Prostate News Forum

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Study shows that consumption of walnuts can slow prostate cancer in addition to being good for your heart.  New research studies will explore the possibility of preventing prostate cancer by eating certain types of nuts.  The mice in the study only consumed an equivalent of 500 calories worth of nuts.  So why not add a few servings on nuts to your diet - you have very little to lose and allot to gain.  

Walnuts slow prostate cancer growth

March 27th, 2010

UC Davis researchers tested these nuts on prostate cancer after walnuts proved beneficial to the heart

SAN FRANCISCO A new study suggests that mice with prostate tumors should say “nuts to cancer.” Paul Davis of the University of California, Davis, hopes follow-up data by his team and others will one day justify men saying the same.

For years, this nutritionist had been studying heart benefits of walnuts. Most nuts – in sensible quantities – can benefit the heart. But among walnuts’ special attributes were their ability to fight inflammation, an underlying cause of much heart disease, and to allow vessels to dilate as needed, which should limit unhealthy blood pressure hikes. But inflammation plays a role in many cancers. And Davis notes that walnuts can tinker with production of endothelin, a protein not only related to blood pressure control but also to helping regulate prostate growth.

So Davis and his colleagues decided to test walnuts in a mouse model of prostate cancer.

The line of rodents they used are genetically programmed to spontaneously develop prostate cancer. When fed what is for mice a normal quantity of fat – five percent of calories – the tumors grow slowly.  But bump the fat content of their diet up to a whopping 20 percent of calories and tumor growth mushrooms. Except if that 20 percent of fat calories comes from walnuts, Davis reported this week at the American Chemical Society spring national meeting.

Mice getting the high-fat walnut diets developed the same type of tumors seen in all animals from this cancer-prone strain. Their cancer just grew slowly, similar to the rate seen in animals downing a low-fat diet.

The researchers began supplementing the diet of some 8-week-old rodents with ground up walnuts. The rest got low- or high-fat diets where the source of that fat came from soybean oil. In all other respects, the animals dined on similar chow.

But 18-weeks into the feeding trial, those in the walnut group were exhibiting a tumor mass 30 to 40 percent smaller than in animals on the high fat diet. Six weeks after that, at the end of the experiment, the walnut group was still trending toward having a somewhat reduced tumor mass, relative to the high-soy-oil group, although the difference was no longer statistically significant, Davis reported.

He notes that “We saw reductions in several different mediators [of cancer growth] that are present in the bloodstream.” He was referring to insulinlike growth factor-1, or IGF-1, and tissue plasminogen activator – “both of which, when they’re high, are bad prognostic indicators of prostate cancer.” Indeed, he said, the reduction in these chemicals correlated with the lower prostate-tumor growth in the walnut-supplemented animals.

Davis’ group also used molecular probes to see if they could uncover biochemical signatures differentiating prostate tissues in the two high-fat groups. This gene-chip technology identifies which genes are turned on or off. And comparisons of the two groups turned up a host of differences that the scientists are now poring over. One characteristic change that has already emerged is a reduction of gene activity for IGF-1 in the walnut-supplemented mice.

When asked what constituents of walnuts might be slowing tumor growth, Davis said “I suspect it’s a combination of things.” He pointed to the omega-3 fatty acids, such as alpha linolenic acid, together with minerals, other trace nutrients – perhaps even some of the proteins. Other nuts might also prove beneficial, he allowed, but he has no plan to study them since he’s funded through the University of California by the state's Walnut Board.

How many walnuts would a man have to consume for his intake to be roughly equivalent to what the mice downed? About 500 calories worth, Davis says – the energy content in a “MacDonald’s big fries.” Studies by others have indicated that additional foods might also fight prostate cancer, including tomatoes, pomegranates,selenium-rich foods and tea. “And I heard through the grapevine,” Davis adds, “that pistachios are being examined [for preventing prostate cancer.”

When someone asked Davis if he would recommend walnuts to men concerned about prostate cancer, he said “I don’t think it will do any harm.”

But remember not to expect a cure. At best, just a slowing in the growth of any cancers. And achieving that could be great, he noted, since most men will – if they live long enough – eventually develop prostate cancer. The goal, he says, is to find foods that might help ensure that when it comes to this malignancy, men “die with it, not of it.”

