Why Prostate Cancer Screening Is So Tricky : Shots – Health News : NPR

26 02 2013

Why Prostate Cancer Screening Is So Tricky : Shots – Health News : NPR.





Know Your Stats!

31 01 2013

Great resource for “all things prostate”.  Check it out!

via Know Your Stats || Resources.





Post prostatectomy Radiation, Does it Help?

10 01 2013

Adjuvant (post operative) Radiotherapy for High-Risk Prostate Cancer

At median follow-up of 10.6 years, postoperative radiotherapy improved biochemical progression-free survival (PSA undetectable), but not clinical disease progression.

The goal of adjuvant radiotherapy after radical prostatectomy is to sterilize the prostatic bed and, in selected settings, regional nodes to decrease the potential for local recurrence and, ultimately, reduce the systemic spread of the disease and improve survival. Recent randomized trials have shown that in patients with T3 disease or positive surgical margins, postoperative radiotherapy to the surgical bed improves local control and biochemical (prostate-specific antigen) progression-free survival (PFS).

One of these trials, by the Southwest Oncology Group (SWOG), demonstrated that adjuvant radiotherapy versus observation significantly reduced risk for distant metastases and improved overall survival (J Urol 2009; 181:956). However, another one, by the European Organisation for Research and Treatment of Cancer (EORTC) did not show such an overall survival benefit. The EORTC study reported results after a median 5-year follow-up of 1005 patients (age, ≤75) with pathologic stage PT2-3,N0 and at least one of the following risk factors: positive surgical margins, capsular perforation, or seminal vesicle invasion (Lancet 2005; 366:572).

Now, after a median 10.6 years of follow-up, the EORTC investigators report that patients who received adjuvant radiotherapy versus observation continued to achieve improved biochemical PFS (the primary end point) with similar severe late toxicity. Patients who received radiotherapy also achieved improved local–regional control and were less likely to receive subsequent hormonal treatment. However, no intergroup differences were observed in either overall survival or distant metastases, and the initial observation of a significant improvement in clinical disease progression was not maintained. Patients with pT3 disease and positive surgical margins achieved the greatest benefit from adjuvant radiotherapy.

Comment: The discordant findings of the EORTC and SWOG studies on overall survival continue to be the subject of debate, and the larger clinical issue regarding the role of immediate adjuvant radiotherapy versus salvage radiotherapy was not addressed, though it is the subject of ongoing clinical trials. As noted by editorialists, the EORTC trial showed that adjuvant radiotherapy resulted in acceptable long-term morbidity and quality of life as well as reduced the use of subsequent androgen deprivation therapy (ADT) by half, although the timing and clinical setting in which ADT is administered remains controversial.

 Robert Dreicer, MD, MS, FACP

Published in Journal Watch Oncology and Hematology November 13, 2012

CITATION:

Bolla M et al. Postoperative radiotherapy after radical prostatectomy for high-risk prostate cancer: Long-term results of a randomised controlled trial (EORTC trial 22911). Lancet 2012 Oct 19; [e-pub ahead of print]. [PubMed® abstract]





Precancerous Lesions of the Prostate

7 01 2013

Precancerous Lesions of the Prostate.

Not all prostate biopsies are negative.  Not all are positive.  Some are “in between.”  High Grade PIN is a lesion noted in about 15% of biopsies that, from a cellular architecture, is benign.  It does, however, require close follow up, and in more involved cases, repeat biopsy.  The link above provides a comprehensive overview.





Prostate Cancer – Do Your Homework!

7 12 2012

Being newly diagnosed with prostate cancer can be overwhelming.   Immediate thoughts of our own mortality can overcome us.  The fact is that 1 in 6 men in their lifetime will get this news, and there are many very successful treatments.  I encourage all my patients to educate themselves with the many resources  available  and so that together, we may make an educated treatment decision.  There are a lot of myths and stigmata out there surrounding different treatment options.  Below is a list of several reputable websites which I routinely refer my patients to so they may study their condition.

