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Posts Tagged ‘prostate cancer blog’

The WordPress.com stats helper monkeys prepared a 2011 annual report for this blog.

Here’s the sad thing…I do a post for fun about bleeding scrotums and whadaya know? It’s the number one viewed post. Go figure.

Happy new year!

Here’s an excerpt:

The Louvre Museum has 8.5 million visitors per year. This blog was viewed about 80,000 times in 2011. If it were an exhibit at the Louvre Museum, it would take about 3 days for that many people to see it.

Click here to see the complete report.

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whether you think you can or think you can't...you're right

First off all…look at the sentence I highlighted in bold. Are you kidding me? Concerns about a CT scan and radiation all the while finding no complaints regarding treating the prostate cancer with radiation regardless if it’s seeds, Proton, or external beam.

The use of “misuse” is an attention getter is it not.

We have known for years that the likelihood of a positive bone scan for bone metastasis and a positive CT scan showing pelvic lymph note involvement is low in the patient with low Gleason’s and low volume disease on his prostate biopsy report.

In today’s world I as a urologist can tell the patient that biopsy shows cancer and then say, “The chances of finding anything on a CT scan or bone scan is low. It is however a part of the staging work-up for the newly diagnosed prostate cancer patient. Would you rather not do these studies? The patient decides based on the information that I have given him. These test are most commonly negative…but not always. What is the consequence of not doing the tests in the face of unknown metastatic disease? Well you get your prostate out, or get radiation, or HIFU, or cryosurgery for local disease when in reality it is not. Are you Okay with that?

You see what all the studies and reports fail to “get” is that statistics are different from actually sitting down with the patient and family and making decisions.

I guess with a National Healthcare Plan…the doctor will just say, ” Your prostate biopsy shows cancer and there is no need to do a bone scan or CT scan based on statistics of similar patients with a biopsy like yours.” Done.

Which is right or which is wrong? Well…everytime I make the diagnosis of prostate cancer someone somewhere sends me a form to fill out about the stage of Prostate Cancer my patient has. Well…if I don’t do a bone scan and a CT…I am assuming. Maybe the forms…i.e. the National Cancer Registry, or your local hospital’s Tumor Board has a little box to check stating the stage is I but that because of parameters of the biopsy a staging work-up was not done. As of yet and as of today…that box does not exist, but I am continually having to stage my patient’s cancer on some form.

So what to do?

Doctors misuse scans? Is it really that simple? Dear Dr. McHugh quit doing bone scans and CT’s to stage your patients. Also please fill out the attached form informing us of your patient’s prostate cancer stage or risk losing your hospital privileges until your medical records are up to date. What’s a doc to do?

Regarding the title of this post-My patients, after I have explained the likelihood of the results of the scans, most commonly opt to have the studies done. It is more information about their cancer and allows them to make treatment decisions. Right or wrong? What would you do given the choice?

What did I do? I did not have a bone scan or CT.

Doctors misuse scans in prostate cancer: study

Fri, Aug 26 2011

By Genevra Pittman

NEW YORK (Reuters Health) – Too many men with low- or medium-risk prostate cancer get CTs and bone scans that aren’t recommended for them, suggests a new study.

The scans are intended to tell doctors if cancer has spread beyond the prostate in men with high-risk cancer.

Doing them in other cases is a concern because CTs expose patients to small amounts of radiation — which itself is linked to future cancer risks — and the scans cost the healthcare system extra money, but have little potential benefit.

The research also suggests that not enough men with high-risk cancer get the scans, which means some of them may get treatment for local (confined to the prostate) cancer that’s unlikely to help if the cancer has spread.

“In high-risk patients, those are the ones that have a high risk of positive lymph nodes or (cancer that has) spread to the bone,” said Dr. David Samadi, a prostate cancer surgeon at the Mount Sinai Medical Center in New York who was not involved in the new study.

“Otherwise for low-risk disease, the likelihood of finding a positive bone scan or CT scan is low,” he told Reuters Health.

Guidelines from the American Urological Association say that doctors should use other measures such as prostate-specific antigen (PSA) testing to determine a man’s risk of advanced cancer and then only scan those with high-risk disease to determine the best treatment.