 By Janet Raloff

 

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A large international study reported in the New England Journal of Medicine found that dutasteride (marketed as Avodart® by GlaxoSmithKline), a drug currently prescribed to treat  benign enlarged prostates, significantly reduced the chances that certain high risk men would be diagnosed with prostate cancer.  Avodart was also noted to improve the accuracy of a PSA test in detecting prostate cancer.  As Avodart is known to reduce PSA levels by as much as half any increase in a patient’s PSA levels may indicate an increased chance of prostate cancer.

Drug reduces risk of prostate cancer diagnosis in high-risk men

Washington University in St Louis News: April 1, 2010

A drug already prescribed to shrink benign, enlarged prostates has been shown to reduce the risk of a prostate cancer diagnosis by 23 percent in men with an increased risk of the disease, a large international trial has found. Results are reported April 1 in the New England Journal of Medicine.

The four-year study found that dutasteride (Avodart®) significantly reduced the chances that men would be diagnosed with the tumors that are most often treated excessively: those that fall in the mid-range of aggressiveness. These tumors, which account for the majority of all prostate cancers, grow unpredictably. This uncertainty leads many men to opt for surgery or radiation therapy — treatments that can lead to incontinence and impotence.

“Dutasteride may potentially offer many thousands of men a way to reduce their risk of being diagnosed with prostate cancer,” says the study’s lead author Gerald Andriole, MD, the Robert Killian Royce, MD, Distinguished Professor and chief of urologic surgery at Washington University School of Medicine in St. Louis. “This means more men could avoid unnecessary treatment for prostate cancer along with the costs and harmful side effects that can occur with treatment.”

Lowering prostate cancer risk   A new study finds that dutasteride significantly reduces the chances that men at high risk of prostate cancer will be diagnosed with the kinds of tumors that are most often treated excessively: those that fall in the mid-range of aggressiveness. These tumors account for the majority of all prostate cancers and grow unpredictably. This uncertainty leads many men to opt for surgery or radiation therapy - treatments that can lead to incontinence and impotence.

Andriole chaired the steering committee that oversaw the trial, known as REDUCE (Reduction by Dutasteride of Prostate Cancer Events), which was conducted at 250 sites in 42 countries. It is the first to evaluate chemoprevention for prostate cancer in men at increased risk of disease. The study was funded by GlaxoSmithKline, the manufacturer of Avodart®.

The trial involved 8,231 men ages 50-75 who were randomly assigned to receive a placebo or a daily 0.5 mg dose of dutasteride, a drug that is known to shrink the prostate. Men in the study were considered to be at increased risk for prostate cancer because they had elevated PSA levels (2.5 ng/ml–10 ng/ml) but no evidence of cancer on biopsies performed within six months of enrolling in the trial.

“Many men every year are in the situation of having elevated PSA levels but a negative biopsy,” Andriole says. “We know from experience that many of these men are likely to have microscopic prostate tumors that were missed by their original biopsy.”

The investigators performed scheduled biopsies on the men two years after they enrolled in the study and again after four years. Overall, 659 men (19.9 percent) taking dutasteride were diagnosed with prostate cancer, compared with 858 men (25.1 percent) taking a placebo. None of the men in the study died of prostate cancer.

Among men with a family history of prostate cancer, the drug reduced the relative risk of a prostate cancer diagnosis by 31.4 percent.

“The most likely explanation for the study’s results is that dutasteride is keeping tumors small or even shrinking them to the point that they are unlikely to be detected by a biopsy,” says Andriole, who also is chief of urologic surgery at Barnes-Jewish Hospital and the Siteman Cancer Center.

Dutasteride was most effective at reducing the risk of medium-grade tumors, defined as 5-6 on the Gleason scale. The Gleason scoring system measures tumor aggressiveness based on biopsy results and can range from 1-10, with 10 being the most aggressive. Over the study’s four years, 70 percent of all men diagnosed with prostate cancer had Gleason 5-6 tumors, roughly the same percentage doctors see in clinical practice. These included 617 men (18.1 percent) taking a placebo and 437 men (13.2 percent) taking dutasteride, a statistically significant difference.

Dutasteride was approved by the U.S. Food and Drug Administration in 2001 for the treatment of benign prostatic hyperplasia (BPH). The condition causes frequent urination that is difficult or painful because the swollen prostate gland blocks urine flow. Dutasteride is not approved for prostate cancer prevention.

