Monday, December 21, 2009

In the News.... Coffee May Lower Risk of Aggressive Prostate Cancer

HOUSTON—Drinking regular or decaffeinated coffee is associated with a reduced risk of advanced prostate cancer, new research suggests.

“Coffee has effects on insulin and glucose metabolism as well as sex hormone levels, all of which play a role in prostate cancer,” said Kathryn M. Wilson, PhD, a postdoctoral fellow at the Channing Laboratory in Boston.

She and her colleagues found that men who drank the most coffee had a 59% decreased risk of either lethal or advanced prostate cancer compared with men who drank no coffee. The magnitude of risk reduction was more pronounced in men who never smoked; in this group, the biggest coffee consumers had an 89% decreased risk compared with men who did not drink coffee.

Dr. Wilson, who presented study findings at the American Association for Cancer Research Frontiers in Cancer Prevention Research Conference in Houston, said caffeine is not the key factor in this association.

The researchers analyzed data from men who participated in the Health Professionals' Follow-Up Study. They documented the regular and decaffeinated coffee intake of about 50,000 men every four years from 1986 to 2006. Prostate cancer developed in 4,975 men during this period.

“Very few lifestyle factors have been consistently associated with prostate cancer risk, especially with risk of aggressive disease, so it would be exciting if this association is confirmed in other studies,” Dr. Wilson said. “While it is too early to recommend increasing coffee intake based on this study alone, our results do suggest there is no reason to stop drinking coffee out of any concern about prostate cancer.”


Article Source

Tuesday, September 22, 2009

In Todays News: Robotic-assisted surgery speeds recovery from prostate removal

By Body and Mind staff
September 22, 2009, 12:00AM


Submitted photo: The da Vinci Surgical System uses a console with a magnified image of the operative field that allows doctors to see through small incisions in the skin.

Robotic-assisted surgery means fewer complications, a shorter hospital stay and quicker recovery for men with prostate cancer.

Using the da Vinci Surgical System, doctors can do a prostatectomy, or removal of a cancerous prostate gland, with greatly enhanced precision and a 3-D view of the patient's anatomy.

"The da Vinci allows us the ability to use articulation of the wrist, hands and fingers so that we're operating with the same finesse as with live, hands-on surgery but with a lot less blood loss," said Dr. R. Scott Owens, a urologist at Urology of Central Pennsylvania in Camp Hill. "The patient can go home in 24 to 48 hours and get back to normal activities in three to four weeks, rather than six to eight weeks."

A console that displays a magnified 3-D image of the operative field allows doctors to see depth and detail as they manipulate the instruments -- essentially a robotic hand and wrist -- through small incisions in the skin.

With colleague Dr. Christopher Moyer, Owens will be presenting "The Age of Robotic Surgery" on Sept. 28 at a prostate cancer awareness event at Holy Spirit Hospital.

For patients with localized prostate cancer, there are five options for treatment, Owens said. They are: surveillance, using the prostate-specific antigen (PSA) blood test; external radiation; insertion of radioactive seeds, or pellets, into the prostate; cryosurgery, which involves freezing the prostate to minus 40 degrees Celsius to kill normal and cancerous tissue; or radical prostatectomy.

Patients and their doctors decide on the best option depending on the patient's age, overall health status and grade or aggressiveness of the cancer, Owens said.

"Men who are good candidates for the da Vinci surgery are those under age 70 with localized prostate cancer and who have low, medium or high grade cancer," Owens said.

Incontinence and impotence are two complications of conventional open surgery that scare men away from it. With da Vinci, surgeons are beginning to see decreased incidence of those, making the decision to have surgery less intimidating, Owens said.

"If you're 50 and you have a higher grade cancer, you want that prostate out of there for a better chance of cure. With radiation, you never know, did it get all the cancer?" Owens said. "If you're 70, surgery has potentially higher risks and radiation is a safer alternative with less impact on quality of life."

Although both da Vinci and conventional laparoscopic surgery are minimally invasive because they use small incisions, da Vinci instruments allow doctors a much greater range of motion as they manipulate tissue.

Before da Vinci, most doctors were still doing open surgery involving large incisions because conventional laparoscopic surgery was so technically challenging, Owens said. Now, the da Vinci robotic surgery is used in about 70 percent to 80 percent of prostate cancer surgeries, he said.

In 2006, a Patriot-News report indicated da Vinci was used in about 25 percent of prostate removals nationwide.

Gynecologic and heart surgeries are also done using da Vinci, and it is likely to be used for many more types of surgery in the future, Owens said.

Holy Spirit Hospital, which purchased its da Vinci this summer, has the latest model with upgrades in technology and ergonomic improvements, he said.