NCCN Guidelines:

http://www.nccn.com/files/cancer-guidelines/prostate/index.html#/1/

The NCCN Guidelines are the most comprehensive and most frequently updated clinical practice guidelines available in any area of medicine. These guidelines provide information that many doctors follow to make sure their decisions for people with cancer are well informed. The NCCN Guidelines are developed by 43 different NCCN Guidelines Panels composed of nearly 900 world-leading experts from each of the NCCN Member Institutions. Cancer is treated by teams of doctors and other health professionals who work together to diagnose and treat cancer. NCCN Guidelines Panels are multidisciplinary, which means they include experts in different fields reflecting the way cancer is treated. These fields include medical oncology, surgical oncology, radiation oncology, pathology, radiology, nursing, and social work. Recommendations in the NCCN Guidelines are based on evaluation of evidence from clinical trials that are published in the medical literature. Most of the panel members who develop the NCCN Guidelines perform both clinical research and treat people with cancer. 1

US National Library of Medicine

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004906/pdf/consprostate.pdf

The U.S. National Library of medicine (NLM) is the world’s largest medical library. It has millions of books and journals about all aspects of medicine and health care on its shelves. Its electronic services deliver trillions of bytes of data to millions of users every day.  This is a plain english guide to understanding the disease process and treatment options.

Urology Care Foundation

http://www.urologyhealth.org/urology/index.cfm?article=146

This is the American Urological Association’s official patient resource website.

 

Intuitive Surgical

http://www.davinciprostatectomy.com

Makers of the da Vinci Robotic Surgical system.  This is the standard of care for surgical removal of the prostate.  We have extensive experience with this technology, and firmly believe in it’s merits.

 

1.  NCCN.org





AUA issues new guidelines for Asymptomatic Microscopic Hematuria

29 10 2012

http://wp.me/p2rYp6-G





Saw palmetto seems safe in men with urinary problems | Reuters

23 10 2012

Recent study in the Journal of Urology shows that Saw Palmetto is safe but not effective.  Don’t spend a lot of money!

Saw palmetto seems safe in men with urinary problems | Reuters.





Know Your Stats || Home

24 09 2012

September is Prostate Cancer Awareness month.  Check out this link:

Know Your Stats || Home.





Actos and Bladder Cancer

14 08 2012

I get a lot of questions about this. Here is a link to a recent study which shows an increase in relative risk in those on Actos

http://www.epocrates.com/dacc/1207/pioglitazonebladdercancerBMJ1207.pdf

Conclusion: Those with Type 2 DM have an increased risk if taking Actos.





Stress incontinence and the differences in mesh

30 07 2012

Here are some FAQ’s on slings and the recent mesh issues used for pelvic organ prolapse.

WHAT IS STRESS URINARY INCONTINENCE (SUI)?
Q: What is Stress Urinary Incontinence and is it a common problem?

A: Stress Urinary Incontinence (SUI) is an involuntary loss of urine that occurs during physical activity, such as coughing, sneezing, laughing, or exercise. Approximately 1 out of 3 women over the age of 45, and 1 out of every 2 women over 65 have SUI. In fact, in 2010, there were 211,000 women who had some type of surgery for SUI.1

TREATMENT OPTIONS FOR SUI.
Q: What is a SLING for Stress Urinary Continence? And, how is it used?

A: It is a small strip or sling of a very soft and flexible synthetic material. A SLING becomes integrated in your tissues and forms a “hammock of support” under your urethra (tube where one urinates through) to support it when necessary. SLINGS have been developed by biomedical engineers and clinical researchers to be compatible with your tissues.

A SLING is usually about 0.6 inches wide and can vary in length depending on the approach from 3.4 inches to longer depending on the product used and your anatomy.2

Ask your physician for clinical study information on the SLING he or she recommends for you.

Q: What alternative procedures exist for Bladder Leakage?

A: Depending on the severity of your symptoms, your surgeon may recommend Pelvic Floor Training, sur- gical procedures such as fascial slings, minimally invasive SLING procedures, suspension procedures using other materials or sutures, or bulking agents.

Q: How do I know if a SLING is a good option for me?

A: This is a decision that should be made by you in consultation with your surgeon. You should discuss with your surgeon all of your options and which treatment plan is most appropriate for your specific medical situation. This is a personal choice that your surgeon is ready to discuss with you.

For moderate to severe BLADDER LEAKAGE primarily caused at time of exertion, of all of the techniques available, the synthetic mid urethral SLINGS have been shown to be the most effective treatment.3

Q: How is a SLING for Bladder Leakage placed?