Researchers led by Dr. Jim Hu of Brigham and Women’s Hospital in Boston wanted to see how frequently those recommendations were being followed.

They consulted a database of U.S. men covered by Medicare who were diagnosed with prostate cancer in 2004 and 2005 — a total of 30,000 cases.

Both bone scans and CTs were more common in men who were diagnosed with high-risk cancer.

Sixty percent of those men had one of the scans. Still, one-third of men with low-risk cancer and almost half of those with medium-risk cancer had a scan in between diagnosis and treatment.

Hu and colleagues calculated that the cost of unnecessary scans in men with low- and medium-risk cancer billed to Medicare during those two years was about $3.6 million for their study group. (The government-run insurance program paid an average of $226 for each bone scan and $407 for a CT).

Extra scanning not recommended by guidelines “significantly increases Medicare expenditure without improving quality of care rendered for men with newly diagnosed prostate cancer,” the authors wrote in the journal Cancer.

And each extra CT scan exposes men to a small amount of radiation, while also providing an opportunity for doctors to catch something “incidental” that may not pose a threat but still leads to more testing or procedures, Samadi said.

Another recent study found that coaching and feedback from peers about the proper use of the tests helped prostate surgeons reduce the number of unnecessary scans they ordered. Samadi thinks many doctors are just trying to be on the safe side by ordering more tests.

“A lot of it has to do with the fact that most urologists when they think of prostate cancer it’s almost like a knee-jerk reaction — automatically they think bone scan and CT scan,” Samadi said.

The researchers noted that finding four in 10 men with high-risk cancer aren’t getting a scan is also “worrisome.”

If doctors don’t recognize that cancer has spread in some of those men, they said, they won’t benefit from treatment directed just at the prostate.

SOURCE: bit.ly/pYwBrh Cancer, online August 5, 2011.

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if you tell the truth , you don't have to have a good memory...

First of all, if he had any type of medical problem it would change his perspective on things. From a marketing standpoint, Sheen has been brilliant. Maybe he has been held back by the traditional roles and media (movies and tv) and has been yearning for something new. I understand he has sold out a live show in New York at the Radio City Music Hall. I’d go to see what he’s about. Is he exploding, imploding or is he brilliant. He doesn’t really look well to me…maybe he is sick from something.

Anyway…Robert DeNiro chose to have his prostate removed. So did Arnold Palmer. Rudy chose  seeds. The people writing books with titles like….cure without the knife or beware of a urologist taking your prostate from you etc…all used radiation of some sort. The really “smart” and informed patients who have the money to do it….might consider non FDA approved methods and go out of the country for a treatment. John Wayne? He’d have it out by the open method. James Brown…he chose cryotherapy.

Now hold on a minute….am I  being sarcastic…well yes but don’t get me wrong. I think there is promise for HIFU and the NanoKnife and a role for proton therapy and I am not opposed to surveillance, robotic, open prostatectomy, external beam or seeds. I like them all………..

My point is this….the treatment a patient chooses often times has to do with the type of person they are and their financial resources. Having extra cash complicates things because you begin  to think….”I can do anything and I can go anywhere to have it done.” So when a patient of mine scheduled an office visit in Miami with a urologist after I diagnosed his prostate cancer, then flew to the Bahama’s to  have HIFU and came home with a suprapubic catheter in and had to  wear it for five days, and then called me and told me that the suprapubic catheter was a “new way” to have a catheter and asked what would happen if there  was a  problem with the catheter and he was in Atlanta and his doctor was in Miami……..I thought of Charlie Sheen.

So what would ole Charlie do? He’d have Proton Radiation and he’d do it in California.

What do you think?

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never let a problem to be solved be more important than a person to be loved

 The PSA is variable when used in the diagnosis of prostate cancer. It can be low and someone have cancer, it can be high and not have cancer. It can go down with antibiotics and a person could still have cancer (this happened to me). So the use of the PSA in the diagnosis is variable and why all the fuss about screening and its usefulness.

However, when it comes to recurrence of disease….it is very accurate. In the above question, the first  thing to do is to repeat the PSA. If it is still high then that means there is prostate cancer somewhere.

The most common area is local or the bed of where the prostate was removed. After that bone and lymph nodes are common locations.

In the above question…the patient may have waited too long between PSA’s thinking that if it had been over ten years all must be well.