The investigators found no significant increase in aggressive, high-grade tumors (defined as a Gleason score 7-10) among men who took dutasteride over four years. There were 220 men (6.7 percent) on dutasteride with aggressive, high-grade tumors, compared with 233 men (6.8 percent) on a placebo. However, they noted a disparity in the most aggressive tumors (defined as a Gleason score 8-10) among men taking dutasteride in Years 3 and 4 of the study: 12 such tumors were detected in the dutasteride group versus one in the placebo group.

The study was designed so that men were withdrawn after they had a positive tumor biopsy.

“But it’s likely that if the men in the placebo group who were diagnosed with Gleason score 5-7 tumors in Years 1 and 2 had remained in the study and been biopsied again, some of their tumors likely would have been upgraded to a Gleason 8-10 in study Years 3 and 4,” Andriole says. “This so-called tumor upgrading has been observed in other studies.”

Moreover, he says, it is well recognized that Gleason scores based on biopsies are more accurate in men on dutasteride or the similar BPH drug finasteride (Proscar®), who have smaller prostates, than in men with larger, growing prostates, where a needle biopsy is more likely to miss a tumor and to underestimate the true Gleason score.

The observation regarding high-grade tumors parallels that in the earlier Prostate Cancer Prevention Trial, which evaluated finasteride in men with no increased risk of the disease. While finasteride was found to lower overall prostate cancer risk, there were more aggressive tumors detected by biopsies in men taking that drug. Later analyses adjusting for prostate size at the time biopsies were performed showed no increase in high-grade tumors.

When researchers in the current study accounted for prostate size at the time of biopsy, their analysis (published in supplementary materials to the NEJM article) also indicated fewer aggressive cancers among men receiving dutasteride. Despite these considerations, the investigators could not completely rule out that some of the most aggressive tumors were due, in part, to the drug.

Like finasteride in the Prostate Cancer Prevention Trial, dutasteride also improved the accuracy of the PSA test to detect prostate cancer, particularly when tumors are aggressive, Andriole and his colleagues noted in unpublished results. Dutasteride is known to reduce PSA levels by 50 percent.

“If PSA levels started to rise even slightly in a man taking dutasteride, he had an increased chance of being diagnosed with prostate cancer, compared with men in the placebo group who tended to have PSA levels that naturally fluctuated,” he said.

Dutasteride blocks two forms of the enzyme 5-alpha reductase, which converts the hormone testosterone into dihydrotestosterone. In contrast, finasteride inhibits only one form of the enzyme. Dihydrotestosterone is known to drive benign prostate growth and the development of prostate cancer.

Last year, both the American Society of Clinical Oncology and the American Urological Association issued guidelines suggesting that healthy older men who already are taking a 5-alpha reductase inhibitor for BPH or undergoing regular prostate cancer screening tests discuss with their doctors long-term use of the drug for prostate cancer prevention.

The REDUCE investigators also found that dutasteride reduced the risk of urinary retention, urinary tract infection and the need for surgery to alleviate BPH compared with the placebo.

The two most common side effects associated with dutasteride were low rates of erectile dysfunction and decreased libido, which are consistent with earlier studies of the drug.

While rare, the investigators also noted more occurrences of cardiac failure among men taking dutasteride compared with those taking a placebo. Thirty (0.7 percent) men on dutasteride and 16 (0.4 percent) men on a placebo received a diagnosis of cardiac failure. There was no significant difference between the two groups in the occurrence of or deaths from cardiovascular problems.

Supplemental data to the NEJM article indicated that cardiac failure was more likely to occur in men taking both alpha blockers and dutasteride. Alpha-blockers are used to treat a range of conditions, including high blood pressure and BPH.

Among U.S. men, prostate cancer is the second most deadly cancer after lung cancer. About 192,000 cases are diagnosed annually and some 27,300 die of the disease, according to the American Cancer Society.

By Caroline Arbanas

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Editor’s note: Andriole is a consultant for GlaxoSmithKline.

Andriole GL, Bostwick DG, Brawley OW, Gomella LG, Marberger M, Montorsi F, Pettaway CA, Tammela TL, Teloken C, Tindall DJ, Somerville MC, Wilson TH, Fowler IL, Rittmaster R. Effect of Dutasteride on the Risk of Prostate Cancer. New England Journal of Medicine, April 1, 2010.

Washington University School of Medicine's 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children's hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked third in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children's hospitals, the School of Medicine is linked to BJC HealthCare.

 

 

The person who discovered the PSA blood test discusses the controversy and the tests use.  His conclusion is that the most beneficial  way to right way to use the PSA test is to get a baseline test in middle age and have the levels checked periodically.  However, if PSA levels do increase it is important not to rush into treatment. 

