The Lure of the Robot

Robotic surgery is the preferred choice of men today to pluck out there cancerous prostates.  But is it any better than traditional surgery?  Is the promise of fewer side effects living up to the hype?  Is there a financial incentive for physicians and providers to recommend the robot? 

From New York Times, March 11, 2011 ... "Hospitals With Robots Do More Prostate Cancer Surgery"

"Hospitals that buy surgical robots end up performing more prostate cancer operations, suggesting that technology has become a driving force behind decisions about men’s cancer care, new research shows..."

But is it better than any other treatment or doing nothing at all?  There's no evidence to say one way or the other....  

"But," the article continues, "that hasn’t stopped hospitals from conducting intense marketing campaigns that imply surgery using the high-tech robot gives prostate cancer patients a better result."

Ben Org, author of All About The Prostate, put a finer point on the issue and financial incentives in the general promotion of robotic surgery, when he wrote in the following email.... 

"Follow the money. From 2001-06, use of the da Vinci system — the only robot available for this operation — rose from one per cent to 40 per cent of all radical prostatectomies. During that time, the stock price of da Vinci’s maker, Sunnyvale, California-based Intuitive Surgical Inc., increased 11-fold.

A PROSTATE CANCER MONEY TREE

Reposted here from Wall Street Journal, December 2010.  It's worth a second look because the whole idea behind the story is so outrageous, i.e. financial gain is driving overtreatment (with new forms of radiation) of prostate cancer patients ... and it's so easy because Medicare is paying the tab.

A Device to Kill Cancer, Lift Revenue
By John Carreyrou and Maurice Tamman

"Roughly one in three Medicare beneficiaries diagnosed with prostate cancer today gets a sophisticated form of radiation therapy called IMRT. Eight years ago, virtually no patients received the treatment.

"The story behind the sharp rise in the use of IMRT—which stands for intensity-modulated radiation therapy—is about more than just the rapid adoption of a new medical technology. It's also about financial incentives...."

On Recurrence, Running & River Rocks

Anyone who has had cancer holds their breath for their regular tests, even when the pattern has been favorable. For prostate cancer survivors, when a PSA begins rising again—or even creeping up—the anxiety level creeps up with it.

That's the situation I’m facing—my PSA rising in two consecutive tests, from a .9 nadir to 1.3 to 1.5 in December (earlier post). I thought these were low and insignificant numbers until my alarmist urologist began talking “salvage therapy” and another “biopsy” and “cryotherapy” and totally freaked me out. 

His position: three rises would warrant more snipping.  He called my little creep-ups “significant.”

Really?  I didn’t want to hear it. The specter of recurrence hit me harder than the original cancer diagnosis in 2008.  Not sure why, but I got upset and depressed for about five days … until I righted that emotional ship again.

I started running more, upping my weekly mileage.  Running has always been my salvation.  I’ve been a runner since I graduated from the University of Florida, back in 1975.  I ran 13 marathons, including a Boston, two New Yorks, and three Chicagos, and covered more than 20,000 miles— a portion of which were therapeutic miles for everyday life crisis’s, large and small.

A creeping PSA qualified for self-imposed therapy. As usual, as my mileage went up, my head cleared. And when I don't feel like running, I have discovered a neat little new trick to get me out on the road.   

River rocks.

Family Guy Prostate Exam

Click here.

LOL!!!

Prostate Cancer Risk Factors You Can Control

Diet seems to be a 'smoking gun' in the development of prostate cancer, which is much more common in countries where meat and high-fat dairy are mainstays. The reason for this link is unclear.  But dietary fat, particularly animal fat from red meat, may boost male hormone levels, which may fuel the growth of prostate cells. Men who eat fewer fruits and vegetables and high-fat dairy products have higher prostate cancer risk as well.

In other words, a steady diet of greasy fat cheeseburgers -- red meat and dairy cheese -- is a terrible combo for prostate health.


While consumption of saturated fats promote the growth of prostate cancer cells, soy consumption and drinking of green tea reduce the risk, according to the Mayo Clinic.

Health News and Research reports that a U.K. Study found that eating fish, especially oily fish with Omega-3 fats helps prevent prostate cancer. Broccoli provides some protection against this type of cancer, according to a U.S. study. Beans and green peas may provide some protection too.

