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Posts Tagged ‘sexual function after prostate cancer surgery’

we don't always want what is right...

I remember when it was announced that this guy had prostate cancer. It is always interesting to me and sad that a person with the money, education, resources is diagnosed late with prostate cancer when it could have been so easily prevented and then dies in a year or so. How tragic. And yet all we read is about over diagnosis, too many biopsies done, and the worthlessness of the PSA. The following article by Dr. Maguire is good and is something I have written about on many occasions.

Yes…many more men die with prostate cancer than of it. Yes there are slow-growing forms that may not need aggressive therapy. Yes sometimes the PSA causes unnecessary prostate biopsies and angst to the male with an elevated PSA.

But what is a man to do? Hope the percentages are in his favor and just ignore the possibility of prostate cancer?

One in a hundred is 100% if you are that one. Frank Zappa, Bill Bixby, Robert Albin, and two men in my practice this month….Deja Vu all over again.

Death of Canada’s Jack Layton is Cancer Teaching Moment

Written by patrickmaguireon August 23, 20112 Comments

I’m not Canadian and my interest in politics nears zero. Nevertheless, the death of prominent Canadian politician, Mr. Jack Layton, this week gives me reason to write. For those like myself who are ignorant to Canadian politics , Mr. Layton was the charismatic leader of that country’s opposition group in Parliament. At one point, he had been voted the Canadian leader that they’d “most like to drink a beer with.” Now in my mind, beyond even the glowing praise of his abilities and accomplishments in Parliament, that statement says something about a man!

Mr. Layton was diagnosed with prostate cancer a year ago and his cause of death was reported to be from an aggressive form of cancer. While it’s possible that he developed a second cancer type which killed him rapidly, it’s most likely that his prostate cancer recurred (came back), spread (metastasized), and killed him despite aggressive treatment.

Judging from what I’ve read about Jack Layton, he would want to help his fellow countrymen and others even in death as he had throughout his life. In that regard, there are two lessons we can learn here, both generally about cancer and specifically about cancer of the prostate. The first is that descriptions of people “bravely fighting” or “losing their brave fight” against cancer need to go! While I realize it’s difficult to refrain from battle metaphors, these phrases have little meaning for people dealing with cancer and can be downright disrespectful. This point is articulated well in an article by reporter, Carly Weeks, of the Globe and Mail: http://www.theglobeandmail.com/life/health/new-health/conditions/cancer/jack-layton-didnt-lose-a-fight-he-died-of-cancer/article2137736.

The second issue concerns prostate cancer. Yes, many men who are diagnosed with indolent forms of the disease don’t need treatment and will die ultimately of other causes. They will die “with it rather than of it.” However, it’s equally true that within the spectrum of prostate cancer, thousands of men are diagnosed and ultimately die from aggressive forms of the disease. Medical research needs to continue (with increased funding!) to advance toward the day when men like Mr. Layton are not cut down in the prime of their lives. Zealots preaching about the dangers of prostate cancer treatment take heed.

– Patrick Maguire, MD

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my friends my habits my family...they mean so much to me.... modest mouse

 

Well…I see patients all the time who have had an elevated PSA in the past and their family M.D. put them on 2 weeks of Cipro and then had the PSA repeated. Often times the PSA will go to normal and the family M.D. will then repeat a PSA at say 6 months. Often times it is elevated again and then the patient is sent to the urologist. This scenario happened this morning in my office. The patient wanted to do antibiotics again and then repeat the PSA again before consenting to a biopsy. A reasonable approach. We redrew the PSA. His father, a doctor, told him not to consent to a biopsy and this was the patient’s mindset before I saw him as a patient. What we will do in terms recommendations will be heavily influenced by this patient’s preconceived ideas.

My PSA was high and I did a two-week course of Cipro and my PSA went down. I was very pleased. I repeated a PSA 6 months later and the PSA was back up. I did a free PSA and the free % was low and I did the biopsy. The biopsy showed 3 areas of Gleason’s 6 and 7.

Was my elevated PSA on the basis of BPH (enlarged prostate) or cancer? I don’t know.

What did it mean that my PSA went down with an antibiotic? I don’t know.

Is it a bad idea to do a course of antibiotics and then repeat an abnormal PSA? Probably not.

If the PSA goes down after antibiotics does that mean I don’t have cancer?  No.

Why do doctors give antibiotics for an elevated PSA? Thinking that a subclinical prostatitis is causing inflammation and that this is the reason for the elevated PSA.

