Feeds:
Posts
Comments

Posts Tagged ‘Radical prostatectomy’

PROSTABLOG NZ: My last PSA test recently showed it continues to be undetectable, some 20 months after my surgery in March, 2009.

But I’m not getting cocky just yet (forgive the pun).

From what I’ve read about prostate cancer treatment, if the cancer bug has got out of the organ during/after a prostatectomy, there’s a good chance the first signs will come two years after the operation.

My two-year anniversary comes up in a couple of months – so wish me luck.

It’s interesting how long it takes to fully recover from the surgery’s effects.

My scar is virtually gone and I’ve felt fit for ages.

There’s no incontinence. I haven’t done the pelvic floor exercises for more than a year, but there’s never any problem with not being able to hold it in, even when I’m busting.

Not that I put myself in the busting mode if I can avoid it.

So, hey, no regrets and no real worries. I’m bloody lucky.

Well, there is one worry – the number of friends and people I know who have been diagnosed. Talk about an epidemic.

And I wonder if the NZ Parliamentary Health Select Committee will ever get round to reporting back on its prostate cancer inquiry…

Read Full Post »

PROSTABLOG NZ:  HERE are four key issues the NZ Parliamentary inquiry into the detection and treatment of prostate cancer ought now to be focusing on:

  • Mass screening…or not: Not. The evidence in favour of mass screening of all middle-aged men for prostate cancer is not sufficiently strong in statistical terms to overcome the counter-arguments concerning needless and over-treatment and high likelihood of after effects that will blight quality of life.

But…it’s not strong enough yet. That may change as more studies are done and closer analysis of the large random trials is completed. PSA testing may also improve, or be replaced with something better, a test that defines the actual risk to the patient.

  • Guidelines to GPs must be revised. Currently, GPs are forbidden by the Ministry of Health to routinely offer PSA tests and/or rectal examinations for prostate cancer unless a man asks, or mentions symptoms. Since this can be a symptomless disease (until it’s too late), that is unacceptable. It also presumes that people don’t move around, change doctors, lose track of medical records, or simply have little idea of the implications of dad dying of prostate cancer.

If the Ministry of Health wants to avoid high-risk treatment being offered unnecessarily, it needs to move the initial gatekeeping further up the food chain to the specialists.

  • Specialists’ advice needs to be delivered via a more balanced and less costly method. At present, the system works well enough up to the point the pathologist finds signs of cancer in biopsy samples.

But after that, men are left to fend for themselves when it comes to seeking advice from a range of authorities. Some don’t bother, and just go with what the urologist offers. Some can’t afford the $1600 charged by a cancer specialist (oncologist), who may be the most neutral source of advice available.

In the US, the first specialists in the hierarchy, urologists, earned themselves the unenviable moniker of “prostate snatchers” because of the lucrative, medical insurance-backed business of prostate surgery.

How about panels of doctors representing the main treatment options in NZ (surgery, robotic surgery, external beam radiation, brachytherapy, watchful waiting) reviewing the case notes and offering clearly explained options to patients?

  • The public needs to be kept up to date – in layman’s terms – with diagnostic and treatment developments. This is not happening at present. The Ministry and its satellite committees do not have readily available, up-to-date information on the web to help men with newly diagnosed prostate cancer become fully informed before making one of the biggest decisions of their lives.

As wealthy male baby boomers hit the danger zone, enormous amounts of US, European and Asian money are going into researching and developing new drugs, methods of surgery and radiation, diagnostic tools and a bewildering range of related methdologies.

That’s the point – it’s bewildering to the average Kiwi, who must hope his medics are keeping up to date and that the government is adequately funding new treatments.

For example, there is Provenge, a new $100,000+ drug regime that will extend life for a few months, and which is now selling big in the US. When will we see it here?

Communicating the relevance of the overseas prostate industry boom to Kiwis cannot be left solely to the news media here: that’s worse than leaving it to chance and the public relations industry.

Few, if any, journalists in NZ take an abiding interest in prostate cancer (why would they – it’s one of many diseases), and what they do write is sometimes ill-informed, incomplete, inaccurate and out of date.

Finally, the Health Select Committee would be wise to keep its files open on this inquiry. It would be a mistake to shut the doors on a tsunami of prostate cancer information that emerges daily on the web.

Developments are moving so quickly, the committee should require the Ministry of Health to report regularly about what’s happening. The inquiry report, when it finally emerges, should be an interim one that can be updated over time.

The committee is wrestling with questions that are far from settled.

Read Full Post »

NEW PROSTATE CANCER INFOLINK:  Men with low-risk prostate cancer who choose surgery need to realise the possible after-effects – reduced urinary and erectile function, shorter penis, penis distortion – they might have to live with for up to 35 years afterwards. READ MORE>

Read Full Post »

URO TODAY: A more precise grading system is needed to predict men’s erectile function recovery after nerve-sparing prostate surgery, a study shows. READ MORE>

Our data support the adoption of a subjectively assigned nerve-sparing score to more precisely predict erectile function outcomes and suggest that even minor nerve trauma significantly impairs the recovery of erectile function after procedures classically regarded as having achieved bilateral nerve sparing.

Further studies are needed to identify the optimal nerve-sparing system.

Read Full Post »

URO TODAY: Robot-assisted laparoscopic radical prostatectomy for prostate cancer is a safe alternative to classical surgery and the robotic approach is reliable, according to a four-year US study. READ MORE>

Read Full Post »

URO TODAY: One in five men have a DNA variation that increases the risk of prostate cancer recurring after surgery, even though other factors (early diagnosis, low aggression, etc) may be in their favour. READ MORE> and HERE>

Department of Radiation Oncology, Vanderbilt University, Nashville, US:
The A/G genotype of rs10895304 is predictive of decreased recurrence-free survival in patients with clinically localised prostate cancer.

Our data suggest that for this subset of patients, prostatectomy alone may not be adequate for local control.

This is a novel and relevant marker that should be evaluated for improved risk stratification of patients who may be candidates for adjuvant radiation therapy to improve local control.

Read Full Post »

URO TODAY: Men undergoing prostate surgery have a higher risk of later developing a penis-deforming condition called Peyronie’s disease. READ MORE>

Read Full Post »

URO TODAY: The greater number of positive samples in a prostate cancer biopsy (usually 12 samples), the greater the chance the disease has spread to the lymph system. READ MORE>

The percentage of positive cores involved with prostate cancer is the most reliable predictor of lymph node metastases and indicates the need for extended pelvic lymphadenectomy.

Read Full Post »

URO TODAY: Having erectile dysfunction prior to prostate cancer surgery does not affect you chances of surviving the treatment, a study shows. READ MORE>

Pre-operative erectile dysfunction is associated with decreased overall survival and survival from causes other than prostate cancer following radical prostatectomy.

However, pre-operative ED was not an independent predictor of overall survival after adjusting for other predictors of survival.

Urologists should carefully assess pre-treatment ED status to enhance appropriate treatment recommendation for men with prostate cancer.

Read Full Post »

URO TODAY: Use of a carbon dioxide laser to assist in robot-assisted radical prostatectomy improves nerve sparing and reduces damage that can cause impotency. READ MORE>

Read Full Post »

Older Posts »

Follow

Get every new post delivered to your Inbox.

Join 26 other followers