Study: Meat industry antibiotic prevents prostate cancer growth

When I was dazed and confused in the early days of my prostate cancer diagnosis in 2008, I kept stumbling on a theory that as men age, the presence of higher testosterone levels acts as a fuel for prostate cancer growth. It begs the question, why don't men earlier in life get prostate cancer when they are brimming with testosterone?

I'm still unclear on the answer to that question.  But a recent study shows that an antibiotic used in the meal and daily industry can turn off the testosterone receptors and simultaneously increase production of oxygen to damage the DNA in cancer cells.

This lethal combination is shown to prevent the growth of prostate cancer cells. The article is in Science Day, called Compound That Prevents the Growth of Prostate Cancer Cells Identified (Dec. 27, 2010).

Your 50/50 shot of missing prostate cancer with initial biopsy

More than one million biopsies for prostate cancer are performed annually in the U.S., with 40%-50% of initial biopsies identifying cancer.  So more than one half million new cases have negative prostate biopsies.

Yet ... in those who have repeat biopsies because of rising PSAs, cancer is identified in approximately 25% of these men.

In other words, our current biopsy procedure "misses up to half of all small tumors and up to one third of tumors eventually detected even using repeat sextant biopsy," according urologist Dr. J. Stephen Jones, in his article Managing Patients Following a Negative Prostate Biopsy, in Renal and Urology News, Feb. 8, 2011. (Graphic at right from article)

Yeah, that's scary -- there's a lot of missed cancer, but also a lot of unnecessary biopsies.

Famous guys with prostate cancer

I’ll try to keep this updated from time to time.  Many names from the “Health Diaries” and other sources.

Bill Rogers: A 4-time Boston Marathon and New York marathon winner, “Boston Billy” was diagnosed with prostate cancer in December 2007 and had surgery shortly after – and then began a running series benefitting prostate cancer research.

Dennis Hopper: ‘Easy Rider’ and ‘Apocalypse Now’ star succumbed to prostate cancer in May 2010, after being diagnosed with the disease about eight months earlier during a visit to a hospital for the flu.  At the time, his cancer had progressed beyond the prostate and into the bones. He was 74.

Robert DeNiro: The Academy Award winner was diagnosed with early-stage cancer in 2003 at the age of 60. He has kept details of his treatment private. His father died of prostate cancer at the age of 71.  To the right, early career ... as the Taxi Driver.... 

Dan Fogelberg: The American singer-songwriter battled advanced prostate cancer for three years.  He underwent therapy and the cancer went in remission for awhile before he finally died at age 56 in December 2007.

James Brown: The Godfather of Soul was diagnosed with prostate cancer in 2004 but survived. He died of heart failure in 2006.  

More help in making treatment decision

From the Wall Street Journal, Ron Winslow, February 3, 2011

Researchers said they have identified a combination of four genes that appear to play a critical role in determining whether prostate cancer in its early stages will go on to become an aggressive, lethal disease. 

The information could enable doctors and patients to make better decisions after the diagnosis of prostate cancer, a disease that is commonly overtreated today, researchers said.

Predicting Outcomes

From the Arkansas Prostate Cancer Foundation

• Almost 100% of men diagnosed with prostate cancer are still alive in 5 years*.
• Over 90% of prostate cancer cases are found while the cancer is still either local or regional, and nearly 100% of these men are still alive 5 years after being diagnosed.
• In cases where the cancer has spread to distant parts of the body, 34% survive 5 years.
• After 10 years, about 98% of men diagnosed with early-stage prostate cancer are still alive*, but only 17.6% of those diagnosed with advanced-stage prostate cancer survive 10 years*.

*not including those who died from other causes.

Cleansing for prostate health?

Harmful toxins and parasites live in the colon and digestive system, eventually making their way to the prostate, where they accumulate enmasse and set the stage for disease, infection and chronic inflammation, a potential precursor for cancer.

It's a theory, espoused by many, especially in the alternative medical fields, including Dr. Larry Clapp, who popularized the idea in his book, Prostate Health in 90 Days without drugs or surgery (first published in 1997 and updated in 2007).

Even prestigious mainstream researchers like Johns Hopkins Research now report how chronic inflammation from bacterial infection can  trigger changes in our DNA, leading to tumor development.