Versions of the robotic surgical device, made by Intuitive Surgical, have been on the market since 1998. PinnacleHealth System acquired a da Vinci at Harrisburg Hospital in 2006 and has used it in prostate surgeries, according to The Patriot-News archives. Carlisle Regional Medical Center also offers surgery with the da Vinci.

Prostate cancer is the most common non-skin related cancer in American men and the second-leading cause of cancer death in men, according to the American Cancer Society.

Friday, August 28, 2009

Some Recent Prostate Cancer Support Happenings

Last Night Tennis Great John McEnroe talked with Sean Hannity on Fox TV's, The Hannity Show, about the prostate cancer awareness campaign he launched (Link to News Video).

McEnroe's website is Prostatecancerwatch.com

I had the pleasure of seeing Sean Hannity a week ago in Atlanta at the Freedom Concert and took a moment to drop him a line. I also wrote McEnroe to applaud his efforts (his father had prostate cancer) and in an effort to publicize our website and blog, to share that we maintain personal success stories at the site. I would love to find a way to share links and, of course, get some exposure of our website in an effort to educate. I asked if there is anything we can do together.

As we identify good sources of information regarding prostate cancer information, I want to post links and articles and more personal stories for our readers. Please feel free to reply to this blog entry to comment about any suggestions you may have to help us enhance what we do as a volunteer support group. Or, feel free to email me directly.

Ralph E. Jordan

Founder
Vipfriendsonline.com
Email: Rjordan@vipfriendsonline.com

Thursday, August 13, 2009

In Today's News: Dr. Vipul Patel on Robotic Surgery


Florida Hospital doctor an expert in robotic surgery to treat prostate cancer
Surgeon Vipul Patel's success is model for prostate-cancer surgery -
Fernando Quintero, Sentinel Staff Writer

August 13, 2009 - In the field of robotic prostate- cancer treatment, Florida Hospital surgeon Vipul Patel is a rock star.

Patel, who has performed the most robotic surgeries in the world, is an internationally recognized expert in a type of surgical procedure less invasive than traditional prostatectomies. Men who undergo the surgery are more likely to maintain their bladder control and sexual function.

Patel's patients are a very appreciative bunch.

Dunedin businessman Ralph Jordan is president of Patel's fan club. He was the doctor's first patient at Celebration Health, part of the Florida Hospital system. Jordan was so pleased with Patel's surgical skill and bedside manner that he started a Web site, vipfriendsonline.com. The site is filled with glowing testimonials from Jordan and other patients.

"It seems like when someone literally helps cure you of cancer, you feel this need to give back," said Jordan, 68.

Patel is largely the reason Florida Hospital's Cancer Center is one of five programs recently selected to participate in the Association of Community Cancer Centers' prostate-cancer best-practices project. Florida Hospital, where Patel is medical director of the Global Robotic Institute, will learn and share information about model prostate-cancer programs across the country.

"The need for education and support for prostate care is clearly unmet in many communities," said the association's executive director, Christian Downs.

The best-practices project, funded by Pfizer Inc. pharmaceuticals, is designed to help hospitals and other medical facilities across the country improve prostate-cancer care, Downs said.

More than 185,000 men developed prostate cancer, and nearly 29,000 died from the disease in 2005, according to the most recent data available from the Centers for Disease Control and Prevention. In Florida, there were 13,253 cases and 2,154 deaths.

Dexterous robot
Patel, who has performed more than 3,000 operations on men locally and worldwide, uses a robotic system called da Vinci to remove cancerous tumors. Seated at a console just a few feet from the operating table, Patel pushes a joystick and foot controls to remotely manipulate robotic arms at the bedside. One arm positions a three-dimensional, high-resolution camera, while the other two arms control tiny surgical instruments.

Patel said the robot can remove a cancerous prostate with less anesthesia, less blood loss and need for transfusion. More important, robot-assisted prostatectomies are less likely to cause nerve damage that can lead to permanent incontinence and impotence.

Patient outcomes are the best indicator of a model prostate-cancer care, Patel said.

"Best practices isn't just about the type of surgical option you use, it's about the type of physicians you select, it's the nursing care, it's the support you get from administration," he said, commenting on Florida Hospital's best-practices recognition. "They all combine to provide the best level of care."

Patel supports a multidisciplinary approach to prostate-cancer care in which patients not only visit with their surgeon, but they also are seen by a urologist, radiation specialist and medical oncologist.

"Men should have experts to inform them about their best treatment options, provide second opinions," Patel said. "Thinking that your only option is to have open surgery and lose your sexual function is not acceptable."

As for Jordan and his other devotees, Patel said they represent a growing trend among men diagnosed with prostate cancer.

"Prostate cancer is coming into its own in terms of the level of knowledge and the level of public awareness," Patel said. "Men are doing their homework and asking questions."