Prostate Test: Lifesaver Or Big Mistake?

National Public Radio: March 22, 2010

The man who discovered PSA — prostate-specific antigen — says most men who get tested for it are thinking about it the wrong way.

"It cannot do what it's been purported to do. It can't detect prostate cancer," says Dr. Richard Ablin of the University of Arizona. "And it's resulted in a public-health disaster."

Can't detect cancer? That's the very reason millions of men and their doctors pay close attention to their PSA number.

It's why a PSA that creeps up from, say, 3.8 to 4.2 causes men sleepless nights — and sends them to the urologist, who will often respond to an "elevated" PSA by sticking a needle into their prostate gland to retrieve tissue samples, looking for cancer cells.

High PSA Not Always A Problem

But wait, Ablin says. Many conditions can cause PSA to go up — prostate infection, the benign enlargement that occurs in most men of a certain age, even sex within 48 hours of a PSA test.

And when PSA leads to biopsy and biopsy turns up cancer, many if not most of those men will soon find themselves undergoing surgery to remove the prostate, or radiation to kill the cancer.

Most of the time, that's totally unnecessary, Ablin says, because many prostate cancers found this way are so slow-growing they would never have caused a problem.

Think of the prostate gland as an open box, Ablin says. Most prostate cancers are like a turtle that slowly crawls around that box but never gets out.

"We can think of an aggressive cancer as a rabbit that jumps out of the box and spreads," Ablin says. "But we don't know which cancers are turtles and which are rabbits."

Treatment Can Cause Impotence And Incontinence

Many men who get treated for "turtle" cancers end up with lifelong impotence and urinary or fecal incontinence. That's the "disaster" part.

A large European study published a year ago found that for every man whose life is saved by PSA monitoring and early treatment, "there are 48 others who may not have died but had the treatment," says Dr. Craig Redfern of Portland, Ore. "A number of those are impotent, and some of them are incontinent."

Redfern knows one such patient. "He was about 66, had a 1- to 2-millimeter area of cancer on his pathology. I think he had one core biopsy, which was positive," Redfern said. The pathologist assessed his cancer's aggressiveness as borderline.

"He probably did not need the surgery," he continues. "He's suffering quite a bit from urinary incontinence. He needs to wear a pad. So he's one who has done poorly."

If Redfern had been the man's doctor at the start, he would have counseled him to hold off doing surgery and monitor the situation closely — an approach that some call "active surveillance."

The American Urological Association is pushing "active surveillance" rather than immediately treating every prostate cancer that is found.

But Dr. Michael Phillips, a Washington, D.C., urologist, says it's the unusual man who's comfortable with watching and waiting.

"Even if a man says, 'Well, if I have this low-grade cancer, it might not cause any problems during my natural lifetime, maybe I'll forego surgery,' " Phillips says. "It's hard to lie in bed at night and look at the ceiling and think, 'I have this cancer inside of me.' "

Phillips disagrees with Ablin that PSA blood testing is a disaster. But he says there is a rethinking going on about how to use PSA in a way that does men more good than harm.

More Men Die With Prostate Cancer Than From It

He agrees with Ablin on one big thing: "We're 'curing' a lot of men with prostate cancer who don't need to be cured," Phillips says. "There are probably way too many PSAs being done. And in some areas, there are probably way too many biopsies being done. I've been around long enough to know that you can get burned either way by the PSA — by picking it up too quickly or by missing it altogether and finding cancer too late."

In fact, Craig Redfern, the Portland doctor who is a PSA skeptic, cites one case that proves the value of the test — if it's interpreted the right way.

That patient is Brad Baugher, a 55-year-old teacher. Baugher and Redfern met in high school and have been best friends ever since.

Baugher got his first PSA test at age 44, before he was Redfern's patient. When he turned 50, he asked his friend to do a PSA test, just to see if there was any change. The results showed nothing to worry about.

But a few years later, Baugher began having the urinary problems that plague many men beginning in middle age. "I had a few symptoms at night, getting up to go to the bathroom," he says. "My wife was bugging me about going to the doctor, getting my PSA measured, getting checked out. So I did."

PSA Test Can Help Save Some Men's Lives

This time Baugher's PSA was 5.5 — above the 4.0 cutoff that has traditionally been considered a potential marker for cancer but not necessarily a worry.

