Tuesday, October 27, 2009

Letter to the Editor, LA Times, on PSA Testing

29000 Men Comment
Below is a copy of my letter to the editor that was published in the LA Times on 10/27/2009. It was slightly shortened to conform to the 150 word limit. Eliminated was my comment that the annual prostate cancer death rate has dropped from the 40,000 men per year in the pre-PSA test era to the approximately 29,000 deaths per year today. If the current debate is successful in convincing men they do need to test and track their PSA, we very likely will see a return to the 40,000 per year death rate. This would mean that an additional 100,000 men would die unnecessarily from prostate cancer each decade.

I believe that we need to focus more on prostate cancer prevention and methods to effectively determine which cancers are the aggressive killers. See the Times letter below.

LA Times Opinion Section, October 27, 2009
Cancer risks and diagnoses

Re “With cancer, it’s always personal,” Oct. 25

Thank you for running Paul Lieberman's Op-Ed article on prostate and breast-cancer screening.

I would, however, retitle his article, "With Cancer, it's never real until it's personal. " My point is that one only comes to terms with cancer after we, personally, are diagnosed. The danger with the current discussion over prostate cancer testing is that the continual focus on possible post-treatment problems may drive the annual PSA testing rate below the current meager rate.

The principal issue with PSA testing is not with the number of men tested but with the treatment decisions made by cancer patients and their physicians. What men need is better information about prostate cancer risk and treatment options, but with real statistics about post-treatment side effects attached.

And, of course, the ability of physicians to be able to reliably differentiate between benign and aggressive forms of prostate cancer.

Robert W. Hess
Manhattan Beach

http://www.latimes.com/news/opinion/letters/

Monday, October 26, 2009

Mayo researchers find few side effects from radiation treatment given after prostate cancer surgery

29000 Men Comment
The following article came from by Cancer Weekly, a leading research newsletter for biotech and pharmaceutical professionals. For more information, go to http://www.newsrx.com/publication.php?pubID=74.

If correct, the results of the study detailed below should be reviewed by all men preparing to undergo prostate cancer surgery. In my case, the option was never mentioned. I’m now 5 1/2 years into my survivorship and recurrence is something I think about often.

“Mayo researchers find few side effects from radiation treatment given after prostate cancer surgery

The largest single-institution study of its kind has found few complications in prostate cancer patients treated with radiotherapy after surgery to remove the prostate. Men in this study received radiotherapy after a prostate-specific antigen (PSA) test following surgery indicated their cancer had recurred.

Researchers say the findings from Mayo Clinic's campuses in Florida and Minnesota suggest that patients and their physicians should not overly worry about toxicity and side effects from the treatment, known as salvage external beam radiotherapy. The study findings will be published in the October issue of Radiotherapy and Oncology.

"There is a general fear of this kind of radiation treatment on the part of some patients and their physicians, but this study shows that it not only effectively eradicates the recurrent cancer in a substantial number of patients, but that there are few serious side effects," says the study's lead investigator, Jennifer Peterson, M.D., from the Department of Radiation Oncology at Mayo Clinic in Florida.

"It is really important that patients and their doctors watch PSA levels after a radical prostatectomy, which is a complete removal of the prostate," she says. In men who have an intact prostate, a PSA test can indicate either an enlarged prostate gland or development of cancer in the prostate, says Dr. Peterson. "But in men without a prostate, a rising PSA level indicates that cancer has recurred. After a recurrence is detected, there is only a narrow window of time during which radiotherapy will be beneficial in controlling their cancer."

"No other therapy besides salvage external beam radiotherapy has been shown to cure these patients," she adds.

In 2009, an estimated 192,000 American men will have newly diagnosed prostate cancer. Approximately one-third (about 64,000 men) will choose radical prostatectomy as their primary treatment, according to the National Cancer Institute. Large studies have shown that one-third of those men, about 21,000 patients, will experience a rising PSA - a recurrence of their cancer - within five to 10 years, says Dr. Peterson. "Two-thirds of these men, if left untreated, will have metastatic disease within 10 years, but the chances of that occurring are greatly reduced in patients given salvage radiotherapy," she says.

Lingering uncertainty about the effectiveness of salvage radiotherapy and its side effects have led many urologists not to recommend the treatment, says co-author Steven Buskirk, M.D., from Mayo Clinic in Florida.