A: The procedure can be performed on an outpatient basis under local anesthesia with IV sedation. A small vaginal incision of about 1.5 cm is made. Small instruments are passed to place the tension free mesh. No stitches are used to attach a tension-free sling to the tissue. Instead, tissue itself holds the sling in place initially. Eventually scar tissue forms in and around the SLING to keep it from moving. As with any medical procedure, complications from the surgery can occur.

Q: How long is the SLING surgery?

A: In most cases, the surgery should last less than 30 minutes4 and if your surgeon recommends, the procedure can be done under local anesthesia with IV sedation. SLING procedures are frequently outpatient procedures, in which case you may be returning home the same day of surgery. Many times, the SLING is part of another procedure and you may need additional surgery to support a dropped bladder, uterus or rectum. Your surgeon will discuss this with you.

What can I expect during recovery?

Every patient’s recovery experience is unique and you should consult your physician as to what he or she expects in your case. After undergoing a SLING surgery, you may feel sore for a short period of time. Please consult with your surgeon on activities to avoid during recovery to achieve optimal outcomes.

What complications can occur with the use of SLINGS?

Your surgeon will explain the risks and benefits associated with vaginal mesh placement. Vaginal mesh placement can result in problems such as exposure (small amount of the SLING material exposed into the vagina), infection, irritation or inflammation. These problems can often be treated by your surgeon in his or her office as an outpatient procedure. More serious complications such as pain, infection, bleeding, organ perforation, urinary problems (such as urinary tract obstruction, retention, worsening incontinence or overactive bladder symptoms), erosion of the SLING through the urethra (tube you urinate through), or surrounding organs, migration or fistula formation can occur. These responses may require additional intervention by your surgeon or may require removal of all or part of the mesh.

Will a SLING cure my incontinence symptoms with 100% certainty? And, if the SLING does not work, can I still have a different procedures?

There is no surgery for incontinence that has a 100% cure rate, but SLINGS for Bladder Leakage have been studied since the mid-90’s and have shown to have high success rates of 80-95%.5 Other incontinence procedures are possible after SLING placement. If necessary, inform your surgeon about having a SLING when considering additional treatment options.

What is a suspension procedure?

For this procedure, an incision is made in your lower abdomen. Your surgeon then places stitches in the tissue near the bladder neck and secures the stitches to a ligament near your pubic bone (Burch procedure) or in the cartilage of the pubic bone itself (Marshall-Marchetti-Krantz procedure). This procedure involves an abdominal incision. It’s done under general or spinal anesthesia.

RECENT COMMUNICATIONS FROM THE FDA.

Q: What is a Public Health Notification?

A: A Public Health Notification is an important message from the FDA’s Center for Devices and Radiological Health to the health care community describing a risk associated with the use of a medical device and providing recommendations on its use.

Q: What did the FDA say in its October 20, 2008 Public Health Notice?

A: On October 20, 2008, the FDA issued a Public Health Notification (PHN) regarding potential complications associated with transvaginal placement of surgical mesh to treat pelvic organ prolapse (POP) and stress urinary incontinence (SUI). The PHN provided recommendations and encouraged physicians to seek specialized training in mesh procedures, to advise their patients about the risks associated with these procedures and to be diligent in diagnosing and reporting complications.

What has happened since the 2008 PHN?

In July 2011, the FDA issued an update to the October 2008 PHN. In this update, the FDA maintained that adverse events for POP mesh repair are not rare, as previously reported, and questioned the relative effectiveness of transvaginal mesh as a treatment for POP as compared to non-mesh surgical repair. Although the PHN made mention of mesh for use in SUI repair, the FDA did not address this SUI treatment approach and communicated that further evaluation would be required prior to releasing any statement in that regard.6 The July 2011 notification continued

to encourage physicians to seek specialized training in mesh procedures, to consider and to advise their patients about the risks associated with these procedures and to be diligent in diagnosing and reporting complications.

On September 8-9, 2011, the FDA convened an Obstetrics and Gynecology Devices Panel of the Medical Devices Advisory Committee to further address the safety and effectiveness of transvaginal surgical mesh used for repair of POP. The panel examined the use of transvaginal surgical mesh products to treat both pelvic organ prolapse (POP) and stress urinary incontinence (SUI).

The panel recommended to the FDA that slings for the treatment of SUI are properly classified by the FDA with respect to risks and benefits offered. Regarding retropubic and TOT slings, the panel concluded that no additional post-market surveillance studies are necessary. Regarding mini-slings, the panel recommended pre-market studies for new devices and additional post-market studies.