Still, Redfern says, "since he was my friend and I didn't want any potential conflict of interest over decision-making, I suggested he just see the urologist and decide whether to proceed with the biopsy."

The urologist suggested a course of antibiotics in case Baugher's PSA reflected a minor prostate infection, followed by a repeat PSA. Two months later, that PSA test showed Baugher's level had gone up to 7.2. That triggered a biopsy, which found cancer in four out of five tissue samples.

A pathologist assessed Baugher's cancer as potentially aggressive, which convinced him to have a radical prostatectomy — surgical removal of the entire prostate gland. Fortunately, that surgery, done in October 2008, has not caused the side effects that men and their doctors dread.

So Baugher is happy he watched his PSA. "I think maybe the test did save my life," he says.

Redfern agrees: "In a couple of years, [the cancer] would have come to light in other ways and probably wouldn't have been curable."

Ablin agrees that Baugher represents the right way to use and interpret PSA — get a baseline test in middle age, check it periodically, don't rush to biopsy or treatment when the PSA level goes up.

But still, the 69-year-old Ablin has never asked his doctor to do a PSA test to screen him for cancer. And neither has Redfern.

"I think the decision in my mind is really whether it's worth it to screen or not," the Portland doctor says. "And my assessment is the burden of harm outweighs the potential benefits, and I don't want to step onto that slippery slope. Every man has to make his own decision."

by Richard Knox

It is important to note that the American Urological Association (AUA) continues to urge routine PSA screening.  Further, prostate cancer survivor groups are upset with this change in policy calling it irresponsible.  Many survivors believe that early detection using the prostate test saved their lives.

The PSA test certainly has limitations but it is still the best test available for early detection of prostate cancer.  We continue to believe that it is better to know what is happening in your body so that you do not limit your options for care.  Advising doctors to not recommend the prostate test is a step back for the evolution of consumer healthcare in the United States.

Cancer society stops urging docs to offer PSA test

The Associated Press:  March 3, 2010

ATLANTA — The American Cancer Society has updated its advice about prostate cancer screening. The society wants doctors to talk to men and give them plenty of information before they have a PSA test to make sure they understand its limits.

Recent studies suggest the popular PSA test may lead to unnecessary treatment for many men. The test can't clearly indicate whether a cancer is aggressive or harmless. The cancer society has not recommended routine screening for most men since the 1990s. And its new guidelines no longer urge doctors to offer the test.

By MIKE STOBBE (AP)

 Fifth of men 'denied cancer test'

Press Association:  February 28, 2010

A fifth of men in at-risk age groups who ask their GP for a test used in the diagnosis of prostate cancer have their requests turned down, a survey has revealed.

Seven out of 10 men are unaware they even have the right to ask for a PSA blood test, which for some could be a lifesaver.

Men from less affluent backgrounds were more likely to be uninformed about the test, the results showed.

They were three times less likely to request a PSA blood reading than men from higher socio-economic groups.

John Neate, chief executive of The Prostate Cancer Charity, which commissioned the poll, said: "Our survey highlights the critical role GPs play in providing balanced information to men about the PSA test.

"It is completely unacceptable that so many men at risk of prostate cancer are unaware of their right to request a PSA test.

"We must move swiftly to a position of 'universal informed choice' where all men are made aware of their right to request a test and to be given clear information about its usefulness and limitations so they can decide whether having the test is right for them.

"We are working intensively on proposals for how this can best be achieved and plan to make these public over the coming months."

Mr Neate said: "For many men, undergoing a PSA test could expose a slow growing cancer which may never cause a problem - even without treatment. At the same time, for men with an aggressive cancer, who have no symptoms of the disease, the test may be the only way the disease will be identified at a time when effective treatment can be offered.

"The decision on whether to have the PSA test must therefore be made by men themselves - based on unbiased advice about its pros and cons."  

Screenings help men get in touch with their health

The Tampa Tribune:  February 17, 2010

Gene Moore was vigilant about getting annual prostate screenings. The retired physician got a prostate-specific antigen, or PSA, test every year for 10 years.  Elevated levels of PSA in blood serum are associated with prostate enlargement and prostate cancer. Last October, Moore's PSA results showed a spike. Moore got a biopsy and the results showed he had prostate cancer.

"As a physician and an older man, I knew the need to check (my prostate) regularly," says Moore, 69, a part-time St. Petersburg resident with a history of having an enlarged prostate. "There's an emotional shock in hearing the word cancer, whatever type of cancer it is."

