TREATMENT/DIETARY advice

Latest robotic surgery techniques

SEPTEMBER, 2009: TECHNOLOGY.AM: The first robotic-assisted surgery performed in 1995 utilised a robotic platform to eliminate the need for an assistant to hold the camera during laparoscopic procedures.

Now the new da Vinci system represents the next evolutionary step, offering an instrument that can control a camera with one hand while simultaneously manipulating tiny laparoscopic surgical tools in its other hands. READ MORE>

What should you eat?

JULY, 2009: Advice for prostate survivors – drink pinot noir red wine from a cool climate like Central Otago in NZ’s South Island, pomegranate juice and soy milk.

And eat goji berries, broccoli, and cooked/processed tomato like good old Watties tomato ketchup.

These are just a few of the tips for men with prostate cancer who are looking for a suitable diet, says one half of an eminent NZ scientific duo.

Immunologist Dr Richard Forster – who with molecular and biological scientist Dr Jim Watson has founded a company purely to develop a new immunological treatment for advanced prostate cancer – told the Prostate Cancer Foundation’s annual conference in Napier today that diet is one of the essential tools in dealing with the disease.

Both men have advanced prostate cancer which was diagnosed too late for conventional early treatment, so are devoting their considerable scientific knowledge to finding a better way to help men in their situation.

The chart below lists their advice on diet change:

What’s your prognosis?

JUNE, 2009: What’s the most accurate way your specialist can predict your fate when you first learn you have prostate cancer? Using something called a nomogram, according to latest analysis. READ MORE>

Researchers at the University of Montreal Health Center reviewed tools available to clinicians involved in treatment decisions in newly diagnosed prostate cancer and examined their accuracy to provide individual life expectancy.

“…nomograms provide the most accurate health-adjusted life expectancy prognostication,” they conclude.

What’s a nomogram?

It’s a calculation that gives an estimate – in this case, of life expectancy – after known information is fed into it.

The Memorial Sloan Kettering Cancer Center in the US has one for prostate cancer on its website. Anyone who knows the results of PSA, biopsy and Gleason grade can use it: CLICK HERE>

Which treatment is best?

MAY, 2009: No one therapy can be considered the preferred treatment for localised prostate cancer, says a US Department of Health and Human Services report, Comparative Effectiveness of Therapies for Clinically Localized Prostate Cancer, published in 2008. READ WHOLE REPORT>

This is because of limitations in the body of evidence, as well as the likely trade-offs an individual patient must make between estimated treatment effectiveness, necessity, and adverse effects, say the report’s conclusions.

All treatment options result in adverse effects (primarily urinary, bowel, and sexual), although the severity and frequency may vary between treatments. Even if differences in therapeutic effectiveness exist, differences in adverse effects, convenience, and costs are likely to be important factors in individual patient decisionmaking.

Patient satisfaction with therapy is high and associated with several clinically relevant outcome measures. Data from nonrandomized trials are inadequate to reliably assess comparative effectiveness and adverse effects. Additional randomized controlled trials (RCTs) are needed.

Limitations in the existing evidence include the following:

• Few randomized trials directly compared the relative effectiveness between (rather than within) major treatment categories.
• Many randomized trials are inadequately powered to provide long-term survival outcomes, with the majority reporting biochemical progression or recurrence as the main outcomes.
• Some randomized trials were old, conducted prior to prostate cancer detection with PSA testing (i.e., studies before the current era, when tumors are diagnosed in an earlier stage, giving more lead time, and there is a higher percentage of benign tumors, resulting in length bias and overdiagnosis), and used technical aspects of treatment that may not reflect current practice; therefore, their results may not be generalizable to modern practice settings.
• Wide variation existed in reporting and definitions of outcomes.
• There was little reporting of outcomes according to major patient and tumor characteristics.
• Emerging technologies have not been evaluated in randomized trials.

Adjuvant Chemotherapy

APRIL, 2009: The types of cancer in which adjuvant chemotherapy is used are quite various and here we may include colon cancer, lung, pancreatic, breast and prostate cancer as well as some forms of gynecological cancers. READ MORE>

Treatment options for prostate cancer and how they compare.

APRIL: 2009: WALL STREET JOURNAL health section.

TREATMENT	RECOMMENDED FOR	PROS	CONS
Active Surveillance: Also known as watchful waiting; no treatment, but continued monitoring via PSA, biopsies, scanning.	Gleason score below seven, PSA below 10; small, localized tumors; men with less than 10 years’ life expectancy.	85% of prostate cancers don’t cause problems; no surgery, no hospitalization, no side effects; new imaging techniques allow close monitoring.	15% of prostate cancers do spread, requiring more aggressive treatment later; requires regular follow-ups; psychological stress.
Prostatectomy: Removal of the prostate gland by traditional open, laparoscopic or robotic surgery.	Cancer confined to the prostate, men under 65 and healthy enough for surgery.	Fast cancer removal; gives best information on disease stage; can be followed by radiation.	Requires hospitalization, urinary catheter for seven to 10 days; erectile and urinary side effects.
External-Beam Radiation: Prostate is bombarded from outside the body with X-rays or proton beams.	Cancer outside the prostate; men over 70 and those who can’t have surgery.	No incisions, hospitalization or anaesthesia; few immediate side effects.	Up to 40 daily sessions; can cause erectile and urinary problems that worsen over time; can cause rectal soreness.
Brachytherapy: Tiny radioactive seeds are implanted in prostate and kill the cancer cells gradually.	Low and medium-grade cancers.	One-time, minimally invasive procedure; no hospital stay.	Urinary and erectile problems can develop over time.
Focal Ablation: Cancer is destroyed by freezing (cryotherapy) or high-frequency radio waves.	Small, localized tumours that can be seen clearly via imaging or mapping biopsies.	Minimally invasive; leaves part of prostate intact; can be repeated as necessary.	Heat and cold can damage surrounding tissue; little long-term data on the procedure.
Drug Therapies: Hormone medications block androgens that fuel cancers; can be combined with radiation or chemotherapy.	Advanced, high-grade or recurrent cancers.	Can help halt spread of cancer, shrink enlarged prostate.	Loss of libido and erectile function; osteoporosis; decreased muscle mass; hot flashes; breast enlargement; diminished mental acuity.

Active surveillance

APRIL, 2009: When prostate cancer is diagnosed, sometimes there is the option of doing nothing - called ”watching and waiting”. But how do you decide? READ MORE>