PROSTATE FOCUS

MAY 2009

 

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You need to be in control.

Your life.

Your decisions.

You have been asked or have decided to have a PSA test.

How do you know it is the right thing to do ?

Whenever you see newspaper headlines about prostate cancer, often you will read some newly diagnosed man who has been ‘saved’ by his wife nagging him to go along to his G.P.  for a PSA test.  With the accepted belief, in most circles, of the total unreliability of PSA tests, I gaze in wonder at such wordage, grit my teeth and promise not to write to the letters editor.

Many such articles or similar interviews on the radio give the impression that the man is cured. That all his troubles are behind him and because of his partner’s action the future is golden.

 

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You need to be in control.

 

Every man, before he commits to a PSA test or contemplates treatment for prostate cancer, should take the following review detail on board and have it well in the forefront of his mind when he goes to see his medic for a final assessment. The review is of literature by the Department of Urology, Royal Surrey County Hospital and published in Eur. Urol. As long ago as February  2004 has this to say:-

“There is little agreement on the best form of treatment among men who require curative treatment for prostate cancer.  The relative ‘impact’ of the various treatments on symptoms and health- related quality of life is also controversial. Review of current literature suggests that radical prostatectomy, external beam radiotherapy and brachytherapy (seed implantation) offer a good long-term health-related quality of life”.

First of all it is important to say that this review of medical studies does not say that one of the above treatments is a ‘cure’.   So however much a surgeon may be convinced that a radical prostatectomy will cure your prostate cancer there is no study which confirms this.  This also applies for the other current treatments listed and underlined above. What they do, it says, “is to offer a good long-term health related quality of life”.

Now it depends upon your definition of  ‘long-term’ and ‘quality’, neither of which are qualified. The reviewers then continue with the downside of this.

“However, differences exist in the toxicity of treatment in terms of erectile function, voiding difficulty, incontinence and bowel function”. 

Now for Mr. A, a lack of erectile function may be neither here nor there compared to a possibility of extended life.  But for Mr. B, still in what he considers the prime of life at 55, this may be a problem he can well do without. Some men may regard a future with the loss of bladder and/or bowel control as ‘beyond the pale’ whilst others could take it in their stride.

 

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Alfred. “Tell me Joe, what would you recommend, Jane Plants diet system,** a macrobiotic diet, or a radical prostatectomy ?

 

So which direction to take ?  An alternative, like Prof. Jane Plants method** or a macrobiotic diet? You need to study any option as fully as you would any radical treatment mentioned above.  If you decide to follow your medic’s advice and opt for one of the previously mentioned treatments then the review offers some help in that… “seed implantation offers a high probability of maintaining continence, potency, and normal rectal function, although both storage and voiding urinary symptoms have been reported”.

What has always concerned me is that most of the data one reads in the press and elsewhere is usually based on five year studies. For example,  “98% of men treated with X have survived five years”  “80% of men having radical surgery have survived for five years”.  Prostate cancer appears to have a ‘life’ (if that is the correct word), of 10 to 15 years, and that does not include the majority of minute prostate cancer cells which can produce a high PSA but which may never develop to cause any problem at all. 

If you begin treating a man with early detected, minute cells in ‘year one’ whatever treatment you give him he will most likely be hale and hearty by ‘year five’. Except, that is, from any side-effects he has received as a result of the treatment he has had!

So what I am waiting for are statements that “90% of men with detectable aggressive cancer who have had X treatment have survived in excess of 10 or 15 years”. That to me would be a cure.  

Whilst on the subject of treatments and extended life, I see the U.S. Federal Drugs Agency (FDA) have approved a drug called ‘Taxotere’ produced by Aventis.  This drug is prescribed for prostate patients in conjunction with a steroid prednisone and is an option for men who do not respond to hormone treatment.***

When hormonal treatments are no longer effective for treating prostate cancer that has spread outside the prostate gland, the condition is called Hormone-Refractory Prostate Cancer (HRPC).

Options for treating HRPC are strictly limited. Radiation therapy can be used to manage localized pain. For more generalized or widespread pain, systemic analgesics or narcotics like morphine have been prescribed.

Lester M. Crawford, MD, acting FDA commissioner, said in a news release."We consider this approval an important advance in the treatment of prostate cancer because it can help some patients live longer. Patients need as many effective treatment options as possible. Taxotere, in combination with prednisone, offers hope to certain patients who have not responded to other treatments."

Taxotere works by inhibiting tubulin, a protein cancer cells need in order to multiply. The most common side effects reported were nausea, hair loss and bone marrow suppression. Fluid retention and tingling sensations in the extremities also occurred in some patients.

Taxotere is also approved in the U.S. to treat patients with locally advanced or metastatic breast cancer after failure of chemotherapy and for treatment of locally advanced or metastatic non-small-cell lung cancer. Prostate cancer treatment is a recent approval.