Summary: No harm in trying antibiotics and repeating an abnormal PSA. The key is to maintain follow-up on any abnormal PSA and monitor the trend. It is important that the patient have good understanding of what you are trying to do by repeating values in the hopes of it reverting to normal and that a biopsy not be done.

The problem: Since there are so many variables about prostate cancer in terms of the rectal exam and PSA the only definitive way to know is to do a prostate biopsy. Whether this is done or not depends (usually) more on the mindset of the patient (anxious will want to biopsy-a hesitant type will drag his feet) more than the recommendation of the doctor. Trust me on this…it is more about the patient than the doctor that guides decisions in prostate cancer.

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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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god gave burdens...also shoulders

New Robotic Surgery Technique Maintains Sexual
Function After Prostate Cancer Surgery

The SMART Technique (Samadi Modified Advanced Robotic Technique) Enhances
Surgical Precision and Maintains Sexual Wellbeing After Prostate Cancer
Treatment

Dr. David Samadi, Vice Chairman, Department of Urology, and Chief of Robotics
and Minimally Invasive Surgery at The Mount Sinai Medical Center knows the wide
range of emotions and fears that men with prostate
cancer
face. As a robotic
prostatectomy
and prostate
cancer treatment
 expert, Dr. Samadi cares for the total patient, helping
them deal with all aspects of treatment, recovery and cure. Robotic
prostatectomy procedures, performed to remove the prostate gland and surrounding
cancer, can provide excellent cancer cure results, though many men fear the
potential side effects of the surgery. Top on their list of concerns: will they
be able to have and enjoy sex
after prostate cancer treatment
?

Dr. Samadi understands this concern. “For most men, sexual function is
equally as important as eliminating prostate cancer. Many of their fears about
sex after surgery are carry-overs from what they know of older open and
laparoscopic prostatectomy techniques. Thanks to robotic
surgery
, these fears can be greatly reduced.” Historically, the prostate
gland was removed through invasive surgery during which surgeons had a difficult
time sparing the tiny nerve bundles responsible for erectile and sexual
function. Often, a man’s ability to have sex after surgery was negatively
impacted. With the advent of robotic surgery techniques, experienced surgeons
like Dr. Samadi have an enhanced view of the prostate gland, allowing increased
precision and dexterity. As a result, the risk of damage to the nerves vital to
sexual function is significantly diminished.

When treating his prostate cancer patients, Dr. Samadi employs a
start-to-finish approach, including an individualized evaluation of sexual
function prior to surgery and on-going, post-surgical assessments of options to
aid the return of sexual function. “I consider robotic surgery successful when
the cancer is cured and the patient has full continence and potency. All three
criteria must be met for me to consider the surgery a success.” Dr. Samadi dubs
this whole-patient approach, “Treatment Trifecta.”

Dr. Samadi customizes robotic surgery with his own SMART
(Samadi Modified Advanced Robotic Technique) method
. Using the da Vinci
System, the commonly recommended treatment for localized prostate cancer, Dr.
Samadi is able to perform highly precise movements at the surgical site:
cancerous tissue is cleanly removed and critical nerves are spared. By not
opening the surrounding fascia around the prostate and not suturing the dorsal
vein complex, Dr. Samadi has improved the quality of men’s post operative sex
life. Ultimately, this leads to faster recovery and an improved outlook for
regaining sexual function and urinary continence.

“Men want to know they can return to a normal life when this is all over.
They want the cancer gone and they want to move on and enjoy sex the way they
always have,” says Dr. Samadi. While the resumption of sexual potency can take
up to 12 months or more, Dr. Samadi assures patients that this is within the
normal course of recovery. His comprehensive approach to prostate cancer
treatment and sexual wellbeing continues beyond surgery. “It’s not uncommon for
men to experience some ED immediately following prostatectomy procedures, but
this is not an indication of their long-term sexual potency. I continue to work
with patients to achieve the complete results they desire.”

More can be seen from prostate cancer expert, Dr. Samadi, who is also part of
the Fox News Team.

Prostate
Cancer Treatment Options Compared: Robotic Surgery vs. Watchful Waiting

Robotic
Surgery on Good Day New York

Related Links:

http://www.smart-surgery.com/

http://www.roboticoncology-it.com/

http://www.roboticoncology-il.com/

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when you are young pain is not having pleasure...when you are old pleasure is not having pain...