Did his research first
When Jordan was diagnosed with cancer in July 2007, a local urologist recommended he undergo a traditional radical prostatectomy right away.

"Thank God I knew enough to do a little research first," Jordan said.

He learned that there was a variety of treatment approaches. In addition to a radical prostatectomy, where the entire prostate gland and nearby lymph nodes are removed, some doctors employ radiation therapy.

A device like an X-ray machine is used, or radioactive pellets called "seeds" are injected into the prostate gland.

For slow-growing cancers, some doctors recommend simply monitoring the tumor.

Jordan learned his tumor was growing slowly, and that he had time to determine what was best for him. In his research, Patel's name kept popping up.

Jordan, whose company specializes in outsourcing specialized surgical personnel, also contacted the manufacturer of the robot Patel uses in his surgeries.

Again, Patel got rave reviews.

"When he actually called me at home one night to talk to me about my surgery, that sort of clinched it," Jordan said.

Willing to open up
Dr. Richard Reiling, an advisory member to the best-practices project and former president of the Association of Community Cancer Centers, applauds men such as Jordan for seeking out information and sharing it with other men.

"It used to be something men didn't talk about because it meant discussing things like incontinence, erectile dysfunction and that uncomfortable exam in your doctor's office," Reiling said. "But society is opening up. Men are more willing to talk about things men of my generation once thought were too personal."

Fernando Quintero can be reached at fquintero@orlandosentinel.com or 407-650-6333.

By the numbers
185,000 men developed prostate cancer.
29,000 died from the disease in 2005, according to the most recent data available from the Centers for Disease Control and Prevention.
13,253 cases in Florida.
2,154 deaths in Florida.

On the Controversy of PSA Testing - Comments Welcomed!

Recently, FOX News in Orlando, FL Reported on Reports that PSA Test Results (if elevated) may cause men to overreact unnecessarily and that elevated PSA rates may not be reliable. Here is a video interview with Dr. Patel and includes an interview with Ralph Jordan, Founder of VIP Friends Online. Comments Welcomed!


Wednesday, July 29, 2009

Post-Op Expectations about Sexual Function - Article Reprint

Post-radical prostatectomy expectations
about sexual function unrealistic

By Mac Overmyer

Patient education about post-surgical outcomes is necessary

Chicago
—A significant number of patients undergoing open or robotic radical prostatectomy have unrealistic expectations regarding postoperative sexual function, according to a study from Weill Cornell Medical College, New York.

The study, presented here at the AUA annual meeting, found that many patients were unaware that the prostatectomy would lead to an inability to ejaculate, and "almost none understood that there are documented orgasm changes or that radical prostatectomy may be associated with Peyronie's disease," the authors wrote.

"I think there are many patients who just have false expectations going into their prostate surgery," senior author John Mulhall, MD, who was an associate professor of urology at Weill Cornell at the time of the study, told Urology Times. "They think they are going to get back to the way they were before the operation. For a significant number of men, that is just not true. They are not going to ejaculate. There are patients who are going to have orgasmic dysfunction. There are penile length loss issues, and many appear to just not know that."

The researchers posed 11 questions to 336 patients, 216 of whom had undergone open radical prostatectomy and 120 who had undergone the robotic procedure. The procedures were performed by nine different referring urologists.

Only 10% of the open procedure patients and 12% of the robot-assisted laparoscopic prostatectomy (RALP) patients said they knew that their orgasms would be different after their respective procedures. While 70% of the open surgery patients and 60% of the RALP patients understood that they would not ejaculate (produce semen) following the operation, only 2% of the RALP patients seemed to know that the procedure carried the risk that pain might accompany orgasm or that orgasm might be accompanied by urine leakage.None of the RALP patients seemed to be aware of these possible sequelae, and neither group knew that Peyronie's disease was also a potential risk of the procedure.

"What we need to do is develop a structured discussion for patients prior to treatment. We need to document that the discussion has occurred, and the patients need to be given educational material that comprehensively addresses the different and often transient sexual side effects," said Dr. Mulhall, who is currently director of the male sexual and reproductive medicine program at Memorial Sloan-Kettering Cancer Center in New York.

The study also found curious differences in responses between those undergoing the open and robotic procedures. The average open procedure patient anticipated that he would return to full sexual function in 12 months. The average RALP patient thought he would return to full function in 6 months. Half (50%) of the open patients thought they would have full recovery compared to 75% of the RALP patients. Only 20% of the open patients were aware of the potential need for intercavernosal injections to achieve erections, while only 4% of the RALP patients were aware of it.

The study was designed to establish parameters for patients' understanding of prostatectomy outcomes. It was not designed to determine the origins of their knowledge or their ignorance.