Because of the prostate's vulnerability to infection and inflammation—by definition prostatitis, the number one reason why men visit urologists in the U.S—JHR has called the prostate "a breeding ground for cancer."

Check out Coming Clean On My 9-Day Cleanse ... in it, I blog about my second experience with a cleanse and some thoughts on cleansing and prostate health.

I don't have any interest in the company, Isogenix, that produced the cleanse products.

New Prostate Cancer Statistics

• Prostate cancer is the most common cancer among men, excluding skin cancer.
• American Cancer Society (ACS) estimates for 2010 include 217,730 new cases of prostate cancer in the US.
• Year 2010 estimates include 32,050 deaths occurring from prostate cancer in the US alone, making it the second leading cause of cancer death in men.
• All men are at risk for prostate cancer. The risk increases with age, and family history also increases the risk.
• African American men are more likely to have prostate cancer than Caucasian men, and have nearly a two-fold higher mortality rate than Caucasian men.

To treat or not to treat--new biomarker may help make decision

        A new "biomarker" has been have identified that may help men make a life-altering decision, whether to opt for radical surgery or radiation or to let the prostate cancer go untreated—knowing that, in most cases, prostate cancer is slow-growing and will never become fatal. After studying the medical records of 6,710 men over a period of five or more years, the researchers found that those with the highest ionized calcium levels in their bloodstream were three times more likely to die of prostate cancer than those with the least amount of the calcium.
       The study was reported in the February issue of Cancer Epidemiology, Biomarkers & Prevention

Aspirin may reduce prostate cancer deaths

Taking an aspirin a day has many health benefits, and reducing prostate cancer may be one of them.  New research shows men who use aspirin or other blood thinners after treatment for prostate cancer have a substantially lower risk of dying or seeing the cancer spread to another organ.


Christopher Logothetis, M.D., a medical oncologist at the University of Texas MD Anderson Cancer Center in Houston, said the study is in line with others that suggest aspirin's blood-thinning and anti-inflammatory properties reduce the risk of many kinds of cancer.


"Anti-inflammatory" is the key word here.  The Prostate Storm discusses at some length the connection between inflammation in the prostate with the occurrence of cancer.   The notion is that if you can reduce prostatic inflammation (prostatitis, by definition) through an anti-inflammatory diet, you can reduce prostate cancer as well.

PSA Rising? Say it Ain't So ...

Only days before publishing what I thought would be my first and last book on prostate cancer, The Prostate Storm, I got a call from my urologist’s office.  The nurse tells me the doctor wants to see me “immediately” about my latest PSA level.  

My alarm bells going off, I naturally ask what the number was.  I had just taken my tenth follow-up PSA test after high-dose radiation treatment 28 months earlier, but I didn’t know the result.  The nurse tells me 1.5 (ng/ml), which initially was a relief but I realized too it had risen from a nadir of 0.9 to 1.3 and now 1.5 in just six months. 

I wasn’t sure what a little bump up like that meant.  A year ago I had experienced a full point jump, the phantom “bounce” which happens to a lot of guys who have radiation therapy; it settled back to the nadir within three months.  

Like most guys with prostate cancer, I also had a history of BPH and prostatitis, which can influence PSA levels, so my initial reaction was not to worry.  A small rise could be attributable to lots of things, including sex. So I asked the nurse to have the urologist to please call me, but she explained the doctor didn’t make phone calls to patients “otherwise he’d be doing that all the time.” She insisted Dr. JM wanted to see me “as soon as possible” — which, she said, would have to be next Friday, a full week away.

Huh?  Doctor raises my anxiety level to Defcon 5, he won’t call me, and he won’t see me for seven days—what crappy patient care is that?  Is that how the “cancer may be returning” message is generally delivered? 

Why Some Prostate Cancers Are More Aggressive than Others

Researchers have uncovered a mechanism that determines prostate cancer aggressiveness -- a study published in Cancer Cell (July 13, 2010)

Why is this interesting?  For one thing, if science can determine which prostate cancers are more aggressive and hence life-threatening, physicians may not blanket recommend major interventions -- surgeries and radiation -- that do more harm than good in many men. Watchful waiting may be the more prudent course of action.