This study, which lasted two decades, was undertaken to specifically document those side effects. It studied 308 patients with a median follow-up of 60 months after salvage external beam radiotherapy. Only one patient had a serious (grade 4) complication and three patients had a less serious (grade 3) side effect. None of these effects were fatal, and all were treated. Milder side effects were seen in an additional 37 patients, the researchers say, and all were successfully treated for these complications. Urinary leakage, a concern of many patients who choose not to use radiation, was not a common side effect of treatment.”

Saturday, October 24, 2009

What We Eat and Do May be the Real Strategy for Beating Cancer

29000 Men Comment
“No matter how strange something is, if you give it enough time it becomes normal. American’s have now accepted heart disease, cancer, and other degenerative diseases as a normal part of American life.” (1)

Now approaching six years as a prostate cancer survivor and amateur student of wellness and cancer recurrence prevention, I have arrived at the conclusion that our best chance at avoiding or defeating this disease rests with our own habits.

I’ve been looking at this issue for five years now, and I recently read books by David Servan-Schreier, MD, PhD, Anti Cancer: A New Way of Life, and the RAVE Diet and Lifestyle by Mike Anderson.

I’ll be summarizing what my key takeaways from these books over the next series of posts, and I encourage your feedback - even “pushback.” I’ll also be posting some of my personal recipes for “quick eats that are so easy "Even a Guy can do them!”

Best regards, Robert


Anderson, Mike, The RAVE Diet, RAVEDIET.com, August, 2004.

Thursday, October 22, 2009

Mild Incontinence

In case you have just a small bit of incontinence following surgery or radiation therapy, consider using women's panty liners. They are smaller than men's products, work really well, and are absolutely undetectable. If you are a numbers guys, you can get a small postal scale and track the degree of incontinence and watch as your kegel exercises begin to work.

To PSA or Not to PSA. Is that the Question?

29000 Men Comment
Below is a good description of some of the history of PSA testing and accepted PSA values for specific age ranges. The problem with guidelines is that there are the general rule and don’t cover the statistical outliers. For example, I am an accidental prostate cancer survivor. I was diagnosed at age 57 with a PSA value of 3.2, well within the acceptable range according to the standard. I also had a negative DRE, which was misleading because my tumors were sitting on top of the prostate where they could not be felt. My post treatment diagnosis was Stage 2, with a Gleason Score of 3+3. I am only here writing this blog because my urologist was super diligent and ordered a Free PSA test that came back with a very low ratio (.09; 9%).

Prostate cancer kills almost 29,000 men each year. It is up to each man individually to monitor his PSA, track the changes, and then get the facts. I am not suggesting a rush to treatment, but I do believe it is vitally important for men to know if they have prostate cancer as soon as possible. If you are unlucky and are one of the 1 in 6 men that is diagnosed, the next step is to work with the doctor to determine if you have an aggressive form of the disease.

Please visit us at 29000Men.org and participate in one of our prostate cancer awareness events.

Begin Quote of Referenced Material
The PSA Test


Understanding the PSA Test and Results

Prostate Specific Antigen (PSA) is a protein made in the prostate. Normally, very little should be found in the blood. Rising levels of PSA in the blood indicate a problem with the prostate, which could be cancer but could also be an enlarged prostate (BPH).

Annual screening should start at age 45 for the general population, but the right age to start PSA testing depends on your level of risk.

Doctors usually recommend further testing for men with a total PSA level of 2.5 or more nanograms of PSA per milliliter of blood (ng/ml). This cut-off level has been set by the National Comprehensive Cancer Network, a large network of cancer experts who establish industry wide standards.

As PSA levels increase, so do the odds that it’s due to prostate cancer. About 25 percent of men with a PSA level from 4 to 10 have prostate cancer. About 67 percent of men with a PSA above 10 have the disease.

The change in your PSA level over time, PSA velocity, is very important. Even if your PSA is 4.0 ng/ml or below, an increase of 50 percent or more in one year may indicate prostate cancer. If your PSA is above 4.0 ng/ml, an increase of 75 percent or more in one year could indicate an aggressive case of the disease.