Are SLINGS FDA cleared for use to restore Bladder Leakage?

Yes. There are different treatment options to restore continence. For Stress Urinary Incontinence (or BLADDER LEAKAGE), when conservative treatments are not helping, considering a SLING may be a good option. A SLING is considered one of the primary treatment options if alternative treatments fail7 and considered by many physicians to be the ‘Standard of Care’ or ‘gold standard procedure’8 for Bladder Leakage. This is so especially if you leak primarily with exertion such as coughing, laughing, exercising or sneezing etc. SLINGS have been studied since the mid-90’s and have shown to have high success rates of 80-95%.5, 9, 10, 11, 12 Of the two major types of SLINGS (retropubic and transobturator), equivalency in success rates has been shown for both approaches with relatively low complication rates.13 In addition, another version called “MiniSlings” was introduced in 2007. They show efficacy and minimal complications similar to transobturator SLINGS but with shorter outcome data.14

Has the FDA recalled SLINGS?

No, the FDA has not recalled SLINGS.

I have a SLING (SURGICAL MESH) implanted for Bladder Leakage. Should I have it removed?

As with all important medical decisions, you should consult with your physician. There is no need to remove your SLING if you are satisfied with your surgery and are not having complications or symptoms. Because a SLING integrates in your own tissues, removal may cause complications or symptoms. The FDA recommends you continue with your annual and other routine check-ups and follow-up care. Patients should notify the surgeon if complications develop (persistent vaginal bleeding or discharge, pelvic or groin pain during sex).

REMEMBER

While you’re considering your treatment options, empower yourself and make an informed decision. This is a personal choice that your surgeon is ready to discuss with you, and plan for. Knowing your options can reduce your fear and strengthen your decision. Once you have read this information, consider visiting NAFC.org for additional information and be sure to consult with your surgeon to determine what option is right for you.

  1.  US markets for Urological Devices. Millennium. Oct 2010. Report US31UR10
  2. 12  AMS data on file
  3. 13  Urinary Incontinence PocketGuide, American Urogynecologic Society (2010): In Women (PocketGuides (International Guidelines Center))
  4. 14  Barry C et al. (2007) A Multi Center Randomised Clinical Control Trial Comparing the Retropubic (RP) Approach Versus the Transobturator Approach (TO) for Tension-Free, suburethral sling Treatment of Urodynamuc Stress Incontinence: The TORP Study. Int Urogynecol J 19:171-8
  5. 15  Primus G (2006) One year follow-up on the SPARC sling system for the treatment of female urodynamic stress incontinence. Int J Urol 13: 1410-1414
  6. 16  The FDA Public Health Notification (2011)
  7. 17  Thuroff J et al. (2010) EAU Guidelines on Urinary Incontinence. Eur Urol 59:387-400
  8. 18  Botros S et al. (2007) Detrusor Overactivity and Urge Urinary Incontinence Following Trans Obturator Versus Midurethral Slings. Neurourology and Urodynamics 26:42-45
    Nygaard I. (2007) Marketed vaginal mesh kits: rampant experimentation or improved quality of care? Int Urogynecol J 18:483–484
  9. 19  Andonian S et al. (2005) Randomized clinical trial comparing suprapubic arch sling (SPARC) and tension-free vaginal tape (TVT): one-year results. Eur Urol 47: 537-541
  1. 10  Dalpiaz O et al. (2006) SPARC sling system for treatment of female stress urinary incontinence in the elderly. Eur Urol 50: 826-830
  2. 11  Davila G et al. (2006) Multicenter experience with the Monarc transobturator sling system to treat stress urinary incontinence. Int Urogynecol J 17:460-465
  3. 12  Tseng LH et al. (2005) Randomized comparison of suprapubic arc sling procedure vs tension-free vaginal taping for stress incontinent women. Int Urogynecol J Pelvic Floor Dysfunct 16: 230-235
  4. 13  Richter et al. (2010) Retropubic versus Transobturator Midurethral Slings for Stress Incontinence. N Engl J Med 362:2066-2076
  5. 14  De Ridder D et al. (2010) Single incision mini-sling versus a transobutaror sling: a comparative study on MiniArcTM and MonarcTM slings. Int Urogyn Journal 21:773-8

2011 American Medical Systems, Inc. All rights reserved. 1004446r1 (11/11)