We are proud to announce that both doctors made the list of Top Doctors for 2017.
Dr. Christopher Knoedler and Dr. Robert Gaertner have been honored with this title for multiple years. The nominations are determined by a survey given out to doctors and health care practitioners in the Twin Cities area.
Cancer treatments can cause side effects. These side effects are often more pronounced when patients are not eating enough and/or are not eating the right foods. Prostate cancer patients need to maintain good nutrition to feel their best and have the most energy possible. Here are some strategies to improve your diet:
Set a goal to meet your basic calorie needs.
For a cancer patient, the estimated calorie needs can be determined by multiplying their weight x 15 calories a pound (if their weight has been stable). If the patient has lost weight another 500 calories per day can be added. Example: A person who weighs 150 lbs. needs about 2,250 calories per day to maintain his or her weight.
Plenty of protein is recommended.
To rebuild and repair damaged and normally aging body tissue, protein can be an important factor. The estimated protein needs are 0.5 to 0.6 grams of protein per pound of body weight. Example: A 150-pound person needs 75 to 90 grams of protein per day.
The best sources of protein include foods from the dairy group (8 oz. milk = 8 grams protein) and meats (meat, fish, or poultry = 7 grams of protein per ounce), as well as eggs and legumes (beans).
Make sure to stay hydrated.
In general, people should take in between 30 and 50 ounces of fluid daily to prevent dehydration. (That’s 1 to 1.5 liters). Fluids can come in many types including water, juice, milk, broth, and milkshakes, as well as gelatin, fruits, and salads. The need to stay hydrated becomes very important if you have treatment side effects such as vomiting or diarrhea.
Keep in mind that beverages containing caffeine do not count as much, because they may make you urinate out as much or more than you take in.
Get your vitamins.
If you are not sure you are getting enough nutrients it’s a good idea to take a vitamin supplement. A multivitamin that provides at least 100% of the recommended dietary allowances (RDA) for most nutrients is a good option.
Make an appointment with a dietitian.
You can get a great deal of help from a registered dietitian who can provide suggestions to work around any eating problems that may be interfering with proper nutrition (such as early feeling of fullness, swallowing difficulty, or taste changes).
A dietitian can also help you maximize calories and show you how to include proteins in smaller amounts of food (such as powdered milk, instant breakfast drinks, and other commercial supplements or food additives).
Behind lung cancer, prostate cancer is the second leading cause of cancer death in men living in the United States.
1 in 7 men will get a diagnosis of prostate cancer in their lifetime according to the American Cancer Society. Prostate exams are commonly performed to help reduce the high numbers of deaths from the disease.
What is involved in a prostate exam?
Screening for prostate cancer involves looking for early signs of a disease in healthy people who do not have any symptoms. The aim of screening is to diagnose the disease at an early stage because the earlier it is diagnosed the easier it is to treat and therefore the more likely it is to be cured.
Who should get a prostate exam?
Men over the age of 50 are strongly advised to have at least an informed discussion with their healthcare provider about screening for prostate cancer.
The American Cancer Society recommends that the discussion about screening should take place for men in the following groups:
• 50 years of age – for men who are at average risk of prostate cancer and are expected to live at least 10 more years.
• 45 years of age – for men at high risk of developing prostate cancer. This includes African-Americans and men who have a father, brother, or son diagnosed with prostate cancer at a younger
than age 65.
• 40 years of age – for men with more than one first-degree relative who had prostate cancer at an early age.
What types of tests are available?
There are two main tests most commonly used to screen for prostate cancer. These are the digital rectal exam and the prostate-specific antigen test.
Neither test can confirm prostate cancer. However, they can reveal strong signs that a patient has a prostate problem and requires further testing such as a prostate biopsy.
Men who want to be screened should be tested with the PSA blood test. If a patient gives their consent, the digital rectal exam is usually conducted as an early part of the screening.
Having a digital rectal examination
A DRE is generally not painful and only takes a few minutes to complete.
The specialist will gently insert a lubricated, gloved finger into the rectum. The specialist will determine the size of the prostate and feel for bumps, soft or hard spots, and other abnormalities.
Prostate cancers often begin in the back of the gland, which may be felt during a rectal exam. If the prostate is enlarged, the patient may feel discomfort or mild pain during the exam.
If the doctor finds any areas of concern during the DRE, additional tests may be needed to examine them more closely.
Having a PSA test
The PSA test is a blood test used to detect prostate problems. It usually takes 14 days to get the results back. The test measures a protein called PSA that is made by the prostate gland. Some of this protein leaks into the blood and can be measured by doctors.
A variety of factors can affect PSA levels, such as age and ethnicity. Some prostate glands produce higher levels of PSA than others. In general, the higher the PSA level in the blood, the more likely it is that a prostate problem is present.
PSA levels also can be affected by some medical procedures, types of medications, an enlarged prostate or a prostate that is infected.