There are some factors that you and your doctor may want to consider when it comes to interpreting your score:

* Your age. Doctors may use age-adjusted PSA ranges to account for the natural increase in PSA with age when considering further testing.
* The size of your prostate. PSA Density is a measure that relates your PSA level to the size of your prostate, to account for the increase in PSA caused by prostate enlargement.
* Your weight. Body Mass Index, a measure of obesity, may also be a factor. The relationship between obesity and lower PSA levels may cause doctors to miss early prostate cancer cases in overweight men.
* Ejaculation within 48 hours before taking a PSA test can also cause a higher reading of your PSA level.

Some doctors recommend the following PSA cut-off levels adjusted by age and ethnicity:

Age Caucasian or Hispanic African American Asian

40 to 49 2.5 2.0 2.0

50 to 59 3.5 4.0 3.0

60 to 69 4.5 4.5 4.0

70 to 79 6.5 5.5 5.0

PSA Test Standards

Today, because there are two standards for PSA tests, the same cutoff should not be used across all PSA tests. It is important for you and your physician to know which type of test your clinic’s lab uses and how to correctly interpret the results.

The Hybritech PSA test established 4.0 ng/mL as the cutoff for a normal test. This means men with a score above 4.0 should be referred for further testing, such as a biopsy. Men with a result lower than 4.0 may not be referred for biopsy, depending on their physician’s instructions. As other manufactures developed PSA tests, they aligned their tests to the same standard, which became known as the "Hybritech standard," and other manufacturers used the same recommended cutoff of 4.0.

By the mid-1990s, some researchers began to recognize that test results from different test manufacturers could be slightly different and joined together to create a common calibration standard to better align results from different PSA tests. This standard was accepted by the World Health Organization (WHO) and soon became known in the medical community as the “WHO standard” PSA test. To establish this new standard, a different scientific process to measure molecular weight of PSA was used and found that weight to be 20 percent higher than was used for the Hybritech test. Because of the way this is calculated, a WHO test would show a proportionately lower PSA concentration level than would a Hybritech test for the same sample. As a result, the cutoff point at which men are referred for further testing would more appropriately be set about 20 percent lower than the 4.0 used for the Hybritech test.

To find out which type of test you have received, your physician should contact his or her lab to determine which brand of test was used for their PSA testing and whether it is WHO or Hybritech calibrated.

Types of PSA Tests

Some of the PSA in the blood is bound to enzymes (complexed) while some is freely circulating (free). Unless otherwise noted, the PSA levels generally refer to total PSA (or tPSA), a combination of complexed and free PSA.

Free-PSA or fPSA refers to the percentage of PSA in the blood that is not bound to enzymes. Doctors are now recommending further testing for men with a free-PSA of less than 25 percent. This is a helpful indicator for men who may be uncertain whether to get a biopsy, such as those with PSA levels between 4 and 10, and negative DRE results.

Complexed PSA or cPSA refers to the measure of one type of bound or complexed PSA. This measure is as accurate as total PSA and may be better at ruling out some people from further testing. Cut-off levels are different for cPSA, so make sure you know whether your PSA test is complexed or total. For example, a cPSA level of 2.2 is equivalent to the cut-off level of tPSA at 2.5.

PSA and Recurring Prostate Cancer

The PSA test is also used to detect and monitor recurrence of prostate cancer after initial treatment. PSA levels should drop dramatically after initial treatment. If they rise again, they are a good indicator that the initial treatment did not catch all the cancer cells.

Source: Zero: The Project to End Prostate Cancer http://www.zerocancer.org/site/PageNavigator/PSA_Test

Tuesday, October 13, 2009

What Ritalin and Prostate Cancer Have in Common

29000 Men Comment
There is an excellent article in the current edition of Bicycling Magazine, Riding with Ritalin, that really does pertain to prostate cancer prevention and survival. The article, which is available at the link above and is a quick and interesting read, describes how cycling made a significant improvement in the live of a child and young person with ADHD, significantly lowering the amount of medication required.

The article notes that, "Research has shown that vigorous exercise is so effective at quelling anxiety and depression that some patients have been able to reduce or eliminate the use of medications such as Prozac and Zoloft. In a study at the University of Southern Mississippi, participants who suffered from generalized anxiety disorder and exercised at 60 to 90 percent of their maximum heart rates for three 20-minute sessions per week saw significant decreases in anxiety sensitivity and fear after just two workouts. Further research has shown that people who get regular vigorous exercise are less likely to develop anxiety disorders and depression."