Dr. Mulhall said a number of factors might have contributed to the data. The patients may not have been adequately informed. They may have acquired misinformation about treatment outcomes from Internet sites that promote success and downplay potential adverse outcomes. They may have focused their thinking on the cancer and its treatment, and neglected consideration of treatment outcomes.

"The message, however, is clear. Patients end up after surgery not understanding what might happen to them. We should be making a structured and concerted effort to ensure these patients know what to expect," Dr. Mulhall said.


Reprinted from:
http://www.modernmedicine.com/modernmedicine/Modern+Medicine+Now/Post-radical-prostatectomy-expectations-about-sexu/ArticleStandard/Article/detail/614300?contextCategoryId=40184

In the News - Good Survivor Rates for Prostate Cancer

"A study of almost 13,000 American men who had a radical prostatectomy -- surgical removal of a cancerous prostate gland -- between 1987 and 2005 found that only 12% of them died of the cancer, according to the report in the July 27 issue of the Journal of Clinical Oncology."



Men Who Have Prostate Cancer Surgery Do Well
By Ed Edelson
HealthDay Reporter
Source: http://www.medicinenet.com


MONDAY, July 27 (HealthDay News) -- A major study has good news for men who have prostate cancer surgery but leaves unanswered the complicated question of whether a man should have that operation, another treatment or just watchful waiting.

The study of almost 13,000 American men who had a radical prostatectomy -- surgical removal of a cancerous prostate gland -- between 1987 and 2005 found that only 12% of them died of the cancer, according to the report in the July 27 issue of the Journal of Clinical Oncology.

"Patients with what we thought of as high-risk prostate cancer had a much lower risk of dying of their cancers than we ever thought," said Dr. Peter T. Scardino, chairman of the department of surgery at Memorial Sloan-Kettering Cancer Center, and a member of the research team. "Patients with more favorable prostate cancers did remarkably well, so well that you have to begin to question whether they should have been treated."

The choice of surgery, radiation therapy or watchful waiting must be made each year for more than 190,000 American men, most middle-aged or older, who are diagnosed with prostate cancer. Most choose some kind of treatment, said Dr. Andrew Stephenson, head of urological oncology at the Cleveland Clinic's Glickman Urological and Kidney Institute, and another member of the research team. From 40% to 50% choose surgery, about 10% choose watchful waiting, and the rest choose some form of radiation therapy, Stephenson said.

For men who have surgery, the new research has produced a tool that can allow them to predict their chance of survival for at least 15 years, Scardino said. Survival is measured by essentially three elements: the clinical stage of the cancer when it is detected, determined in great part by how large it is; the Gleason score, a measure of how much of its normal structure the prostate gland has lost; and blood levels of prostate-specific antigen, a protein produced by the gland.

The study found that the score had an accuracy of 82% in predicting 15-year survival, Scardino said. "If you could predict what would happen in the stock market in the next 15 years with 82% accuracy, you would be a genius," he said.

Overall, there was a greater chance that a man in the study would die of a cause other than prostate cancer. The rate of death from other causes was 38%, compared to 12% attributed to prostate cancer.

The new predictive method will be made public soon, after medical review, so that physicians and men can learn about their anticipated survival after surgery, Scardino said.

"Any person can look at it and put in the numbers," he said.

The new predictive tool is an improvement over the existing method, which relies essentially on readings of prostate-specific antigen levels, Stephenson said.

But no such predictive method exists for newly diagnosed men who must chose between treatment and watchful waiting, and so the study presents a predicament for those men and their physicians, he said.

"It questions the lethality of prostate cancer," Stephenson said. "Perhaps a similarly low risk might have been seen if the men did not have prostatectomy. We can't say whether a cancer poses enough of a threat to the patient so that therapy is needed."

Prostate cancer surgery is not free of problems, Stephenson said. Its major side effects are incontinence and loss of sexual function.

Many prostate cancers grow slowly -- so slowly that an old medical byword is that "more men die with their prostate cancer than of it." No existing method can single out the cancers that will be fatal if left untreated.

"We really need better tools for really identifying prostate cancers that pose a threat to longevity," Stephenson said. "Many have been proposed. All are being investigated, and hopefully in the future we will have better tools that accurately predict the risk of dying from prostate cancer."

Until those tools are available, the question is often "a balance between quantity and quality of life," he added. "That is a very complicated decision that must take many factors into consideration."

SOURCES: Peter T. Scardino, M.D., chairman, department of surgery, Memorial Sloan-Kettering Cancer Center, New York City; Andrew Stephenson, M.D., head, urological oncology, Cleveland Clinic Glickman Urological and Kidney Institute, Ohio; July 27, 2009, Journal of Clinical Oncology, online

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