Moore chose to have laparoscopic surgery to remove his prostate, and spend the night in the hospital.  "I thought it was safe and reasonable for me," he says. "The chances of a good outcome surgically are very good (when caught) at an early stage."  Moore is sharing his story to encourage other men, especially those older than 50, to get an annual PSA test.

The test is among a number of free screenings men can get during the 10th Annual Men's Health Forum on March 6 at the Marshall Center at the University of South Florida. The event, which is open to the public, includes screenings for diabetes, cardiovascular disease, vision, hearing and HIV/AIDS.

More than 10,000 men have been screened at the event through the years, says B. Lee Green of the H. Lee Moffitt Cancer Center and Research Institute's Office of Diversity.

The Men's Health Forum will be a bilingual event. Spanish-speaking faculty and staff will be on hand, and all information will be available in Spanish.

According to the National Cancer Institute, one in six American men will be diagnosed with prostate cancer in their lifetime. Black men have nearly twice the risk of dying from prostate cancer as all other ethnicities. If a close relative has prostate cancer, a man's risk of the disease more than doubles.

But early detection can save lives. Almost 100 percent of men diagnosed with prostate cancer are still alive in five years. After 10 years, about 97.9 percent of men diagnosed with early stage prostate cancer are still alive; but only 17.6 percent of those diagnosed with advanced stage prostate cancer survive 10 years.

A lack of knowledge is the reason many avoid prostate screening, risking a cancer diagnosis late in the game.

"It's lower on their priority list in terms of other things they have on their plate," Green says. "We often find a lot of men come (to the Men's Health Forum) because their wives or significant others want them to be part of the event and get checked."

Moore, who has no family history of cancer, thinks men older than 50 should consult not just their primary care doctor, but also a specialist, such as a urologist.

"The urologist is a specialist in the urinary system; so many times they can find a lump in your prostate when a primary care physician can't," he says.

Moore says one of his friends had three rectal exams by his primary care physician as part of an annual physical and a colonoscopy that came up normal. It wasn't until he went to a urologist that a small lump was found in his prostate.

"This is a great disease to find early because you can take care of it early," Moore says. "A rectal exam can find the problem in some cases even sooner than a PSA."

Prostate cancer is "a very slow cancer," he says. "Even if you do have an elevated (PSA) test, you have the time to make an informed decision about what to do that's best for you."

 

By CLOE CABRERA

 

Prostate cancer: The facts and the dangers

Palm Beach Post:  Feb. 15, 2010

When Keith was diagnosed with prostate cancer at the young age of 49, he was resolute: "I was bound and determined not to let it change my life."

An engineer by training, he decided he would tackle the situation as any engineer would approach a technical problem: weigh the data, develop a plan.

But three years after his diagnosis, despite his best efforts, Keith says, he cannot lie: Prostate cancer has changed his life. It's one thing to read that a therapy has side effects including incontinence and impotence.

It's another thing to live it.

"I think for a man to be told, or to come to realize, that he may never couple with the woman he has loved for a lifetime?" he searches for words. "That's kind of tough."

Prostate cancer is generally the "lucky" cancer. It's usually slow-growing. It usually doesn't spread. It usually responds well to treatment.

But there are exceptions.

Each year, 200,000 men are diagnosed with prostate cancer and about 30,000 die of it.

There has been controversy over a study that concluded too many men may be getting tested for prostate specific antigen at too young an age, leading to unnecessary treatments.

Dr. Abraham Schwarzberg, an oncologist with the Lake Worth-based Cancer Center of South Florida, thinks there may be some truth to those findings.

"Some people will live with their prostate cancer forever, and it will not be clinically relevant," said Schwarzberg, who is affiliated with Massachusetts General Hospital.

But for other men, the cancer can be life-threatening. Schwarzberg said he watches not just the PSA, but its doubling time and something called the Gleason score, which tells how extensive the cancer is.

"We are learning that PSA doubling time is one of the most important predictors of how aggressive a tumor is," Schwarzberg said.

"If someone is a young person whose PSA is doubling every three months, that's not the person you want to take six months to make a decision on."

That was Keith.

He began to suspect something was wrong when he was 47 and he was having difficulty urinating.

The prostate is a walnut-sized gland that sits in a delicate spot between the bladder and the rectum, at the base of the penis. Its job is to help produce semen. When it becomes enlarged with cancer, it can block urine flow or produce blood. But infection can do the same thing.

