TURP is useful for diagnosing early stage prostate cancer

URO TODAY: Benign prostatic hyperplasia patients in whom prostate cancer is suspected and who have urination problems, with a previously negative biopsy result, can undergo transurethral resection of the prostate, which treats bladder outlet obstruction and gives early diagnosis of prostate cancer. READ MORE>

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Combo drug for prostatic hyperplasia in men with enlarged prostate

PHARMA TIMES: US regulators have approved GlaxoSmithKline’s combination drug, Jalyn, to treat symptomatic benign prostatic hyperplasia in men with an enlarged prostate. READ MORE>

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Is ‘opt out’ the answer to conundrum over whether or not men should be offered prostate cancer tests?

PROSTATE CANCER INFOLINK: Rather than having to ask for a prostate cancer test, men should be offered it but have the right to “opt out”. READ MORE>

That’s the novel view put forward by top US prostate cancer website New Prostate Cancer Infolink, whose administrator, Mike Scott, writes:

The way we see this is that men should have an “opt out” clause that allows them not to get tested for prostate cancer risk.

This is a very American option. One can argue over whether it is right or wrong, but it clearly leaves the decision in the hands of the individual.

His latest blog looks at the somewhat ambivalent views of the American Cancer Society:

It would…be helpful, if the ACS’s chief medical officer would be so kind as to articulate the ACS’s official position with clarity, as opposed to his tendency to articulate his personal opinion about “screening” (ie, mass, population-based testing of everyone), so that the average man in the street was getting a clear message about what the ACS actually does recommend.

Scott’s view is:

…the following people should absolutely be getting PSA tests and physical exams as a means of assessing their risk for clinically significant prostate cancer starting somewhere between 40 and 50 years of age depending on their risk factors:

• Any man with a family history of prostate cancer
• Any man with an ethnic risk for prostate cancer (specifically including African Americans)
• Any man who requests such tests
• Any man who asks his physician to decide whether he should get such tests for him

In addition:

• Every man should be having a conversation with his doctor to discuss the relative risks and benefits of testing to detect possible risk for prostate cancer.

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PERSONAL STORY: When prostate rules it’s not OK

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DOMINION POST: In this personal account, a Lower Hutt man recalls the dire effects on his life of an enlarged prostate – and how he finally got it fixed.

When prostate rules it’s not OK

…was too late. I was in trouble again – this time on an island miles from a hospital. I returned in some discomfort to the company and tried to act as if everything was OK. We left soon after. When we got to the cottage I sat on the toilet until I got…read more…

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Prostate size makes no difference to outcome of radical prostatectomy

ABC NEWS: Prostate size affects the technical difficulty of radical prostatectomy but not the functional results. READ MORE>

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NZ government issues new guidelines to GPs on how to handle prostate cancer patients

PROSTABLOG NZ: New guidelines for general practitioners on how to handle men presenting with possible symptoms of prostate cancer (and other cancers) were released today by the NZ Ministry of Health.  READ MORE> and HERE (summary)>

The advice is contained in a 174-page report from the Ministry-backed NZ Guidelines Group called Suspected Cancer in Primary Care – Guidelines for investigation, referral and reducing ethnic disparities, which sets out background data and guiding principles on a range of cancers.

The report avoids getting into population-based screening – a major issue in detecting prostate cancer – saying:

Cancer screening, health promotion and prevention, case-finding in asymptomatic people, recurrence of a previous cancer and metastatic cancer were beyond the guideline scope and therefore are not included.

However, it does relent a little in the section on ethnicity and cancer treatment disparity:

Addressing the issue of cancer screening is outside the broad scope of this guideline. However, because of the impact that screening uptake can potentially have on disease outcomes, it is briefly included as part of this disparity chapter.

In the section on prostate cancer, it outlines the following advice for GPs seeing patients:

1. A man presenting with macroscopic haematuria (blood in urine) should be referred urgently to a specialist;
2. A man found to have an enlarged, smooth prostate on digital rectal examination and a normal PSA should only be referred to a specialist if they have macroscopic haematuria;
3. An older man presenting with lower urinary tract symptoms (frequency, hesitancy, nocturia) should be recommended to have a digital rectal examination and a PSA test.

Men with erectile dysfunction are excluded from the referral guidelines.

The report also contains the latest data on cancer trends and explores in some depth the detection, care and mortality disparities between Maori, Pacific people and European Kiwis.

On the page listing organisations that endorse the report (so presumably have seen it already), the Cancer Society of NZ (which opposes population-based prostate cancer screening) is included – but not the Prostate Cancer Foundation of NZ (which supports it).

The report comes just a week before the Government’s Parliamentary inquiry into prostate cancer detection and treatment, which will hear its first submissions on Wednesday.

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Size doesn’t matter – in case of recovery from radical prostatectomy

URO TODAY: Prostate size does not appear to affect biochemical recurrence after radical prostatectomy. However, estimated blood loss and operation time increased with larger prostate size, and positive surgical margins are more often observed in smaller glands. READ MORE>

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