Patients often choose their treatment for prostate cancer not by which has the best cure of the cancer rather which treatment best blends cure with the risks. Prostate cancer differs in this regard  from most other cancers and why many prostate cancer men choose radiation. Dirty little secret: patients understand and full well know the complications associated with surgery, but often don’t comprehend the potential risks of radiation-both early and late. Paraphrased from “The Decision.”

The five reasons:

  1. You are cut on, you might have impotence and leak urine.
  2. You are cut on, you might have impotence and leak urine.
  3. You are cut on, you might have impotence and leak urine.
  4. You are cut on, you might have impotence and leak urine.
  5. You are cut on, you might have impotence and leak urine.

You could also put at the end of each sentence…”and still not be cured of prostate cancer.”

How do you like them apples!

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Jennie C. Davis: Hall of Fame Senior Year of High School Because of her ability to do as she pleases.

The ability to do as she pleases and “calm as a hurricane”…they got that right!

Mother’s Day circa 1994:

You were born in the Depression years.  You were named after your fathers’ mother – Jennie Cooper.  As a child, you could skate faster and ride a bike better than any boy in LaGrange, Georgia.  You loved your mother but were much closer to your father.  You are a diehard Georgia Bulldog fan and it goes without saying that you hate Georgia Tech but you always respected a “Tech Man.”  You were in the Coast Guard and loved the Big Band era of the war years.  Frank Sinatra was your favorite.  You are an encyclopedia of Southern sayings like, “If you misbehave again, it’s gonna be too wet to plow.”  You feel like there is a difference between which side of the Mason-Dixon Line you’re from.  A twist of fate determined that you would raise your five boys without a husband.  You worked at night and went to school in the day and got your college degree at the age of 51 (you commuted 150 miles a day to do it).  You nursed your mother until she passed away, at home and gracefully, and then you battled cancer and are winning the fight.  You often said, “you don’t know what love is until you have children.”  All this you did with enthusiasm, optimism and vigor – always with vigor.  You are an inextinguishable spirit that is contagious to those around you.  You’re tough.  But most importantly, to your children through all the varied times, you imparted unyielding love.  The formula for a good mother is complex; mixing consistency, discipline, example and material needs to mold a child’s character.  In all these things you may not have been perfect.  But one thing was never in question, one thing was never lacking, one thing you had limitless quantities of, and that was love.  We always received love and felt loved and that was your greatest gift as a mother and a part of you we hope to pass on to our children. 

We love you  Jennie Cooper

LaGrange High School Annual Circa 1938

 

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what one does betters what’s done

See how the articles written for mass consumption leave a lot to be desired. They paint with “broad strokes.” In the young patient below we are not told his PSA, volume on biopsy of disease nor his Gleason’s score.

Readers of this blog, readers of my book should be able to discern which options make more sense based on the specifics of the patient and the disease….
You are welcome!
 

NBC — When Kelly Kellye found out he had prostate cancer even his doctors were surprised because he was only 45-years-old.

“I was the youngest patient that they had to be diagnosed with prostate cancer,” Kellye says.

Doctors are now seeing more and more men with prostate cancer in their 40s, partly because more men are being tested at an earlier age.

“The cancers in the younger men tend to be more aggressive,” says Dr. Alexis Gordon.

So now the treatment is getting more aggressive.

In the past, doctors told some patients it was okay to simply watch and wait, putting off surgery or radiation.

A new study in the New England Journal of Medicine is changing that thinking.

Researchers found surgery reduced the risk of death by 39-percent in men of all ages, but in younger men, it was even more dramatic.

Surgery cut the risk of death by 51-percent in men under age 65.

“The younger guys really shouldn’t wait, it’s something that could eventually kill them,” Dr. Gordon warns.

Kelly was diagnosed two years ago before that new study came out.

Doctors gave him the option of waiting, but he opted for surgery right away.

“If I’ve got something growing inside of me and something simple as surgery can remove it I want it done, and that’s what I’ve done,” he says.

Two years later he has no regrets.

He’s healthy and cancer free.

Some men decide to put off prostate cancer surgery for fear of side effects, including erectile dysfunction, but doctors say the current procedure is less invasive and robotic surgery options may reduce side effects.

“There’s a big misconception that your life is over once you do have the treatment for prostate cancer, and that’s just not the case anymore,” says Dr. Gordon.

Doctors say men should have a baseline prostate cancer screening at age 40, then follow-up screenings based on the results and family history.

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