Keith was so young that his family doctor told him it was probably nothing. A year and a half later, an exam showed an enlarged prostate. A PSA test came back at 16.

"They called me and said, 'You need to get in to a urologist right away.'"

A month later, a second PSA came back more than twice as high, a sign he didn't just have prostate cancer, he had fast-growing prostate cancer. Watchful waiting was out of the question.

Some studies suggest that by the time most men are in their 80s, half of them will have at least some cancer growing in their prostate.

Jesse Seligman, who is 85, watched his father die of prostate cancer. Seligman runs the prostate cancer support group at Wellington Regional Medical Center. While breast cancer has come out of the shadows, most men still wouldn't think of discussing prostate health with each other. Seligman thinks it's time to start.

Men will have a chance to do that on March 20, at the Third Annual W.B. Ingalls Memorial Prostate Health and Cancer Seminar, which will take place all day at The Scripps Research Institute in Jupiter. Nationally recognized scientists and physicians will speak on controversies surrounding testing, as well as advances in treatment. To reserve a place call (561) 776-6666 or go to www.myhir.org.

One of the toughest things about prostate cancer is that there is no one right treatment.

Many doctors would advise surgery for a man Keith's age. But when Keith interviewed several surgeons, he was told he should expect to lose the ability to have an erection after surgery, and he could not be guaranteed that they'd manage to get all the cancer.

He chose radiation, along with androgen deprivation therapy, hormone treatments that block testosterone. The hormone treatments alone can cause impotence. The issue of side effects is not trivial, doctors said.

Dr. Neal Rothschild, an oncologist, discusses many factors before recommending a course of treatment.

"For every patient it's a different equation. You look at tumor factors, patient factors, age, other medical conditions," Rothschild said. But in the end, "the decision is ultimately always the patient's," he said.

Rothschild helped found the Palm Beach Cancer Institute in West Palm Beach. An affiliated foundation supports the Sari Asher Center for Integrative Cancer Care, where free counseling is available for cancer patients. Call (561) 578-5900 for an appointment.

Keith says he's telling his own story to encourage men with concerns to see their doctor and ask questions. But he doesn't want to share his full name and profession. He works on long-range projects, and he's worried that his clients might drop him if they knew he had cancer. Keith speaks with a sense of wonder at his wife's loyalty, her love and her support through his ordeal.

They have been together for almost three decades now, and he loves her more than ever. There has been some good from his journey with prostate cancer.

"I have come to learn the difference between intimacy and sex," Keith says.

PROSTATE CANCER FACTS ...

•The prostate gland lies between the bladder and the rectum, at the base of the penis. It's normally about the size of a walnut. It helps men make semen.

•About 200,000 men a year are diagnosed with prostate cancer. About 30,000 men a year die from the cancer.

Prostate cancer is common, often slow-growing

•Usually, prostate cancer is slow-growing, so that it can take 10 to 30 years for a tumor to grow to the point of causing problems. For that reason, prostate cancer is often treated with 'watchful waiting.'

•Other options, radiation and surgery, have frequent side-effects including incontinence and reduced ability to have an erection. Those need to be discussed with a doctor. Treatments may be accompanied by hormone therapy.

For more information: www.cancer.gov/

ATTEND A LECTURE

Attend the Third Annual W. B. Ingalls Memorial Prostate Health and Cancer Seminar on March 20. Sponsored by the W. Bradford Ingalls Foundation, the seminar will bring together nationally recognized scientists and physicians expert on topics ranging from the usefulness of the PSA test to advances in assessment of risk and treatment of prostate cancers. The seminar will be held at Scripps Florida in Jupiter from 7:45 a.m. to 3:40 p.m. To register call 561-776-666 or go to www.myhir.org/.

Jupiter Medical Center is offering several upcoming lectures on prostate cancer and related issues. Reservations are required. Call 561-745-5737 .

On Wednesday, prostate cancer screening will be discussed from 5 to 6 p.m. This is intended for men over 50 who have not been diagnosed with prostate cancer. Please RSVP. Call 561-743-5069.

On Thursday, prostate cancer screening and diagnosis will be the focus from 5:30 to 6:30 p.m. at Jupiter Medical Center meeting room one.

On Feb. 25, treatment options, including surgery, radiation therapy, brachytherapy and chemotherapy will be addressed from 5:30 to 7 p.m. in Jupiter Medical Center's meeting room one.