So the answer is that probably the cancer is back and he’ll need a CT and Bone scan to prove it is not in lymph nodes or bone. If not he may be a candidate for radiation to the pelvis and or hormonal therapy.

I had a patient recently who I took out his prostate about five years ago. He quit coming to see me opting instead for follow-up with his family doctor.

This patient would get a PSA and be told it was “normal.” By the time he made it back to me his PSA was over 5. He said, “My doctor wants me to see you because my PSA is now abnormal.”

After the prostate cancer has been treated the PSA should go to zero or so and stay there.  For radiation, less than .5 , if surgery less than .05.

Normal after therapy is not the normal before. I advise my patients to stick with me on the follow-up because I will be sensitive to changes in the PSA that are “normal” in the pre treated prostate, but way “abnormal” in the treated prostate.  Doctors look at a lot of labs daily and at a lot of patients labs. The post treated prostate cancer PSA of 2 will be marked as normal by the lab company, but in this case represents the recurrence of prostate cancer. Just a little caveat to know.

One other thing that is demonstrated by the question…you would think that a prostate cancer would be “cured” if the PSA was negligible at 5 years. Recent studies have shown you really have to be out about 10 years to make that statement. The above question suggests that in some it might be longer…..

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live like you are going to die tomorrow, learn as if you will live forever....

Read the following report see what you think about the quotes and conclusions of Mr. Montgomery’s surgery.

I read for my wife the article and she asked, ” So, he will never need another PSA will he? The doctor said he was cured right?”

Report of Eddie Montgomery’s Surgery and Prognosis

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it is better to be quite and appear dumb, than to speak and remove all doubt.

Why men won’t have a rectal explained with humor in a cartoon. I have personally heard these examples from patients. 

What is interesting about this study is that:

  • Older more educated men more likely to agree to get screened
  • Younger and employed men are less likely
  • Of the men who declined the rectal many would not tell why
  • Those who did say why they declined a rectal said it was “embarrassing.”
  • And finally a point that I am in total agreement about…we need to do more about getting all men recognize the importance of the “awareness of prostate cancer.” Until we do, men showing up in their fifties with prostate cancer too late to cure will continue to occur.
  • Embarrassing? Give me a break!

Why Do Men Refuse Prostate Cancer Screening? Demographic Analysis In Turkey

15 Dec 2008

UroToday.com – Prostate cancer is one of the most common cancers in men, with a high incidence rate in Turkey. However, the early detection and diagnosis rates are considerably lower among Turkish men as compared with their counterparts in Western countries. This fact reflects a lack of awareness and fear of prostate cancer as well as low participation in prevention activities. To reduce the disparities in prostate cancer survival, there is a great need to increase men’s participation in screening programs.

The present study was performed to assess why men do not seek screening or participate in screening programs, focusing on the demographics of men refusing free screening programs for prostate cancer.

The sample size (n: 747) was determined using the Systematic Random Sampling Method (95 Confidence and 2% Standard Error) among men over 40 years of age who lived in the Osmangazi region (n: 3285). All were enrolled in the study in a 20-month period and asked to complete questionnaires Then they were invited to attend a public health center to consider having a PSA test and DRE for prostate cancer. Two different questionnaire forms were applied during the study. In the first, the socio-demographic characteristics of subjects were evaluated with 23 questions. The second questionnaire was comprised of the International Prostate Symptom Score Form (IPSS form). Serum PSA level, DRE characteristic, TRUS and TRUS-guided biopsy results were recorded in a third form. Serum PSA value and DRE were used for prostate cancer screening. The screening procedure was conducted by a urologist. If the men had any abnormality on PSA value (4.0ng/mL<) and/or DRE, the results were subjected to further investigation (including TRUS and prostate biopsy). Prostate cancers were finally detected in five subjects.