Separate research shows that a third of all cancers are the direct result of what we eat and a lack of exercise. In the coming weeks, I'll be reviewing the book "Anti Cancer: A New Way of Life" by David Servan-Schreier, MD, PhD.

Making a decision to adopt a different nutritional style and implementing a regular exercise program can have a major impact on your body's ability to prevent cancer or its recurrence. I happen to believe that bicycling is an ideal exercise program component. You can ride a beach cruiser, a mountain, in a velodrome, or on the road. Every town in America probably has at least one bicycle shop and cycling club. To find the one nearest you, simply pose the question in your favorite Internet browser.

If you like to travel, there literally are dozens of touring groups with trip opportunities all around the globe. If you are married, take a family trip or do family rides. If you like a challenge, consider getting your USA Cycling license and participating in a local amateur competitive event.

Finally, we would love to have you be part of our Prostate Cancer Awareness Project Black Tire Affair ® program. We currently have events at the Encino Velodrome here in California, along the Skyline Drive in Virginia, in Las Vegas, Nevada, and at Reddish Knob in Virginia beginning in October 2010.

Monday, October 12, 2009

"PSA Testing - A Failed Medical Experiment"

29000 Men Comment
My thanks to Dr. Dach for commenting on my post concerning the PSA testing controversy, and I encourage everyone to read his excellent article at http://www.jeffreydach.com/2009/10/01/psa-testing-the-failed-medical-experiment-by-jeffrey-dach-md.aspx.

Dr. Dach concludes his article as follows:
"In conclusion,
PSA screening for prostate cancer has been a failed medical experiment leaving behind 1 million male victims treated unnecessarily for a type of prostate cancer that was clinically insignificant, providing little or no benefit in terms of lives saved. Leaders in the field are now alerting us to the pitfalls, harms and limitations involved in PSA cancer screening.

Recognizing that there are 30,000 prostate cancer deaths per year, the urgent challenge is to identify and treat the aggressive cancers destined to kill the host, and avoid harming the other 7 million men representing a silent reservoir of biologically insignificant disease. Hopefully, this will be the subject of future NIH funded research, so that another one million men in the future will be spared needless overdiagnosis and overtreatment."

29000 Men Comment
As a prostate cancer survivor who is alive today because of PSA and Free PSA testing and a determined urologist, it is my deeply held opinion [please note that I am not a physician and can not and do not offer medical advice] that the issue is not with too much diagnosis, as approximately 29,000 men continue to die each year from prostate cancer, but with the treatment decisions made following diagnosis. If the current controversy is successful in convincing men that prostate cancer testing is unnecessary and that men that to do seek treatment are destined to have quality of life degradation, will we not in the future see an increase in prostate cancer deaths? I look forward to a lively discussion on this important issue.

Thursday, October 8, 2009

PLU Codes - Organic or Genetically Modified?

Do you ever wonder about the meaning of those annoying (at least to me they are) little stickers we find on our produce? Well, here’s some interesting information, especially if you are trying to eat organically or simply trying to avoid “engineered” food.

PLU stands for “Price Look Up” standards, which are published by the International Federation for Produce Standards (IFPS) Board of Directors. You can find the full directory at plucodes.com.

What can be really important is the first digit, if the PLU code sticker on your produce contains five (5) digits. If it has only four (4) digits, it is “normally grown,” whatever that means in the country of origin.

If the first digit of a five (5) digit code is “9,” the produce is organically grown - again, meaning whatever standard that entails in the country of production.

But, if the first digit of a five (5) digit code is “8,” it means that the produce is genetically modified. Caveat emptor.

Tour de USA 2010 for Prostate Cancer Awareness

29000 Men Comment

We are moving forward on our planning for our cross country (and back) motorcycle trip to raise awareness for prostate cancer. If you ride a motorcycle and are interested in the ride of a lifetime, pop on over to the TourdeUSA website and watch our TourdeUSA blog for details.

The PSA Testing Controversy

29000 Men Comment

The medical and medical journalistic community continue to struggle with the issue of PSA testing for prostate cancer. The issue is the treatment of prostate cancer that is slow-growing and not a major threat. The difficulty is that is extremely difficult to determine which prostate cancers are “benign” and which are aggressive and life threatening. It seems a bit ironic that we have this major focus on over testing for prostate cancer but no similar debate about testing for breast cancer, when the two cancers are virtual mirror images in terms of annual new cases and death rates.