For more information go to www.jupitermed.com/events

CONNECT WITH OTHERS

Free counseling is available through the Sari Asher Center for Integrative Cancer Care, a project of the Palm Beach Cancer Institute Foundation, 1411 North Flagler Drive, West Palm Beach. For more information call 561-578-5900 .

A support group meets at Wellington Regional Medical Center on the first Friday of each month from 7 to 9 p.m. in the conference center. For more information, call the facilitator, Jesse Seligman, at 561-963-3412 .

The 5-YEAR SURVIVAL RATE

for men with prostate cancer that has not spread is nearly 100%

The 10-YEAR SURVIVAL RATE is 86%

The 15-YEAR SURVIVAL RATE is 56%

THOSE WHOSE CANCER WAS CAUGHT TOO LATE

Telly Savalas

Actor

1924 - 1994

Billy Bixby

Actor

1934 - 1993

Linus Pauling, Ph.D.

Scientist, Two-time Nobel Prize Winner

1901 - 1994

Frank Zappa

Musician

1941 - 1993

Timothy Leary

LSD advocate

1920 - 1996

 

By Stacey Singer  

Prostate cancer testing overhaul

SAN DIEGO UNION-TRIBUNE:  January 10, 2010

Not only do medical experts disagree on how and when to test patients, some aren’t sure that routine cancer screening is effective at all. Which cancer screening test a doctor recommends, or if one is even recommended, may depend on the philosophy to which that medical practitioner subscribes. And, in the end, this may affect which screenings are covered by insurance.

In this third part of a four-part series, we look at the recommended screening guidelines for prostate cancer and how they’ve changed.

Old screening recommendations: Just 25 years ago, the only way to screen for prostate cancer was a rectal exam. Then in the late 1980s, the prostate-specific antigen (PSA) test was routinely used for screening men 50 and older, along with an annual digital rectal exam. Men at higher risk of prostate cancer (African-American men and those with a family history of the disease) were to start screening at age 40.

PSA is a protein produced by both cancerous and noncancerous prostate tissue. Cancer cells usually make more PSA than do benign cells, causing PSA levels in the blood to rise.

New screening recommendations: Professional medical and health organizations vary in their recommendations about the PSA screening test. Some have definitive guidelines while others leave the decision up to men and their physicians.

The Centers for Disease Control and Prevention considers the evidence insufficient to determine whether the benefits of screening outweigh the risks. The National Cancer Institute has no standard or routine screening test for prostate cancer. And, in 2008, the U.S. Preventive Services Task Force recommended against screenings for men over 75, because they’re more likely to die from another cause before a prostate tumor could harm them.

The American Cancer Society does not support routine testing for prostate cancer. However, the group recommends that doctors discuss the potential benefits and limitations of PSA screening with men at age 50. Following the discussion, men who favor the testing should be tested, the group says.

This discussion should take place at age 40 or 45 for men at high risk of developing prostate cancer. This includes African-American men and those with first-degree relatives diagnosed with prostate cancer.

The American Urological Association (AUA) is one of the few professional medical groups that still recommend routine PSA screening. The AUA encourages men who expect to live another 10 years to have a baseline PSA test at age 40. How often the PSA test is repeated depends on the results of the baseline test.

Why the change: A number of studies show that many prostate cancers never spread beyond the prostate gland and are so slow-growing that they never become deadly.

Researchers have found that PSA testing is not very accurate. Although an elevated PSA level can be a sign of prostate cancer, a number of other conditions can also cause PSA levels to rise. The result is a large number of false positives with PSA testing. Only about one in four men who have a positive PSA test turns out to have prostate cancer. On the other hand, some fast-growing prostate cancers don’t produce much PSA, yielding false-negative results.

Last March, two long-running studies found that prostate cancer screening saves few lives but may hurt countless men by leading them to undergo therapies that can cause impotence and/or incontinence.

The AUA, on the other hand, believes when interpreted appropriately, the PSA test may provide important information for the diagnosis, pretreatment or risk assessment of prostate cancer.

“The most valuable thing about PSA is the rate of change over time. But, in order to know how much it increases over time, you need a baseline (PSA level) to compare it to,” says Dr. Ronald MacIntyre, a urologist at Sharp Rees-Stealy Medical Group. “The PSA is an imperfect test. It will lead to diagnosis of some cancers that may not kill the patient. The problem is you don’t know which ones will be aggressive and kill the patient and which ones won’t.”

Approximately 192,000 American men are diagnosed with prostate cancer, and about 27,000 die from the disease annually.

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