Around 15% of prostate cancers are dangerous or life-threatening, regardless of age -- but what makes them dangerous?  Could a guy get a test to see if he is truly at risk instead of having life-altering open or robotic surgery or high dose radiation (see post below on over treatment)?

The research below is focusing in on that question ....

Here's the release from the Sanford Burnham Medical Research Institute:

"How Prostate Cancer Packs A Punch"

Some types of prostate tumors are more aggressive and more likely to metastasize than others. Nearly one-third of these aggressive tumors contain a small nest of especially dangerous cells known as neuroendocrine-type cells. More rarely, some aggressive prostate tumors are made up entirely of neuroendocrine-type cells. The presence of neuroendocrine-type cancer cells is associated with a poor prognosis, but spotting these rare cells can be like finding a needle in a haystack.

More on Over Treatment, Colluding Physicians, PC Putting Medicare at Risk -- A Story of Greed (Docs) and Fear (Patients) -- From WSJ

 A hot topic in The Prostate Storm ... and in the Wall Street Journal this month:

Men with prostate cancer being over-treated (this time with high-dose radiation) and urologists colluding for financial gain ... oh my, could this really be true?  Are the reimbursements Medicare pays out as more Boomers move through their prostate years just too fat to pass up? Apparently...and it could bankrupt the system.

What happened to "do no harm first"?

Here's a couple excerpts from the Wall Street Journal, "A Device to Kill Cancer, Lift Revenue," on December 7, 2010.

"Roughly one in three Medicare beneficiaries diagnosed with prostate cancer today gets a sophisticated form of radiation therapy called IMRT. Eight years ago, virtually no patients received the treatment.

"The story behind the sharp rise in the use of IMRT—which stands for intensity-modulated radiation therapy—is about more than just the rapid adoption of a new medical technology. It's also about financial incentives...."

That's the lead ... later in the story:

"More than 190,000 American men are diagnosed with prostate cancer each year. How—and even whether—to treat the disease has long been controversial because prostate cancer tends to grow slowly. Many victims are more likely to die from other causes.

Check out this great site!

I love this site. Blogs written by people with all cancers, including prostate, the stories are heroic in many instances and will break your heart. The mission of Blog for a Cure is to make life a little bit easier for cancer survivors by providing a free personal web publishing service for them. Created by Jill, a breast cancer survivor, Blog for the Cure invites cancer patients to start a personal blog of their own to keep track of their journey.

COLD PC KILLER: New crytotherapy without side effects?

Just before heading to press with The Prostate Storm, something very cool, literally, crossed my desk on a new form of  crytotherapy that may actually kill prostate cancer cells without the usual side effects.

Well, that's the promise anyway.

It's called focal cryoablation, which allows doctors to freeze cancer cells at negative 40 degrees, using 3D biopsies to target the treatment directly to the tumor.  Sounds like a targeted cold therapy to me -- not unlike the targeted radiation of IGRT compared to the old shotgun approach with external beam.

In conventional crytotherapy, the treatment would freeze the prostate in order to kill off clusters of cancer cells. Side effects are considered rather mild, although the big risk is the impairment of sexual function, so I suppose it depends on your definition of “mild.” The freezing of the prostate may destroy the nerve bundles responsible for erections.

Are Men With Localized Prostate Cancer Being Overtreated?

The other day I'm talking to a friend whose dad, at 75, elected to have da Vinci robotic surgery for localized PC. I couldn't believe his dad had done anything. He had a Gleason score of 6, which is not life threatening at all and indicates a super slow growing cancer, especially at his age:  Why go through the surgery and risk the side effects of therapy?  Which is not fun.

Because, he explained, "my Dad wanted it out."

Get the cancer out at all costs.  Well, that's the first problem.  Most guys don't understand not everyone needs to get rid of prostate cancer, that most ALL men get  PC if they live long enough, and that about 50% of it is so slow growing it's not a risk to their life, according to research from scientists at the University of Michigan (The Prostate Cancer Quandary, Wall Street Journal, June 28, 2010).

Half of all prostate cancer is not a threat.  But guys are freaked out by having it.  Yet doctors are not educating them on watchful waiting as a smarter  option.  Smarter because the side effects of treatment are rough, and likely lifelong -- and completely unnecessary for many guys.