Although all of men (n: 747) responded to the questionnaire forms, only 35.2% of men accepted DRE (n: 263). Subjects were divided in two groups (accepted or refused) for analysis. Participants in the 40-49 year age group were less likely to attend the screening than older ages (p<0.05), and the level of participation increased with age (p<0.05). Men graduating from high school were more likely to go for screening than men with less than a high school diploma and college and above (p<0.05). Retired men were more likely to participate than employed men (p<0.01). There were no significant differences in marital status and health insurance between refusing and attending groups. Although participation increased with the I-PSS score, there was no statistical significant association with urinary symptoms. At the end of the free prostate cancer screening program all the questionnaire forms of the participants who refused were examined from the point of view “what would make it challenging for the men to get free prostate cancer screening?”. About 51% of those who refused failed to give a reason for not participating in a free prostate cancer screening, and while 25% made an appointment, Digital Rectal Examination was not accepted. The other barriers to prostate cancer screening included embarrassment about DRE (5.8%) and other reasons.

Since this screening program was free of charge, we eliminated cost, lack of knowledge, and not having a regular doctor by free charge and informed consent. However, our findings suggested that there were some possible reasons for refusing to participate in prostate cancer screening and few barriers were reported. The current study revealed that in the 50-59 years age bracket, high school graduates and retired men were more likely to participate in prostate screening. Especially, 65.8% (n=173) of retired men participated in screening versus 34.2% (n=90) of employed men.

There are some limitations to the study. The sample was small; this being the first study related to free prostate cancer screening and barriers in Turkey.

 Future research needs to examine how we can assist men in overcoming the barriers they describe. Future efforts should be directed at increasing awareness about screening procedures for prostate cancer.

Written by Esin Ceber, MD as part of Beyond the Abstract on UroToday.com

UroToday – the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice.

To access the latest urology news releases from UroToday, go to: http://www.urotoday.com

Copyright © 2008 – UroToday

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Ability will never catch up with the demand for it. - Confucius

A story about a missed prostate cancer diagnosis.

Suspicious for but not diagnostic of prostate cancer.

I’ve told patients for years that the diagnosis of prostate cancer is an easy one to make for the pathologist. It is probably the most common biopsy they get on a day to day basis. I refer to it as a “bread and butter” diagnosis. The inference is that it is not a uncommon diagnosis and it is something all pathologists see often. I have been asked to send off the slides of a prostate biopsy that was read out as positive on many occasions. I have never had one over turned or the diagnosis changed. In addition to prostate cancer being something that the community pathologist sees often, there are now stains available to confirm the diagnosis in difficult cases.
Prostate cancer is an infiltrative cancer, so the pathologist makes the diagnosis more on the pattern of the prostate cancer glands than on the specific nature of the cells. The pathologist where I trained in Augusta, Georgia had a particular interest in prostate cancer. He would describe the prostate cancer as tiny circles emanating from areas of normal prostate glands. He would make little circles with his fingers and then move them all about the screen projecting the microscopic finding  of  prostate cancer.
PIN or Prostatic intra-nuclear neoplasm is when the cell of the prostate is abnormal but the cells are in the normal pattern. These patients are at increased risk for developing prostate cancer and are usually followed more closely than the average patient.
Suspicious for but not diagnostic of prostate cancer type glands are in a pattern that mimic prostate cancer. This where the stains come in and are utilized to confirm the diagnosis. I suppose in the case of this article, this was not done. Now here’s the thing. The author of this article  is still at increased risk of developing prostate cancer and should be closely monitored and even re-biopsied. Remember this about a prostate biopsy, it usually is twelve cores and that only samples a small percentage of the gland. So if your prostate biopsy shows “suspicious” and your repeat  biopsy is completely negative,  you still have the suspicious cells. This happens as a result of “low volume” disease. This can get confusing.  For this patient the change is diagnosis is a good thing, but he is not off the  hook for future  issues. He’ll need biopsies in the future. For the most part, we know that does not have large volume ,  high Gleason’s prostate cancer, and that’s a good thing.
I wondered about my biopsy being “suspicious” and not really being cancer and requested additional stains…they found more cancer. I was surprised however that our pathologists gave me the diagnosis initially without having done the stains. So what is the upshot of all this… make sure that stains were done on your specimen and that a second opinion never hurts anything.
Also, I felt that the author was very fair in his assessment of his situation and about what had happened.  How he reacted, I feel, was unusual for what I see on the internet. It reminds  me of  thinking you have lost something valuable and then find out that a friend or family member hid it as a joke and then gave it to you.  You are more happy at finding the item, than angry  about the prank. This must be  how  this fellow felt.

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