
According to the investigators, previous research has suggested that men who already have an adequate intake of selenium would not benefit from supplements of the nutrient.
Therefore, the researchers took selenium measurements from the toenails of participants at the baseline of the study.
Selenium is a chemical element most commonly found in seafoods and organ meats, such as liver. Other food sources of selenium include muscle meats, cereals and dairy products.
The National Institutes of Health state that selenium is nutritionally essential for humans and plays roles in reproduction, thyroid hormone metabolism and DNA syntheses, as well as protects against oxidative damage and infection.
According to the Food and Nutrition Board, the recommended dietary allowance for both males and females aged 14 years and over is 55 mcg per day.
For the study, the researchers wanted to determine whether taking daily high doses of vitamin E (400 IU) and/or selenium (200 mcg) may reduce the risk of prostate cancer.
Vitamin E is a group of fat-soluble compounds that act as an antioxidant in the body. The vitamin is commonly found in foods such as nuts, seeds, vegetable oils, green leafy vegetables and fortified cereals.
Dietary supplements ‘not necessarily helpful or innocuous’SELECT began in 2001 and was scheduled to carry on for 12 years. But in 2008, the study was called to a halt on the grounds that no protective effects were found from selenium supplements and vitamin E supplements were thought to increase the risk of prostate cancer.
However, although the men stopped taking the supplements in 2008, the researchers continued following them in order to monitor their prostate cancer risk.
The findings revealed that men who had high selenium levels at the beginning of the study had a 91% increased risk of high-grade prostate cancer. According to the researchers, the levels of selenium for these men became toxic.
The investigators also found that for men with low selenium levels at the baseline of the study, vitamin E increased total prostate cancer risk by 63%, while high-grade prostate cancer risk increased by 111%.
“Many people think that dietary supplements are helpful or at the least innocuous. This is not true,” says Dr. Kristal.
“We know from several other studies that some high-dose dietary supplements – that is, supplements that provide far more than the daily recommended intakes of micronutrients – increase cancer risk.
We knew this based on randomized, controlled, double-blinded studies for folate and beta carotene, and now we know it for vitamin E and selenium.”
He adds that people taking vitamin E or selenium supplements should stop because there is no evidence that they produce any health benefits – only risks.
Dr. Kristal says that even standard multivitamins – which he says have yet to demonstrate any risk – could be harmful in high doses.
“Taking a broad view of the recent scientific studies, there is an emerging consistency about how we think about optimal intake of micronutrients,” he adds.
“There are optimal levels, and these are often the levels obtained from a healthful diet, but either below or above the levels there are risks.”
Of late, there have been many studies questioning the health benefits of vitamin supplements. Medical News Today recently reported on a study suggesting that vitamin C and E supplements may hinder athletes’ training, while other research suggests that multivitamins are a waste of money and have no health benefits.
Written by Honor Whiteman


Metro Urology on the Forefront of MRI Fusion Technology for Prostate Cancer

Invivo brings the power of MRI to the urology suite with the introduction of the UroNav Fusion Biopsy System – the next generation of prostate care.

Targeted MR/ultrasound biopsy is poised to become the new standard in prostate care. UroNav fuses pre-biopsy MR images of the prostate with ultrasound-guided biopsy images in real time, for excellent delineation of the prostate and suspicious lesions, as well as clear visualization of the biopsy needle.

UroNav fusion biopsy system from Invivo enables easy clinical use of this powerful MR/US fusion technique. It combines electromagnetic tracking and navigation with an onboard computer and a real-time imaging interface in one easy-to-use, mobile workstation.

The combination of UroNav with Invivo’s powerful MR image analysis system, DynaCAD for Prostate, creates a comprehensive, next-generation MR ultrasound solution for the detection and biopsy of suspicious prostate lesions. DynaCAD for Prostate provides the diagnostic MR information needed for the fusion biopsy by automatically transferring the relevant prostate images and lesion location data over your computer network for lesion identification and guidance during the TRUS biopsy procedure.

UroNav is designed to work the way you work. There is no need for complex mechanical devices or complicated, time-consuming set-up routines. UroNav’s simple, guided workflow follows the same TRUS biopsy procedure you are used to. UroNav is powerful, fast, and simple.
 

Features

Next step in Invivo’s Clinical Solutions for Prostate Oncology
Clinically validated and supported by several published studies
Based upon six (6) years of clinical R & D
More than 1000 men biopsied to date
Compatible with DynaCAD for Prostate
Simple, guided workflow
DICOM Compliant

Study Shows Robotic-Assisted Prostate Surgery Reduces Hospital Readmission and Complication Rates Compared to Open Surgery

….SUNNYVALE, Calif., Dec. 19, 2013 (GLOBE NEWSWIRE) — A national, multi-institutional database study found readmission and complication rates were significantly lower for robotic-assisted prostate surgery than for open prostate surgery.1 The full study results were published in the November 19 electronic edition of the Journal of Endourology.

“Readmissions for Medicare patients alone currently add $17.4 billion each year in health care spending,” said Lead Investigator Robert Nadler MD, Northwestern Medicine Vice Chair of Urology. “The findings from this study show that beyond the patient benefit, robotic-assisted surgery may be relevant to reducing health care costs as it results in reduced readmission rates compared to open surgery.”

This retrospective study used the National Surgical Quality Improvement (NSQIP) database to analyze data on patients who received a prostatectomy in 2011. A total of 5,471 patients and more than 400 hospitals were included in the study. Of those patients, 1,097 (20 percent) had an open procedure and 4,374 (80 percent) had a minimally invasive robotic-assisted procedure. No patients had a laparoscopic procedure.

Overall, the robotic-assisted group experienced significantly lower overall complication rates, surgical complication rates, and unplanned readmission rates. Although the operative time was significantly longer for the robotic-assisted group than for the open group, this did not result in higher complications during or after surgery. A full comparison between the two procedures showed:1

Robotic-assisted Prostatectomy(n=4374) versus Open Prostatectomy(n=1097)
Overall Complication Rate : 5.62% versus 23.25%
Surgical Complication Rate : 0.91% versus 3.37%
Unplanned Readmission Rate : 3.48% versus 5.47%
Operative Time : 212.3 minutes versus 174.0 minutes