The issue, I believe, is not in over testing for prostate cancer, since early detection is essential for effective treatment of aggressive prostate cancer, but with the level of knowledge men have about prostate cancer and the various forms of treatment. Current American Cancer Society statistics show that only 54% of men test annually for prostate cancer and that almost 29,000 men die each year from the disease. My conclusion is that we are undertesting the male population as a whole, and possibly over treating those are identified. I would love to have a dialogue on this issue.

Dr. Mark Scholz, head of the Prostate Cancer Research Institute in Los Angeles, published the following statement that, I believe, succinctly summarizes the dilemma. My suggestion would be to follow Dr. Scholz’s advice; test, but take the time and steps necessary to ensure you have a form of prostate cancer that requires treatment.

Best regards, Robert

Re: Letter to the Editor Regarding a Wall Street Journal Article titled: 
Two Big Studies Tackle Debate on Prostate Test published on Thursday March 19, 2009



The Wall Street Journal recently published a letter to the editor under the heading, “Lifestyle Is Fine, but Cancer Needs Effective Treatment.” The physician writing the letter vilified the idea of using anything but surgery to treat his prostate cancer. Unfortunately, his uninformed convictions are prevalent throughout the medical community. Now definitive, well-performed studies unequivocally prove that overtreatment is the norm (New England Journal of Medicine 2009;360:1310-9 and 1320-8) .


As has been the case for years, the a priori assumption that “all cancer needs treatment” has confused the expert commentators who are interpreting these crystal-clear study results as being part of an ongoing unresolved controversy about PSA testing. The reality is that huge amounts of precious research dollars are being spent to answer a foolish question. Whether or not to do PSA testing is not the issue. The issue is deciding what to do with the information the PSA provides.


Right now the nation is in the grip of 8-billion dollar industry hell-bent on administering treatment to every kind of prostate cancer whether it is life-threatening or not. The solution to the problem of over-treating prostate cancer is not less PSA testing. The solution is educating physicians to forgo recommending immediate surgery or radiation to every last man who gets a diagnosis of prostate cancer.

Newly-diagnosed patients need to research all their options before agreeing to irreversible radical treatment. PSA testing (in conjunction with other means) has a useful role in determining which men harbor the more aggressive types of prostate cancer. Only with a “go slow” approach, ongoing monitoring known as Active Surveillance, can we distinguish men with aggressive disease who need treatment from men with indolent disease who don’t need treatment.


Mark Scholz, M.D. 
Prostate Cancer Research Institute
Los Angeles, California

Tuesday, October 6, 2009

Male Sling for Incontinence

29000 Men Comment

Often when I talk with men about prostate cancer it quickly becomes clear that the fear of incontinence following treatment is one of the key concerns that prevent men from testing for prostate cancer. While some degree of incontinence is a possible outcome of treatment, it certainly is not an inevitable outcome of treatment. There are numerous methods of dealing with incontinence when it occurs. If this is a concern, take a quick read of the following article or click the link to visit the parent page.


http://www.prostate-cancer.com/coping-with-prostate-cancer/incontinence-male-sling.html



The Male Sling for Incontinence
The male sling is a relatively new procedure to treat men with incontinence as a result of prostate cancer treatment. In most cases this treatment can be done on an outpatient basis or with one overnight stay. The procedure can take less than half hour to one hour and requires a two-inch incision between the scrotum and the rectum.

The male sling is a minimally invasive procedure where a strip of abdominal or synthetic tissue is placed in the pelvis to compress the urethra and prevent urine leakage during stress maneuvers. Six titanium bone screws are placed into the pubic bone after exposing the pelvic bone on each side. Three screws are placed on each side. A permanent suture is attached to each bone screw. The sutures are then passed through the material used to create the sling. On one side of the pubic bone three sutures are passed through one edge of the sling and tied tightly and on the other side three sutures are then passed through the sling and tied to create the closure of the urethra. The incision is then closed. A catheter is usually left in place for a period of 24 hours. Immediately after the catheter is removed most men are able to urinate with better control.

Not all medical establishments have the male sling available. Initial studies have reported 80% incontinence improvement of the men treated. Although still in its infancy, the male sling has become a significant advance in how we treat incontinence, allowing many men to regain their urinary control and improve their quality of life. Patients should consult their physician to determine whether the male sling would benefit them.