NICE, the U.K. body who approve drugs for use, have still not approved the drug as a treatment for breast cancer in women so don’t expect any rush for them to approve it for prostate cancer.  But at least if you have an interest in exploring further treatments after hormone failure you have a name to use to set your specialist on the right track. (PD)  

***It has been brought to my attention that some medics in the USA use Taxotere as a first treatment and have been doing for some years.  They claim that it can be given on a weekly basis with easily tolerated side-effects and none of the side-effects classically associated with chemotherapy.  They claim that it works far better if used early in treatment compared to how it would be used in the UK as a last line treatment.

“We would rather treat when the cancer is at its weakest and the patient is at his strongest, not the other way around” they write.

These medics are concerned that still far too many of their colleagues do not consider hormone treatment for men in the early stages of PC but recommend one of the radical treatments such as surgery.  In their view a much better result can be obtained by using hormones and chemotherapy (for high risk patients) than current treatments.

A recent article stated “given the lack of a survival benefit in men treated with surgery or radiotherapy,  a strategy to manage or control PC seems more logical and appealing than radical efforts to effect a ‘cure’.” 

I repeat Your Life, Your Decisions ! (PD) 

** Prof. Jane Plant was cancer free over 10 years after being given three months to live She showed that breast and prostate cancer, both hormone related cancers, respond to the same treatment which led to her extended lifespan. Her book 'Prostate Cancer - understand, prevent and overcome'  costs £16.99,  we have one or two copies at £10 inc. p&p. Cheque to PHA Langworth, Lincoln,  LN3 5DF. please.

 

Prostatitis leads to unnecessary biopsies..

The prostate-specific antigen (PSA) test measures the level of PSA in the blood. PSA is a protein produced by the cells of the prostate gland. A blood sample is drawn and the amount of PSA is measured in a laboratory. When the prostate gland enlarges PSA levels in the blood tend to rise. PSA levels can also rise due to cancer or benign (not malignant) conditions. Because PSA is produced by the body and can be used to detect disease, it is sometimes called a biological marker or tumour marker.

The PSA does not measure only the possibility of  prostate cancer. It is also affected by the size of the gland and any infection (bacterial or non-bacterial) in the gland (prostatitis) and other traumas. In addition, the Gleason grade, time of day, perhaps day of month, different labs, different assays used, sample handling, what you did in the last 72 hours, etc., may all effect the PSA measurement.

 

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Ensure no abuse of the prostate area!

 

The size of the gland is usually dependant on age. The older we get the larger the gland. This is not always true and there are young men with large glands and older men with small glands. But this is a good rule-of-thumb to remember. Therefore the older a man gets the higher the PSA - BUT THIS DOES NOT MEAN HE HAS CANCER. Nor does it necessarily mean that any minute cancer cells which may at a later date be discovered are going to be a cause of death.

Whenever I have a letter from a member saying he is due for a biopsy after a high PSA reading, I always suggest that if it is a single PSA test and not the last of a series of elevating readings to have a further PSA blood test prior to the biopsy. But first he should ensure that there is no ejaculation for a minimum of 48 hours, no abuse of the prostate area such as long cycle rides, no DRE and that any saw palmetto or similar type BPH capsules are stopped for at least four to five days prior to the biopsy date.

This ensures that there are no outside events liable to trip the PSA reading over or under what it should be.

The wisdom of this advice is brought out in the following USA study carried out last year.

Screening for prostatitis is "safe and effective, and may decrease the number of potentially unnecessary biopsies," Dr. Jeannette M. Potts, of the Cleveland Clinic Foundation, Ohio, suggests in the November issue of The Journal of Urology.

Her team initiated a screening protocol for prostatitis that consisted of two tests:- expressed prostatic secretion and post prostate-massage urine, also known as the voiding bottle 3, or VB3 test. Screening was performed for 122 men with PSA of 4.1 ng/ml to 29 ng/ml and no evidence of acute urinary tract infection.

Forty-two percent of the men had positive laboratory results for prostatitis, although most had negative VB3 cultures. These men received antibiotics for 4 weeks followed by reassessment, whereas men with negative laboratory tests underwent biopsy. After treatment, 22 of the 51 men with signs of prostatitis had normalized PSA levels, while the PSA remained elevated in 29. Of these 29 men, follow-up biopsy revealed cancer in 9 patients.

Overall, the screening protocol reduced the number of biopsies performed by 18%, and increased the positive predictive value of PSA for prostate cancer "substantially," from 37% to 51%. Moreover, all of the men who did not undergo biopsy after treatment for prostatitis had "continued normal or stable PSA" at last follow-up.

I think the last sentence is the most important in the whole trial advice ! (PD)

 

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