If the PSA level is normal, the healthcare specialist may leave further tests to the choice of the patient. They may decide to test the patient every 1-2 years.
If the PSA level is high, the specialist is likely to refer the patient for more tests. These tests might include an examination of the prostate gland and possibly a prostate biopsy.
The specialist will consider a number of factors such as the patient’s age, family history, ethnicity, body weight and previous medical history.
According to a new study, snus, a smokeless tobacco product, may increase a prostate cancer patient’s risk of death.
Some have suggested that because it lacks the combustive effects of smoking, that snus is a less a harmful alternative to smoking.
However, researchers found the men who used snus and had prostate cancer were at increased risk of premature death.
Pronounced as though it rhymes with “goose”, snus is used mainly in Sweden but is also available in the United States. Sold most often in a bag resembling a tea bag, users place the powdered tobacco product under the upper lip for extended periods.
The researchers investigating snus users, found that, compared with men who never used tobacco, those non-smokers who used snus had a 24 percent higher risk of death from prostate cancer during the study period. They also had a 19 percent higher risk of death from any cause.
The study found that for those non-smokers who used snus whose cancer had not spread; these patients were three times more likely to die from prostate cancer than those who never used tobacco.
The study co-author concluded that there is some evidence from animal studies that nicotine can promote cancer progression, and snus users have high blood levels of nicotine. Although snus is a smokeless product, users are still exposed to other carcinogens in tobacco.
The results of the study suggest that the health effects of smokeless tobacco products can be detrimental to men diagnosed with prostate cancer.
A recently-published analysis indicates that many men with prostate cancer obtain second opinions from urologists before starting treatment. Surprisingly though, second opinions are not associated with changes in treatment choice or improvements in perceived quality of prostate cancer care. This analysis also explores motivations for seeking second opinions, and suggests that second opinions may not reduce overtreatment in prostate cancer.
Cancer societies encourage patients with cancer to obtain second opinions prior to starting treatment to help them understand their disease and to thoroughly weigh the risks and benefits of their options. Given the ongoing debate concerning whether prostate cancer patients are being overtreated, second opinions in this context are important because management options vary widely from surgery and radiation therapy to active surveillance programs. However, the study did not find that second opinions affected treatment among low-risk men – the most likely candidates for active surveillance – casting doubt on whether second opinions are sufficient to reduce overtreatment among this group.
A physician at Johns Hopkins University and a team of colleagues sought to assess the frequency of and reasons for second opinions for localized prostate cancer, and the characteristics of those who seek them. They also evaluated whether second opinions are associated with certain treatment choices or perceived quality of prostate cancer care.
The investigators surveyed men as part of the Philadelphia Area Prostate Cancer Access Study. A total of 2386 men who were newly diagnosed with localized prostate cancer in the greater Philadelphia area between 2012 and 2014 responded. Forty percent of men obtained second opinions, commonly because they wanted more information about their cancer (50.8 percent) and wanted to be seen by the best doctor (46.3 percent). Overall, obtaining second opinions was not linked with receiving definitive treatment or with perceived quality of cancer care.
Men who sought second opinions because they were dissatisfied with their initial urologist were 51 percent less likely to receive definitive treatment, and men who wanted more information about treatment were 30 percent less likely to report excellent quality of cancer care compared with men who did not receive a second opinion. Men who obtained second opinions because they wanted more information, were seeking the best doctor, or had been encouraged to by family or friends were more likely to ultimately receive surgery. The analysis suggests this could indicate that for some men, second opinions represent a way to pursue the treatment they already plan on receiving, rather than to explore other treatment options.
Here are some important facts about prostate cancer.
• After non-melanoma skin cancer, prostate cancer is the most common cancer among men in the US.
• Prostate cancer is one of the leading causes of cancer death among men of all races and Hispanic origin populations.
• In the US around 209,292 men are diagnosed with prostate cancer per year.
• Around 27,970 men die from prostate cancer in the US each year.
• According to the American Cancer Society about 1 man in 7 will be diagnosed with prostate cancer during his lifetime.
• Prostate cancer mainly occurs in older men – about 6 cases in 10 are diagnosed in men 65 years or older.
• Almost all prostate cancers are adenocarcinomas – cancers that begin in cells that make and release mucus and other fluids.
• Prostate cancer often has no early symptoms.
• Advanced prostate cancer can cause men to urinate more often or have a weaker flow of urine.
• Most men diagnosed with prostate cancer do not die from it. More than 2.9 million men in the US diagnosed with prostate cancer at some point are still alive today.
Many studies have looked at the possible benefits of specific nutrients (often as supplements) in helping to treat prostate cancer, although most of this research is still ongoing.
Some compounds being studied include extracts from:
Pomegranate
Green tea
Broccoli
Turmeric
Flax seed
Soy
Some early research has found that in men with a rising PSA level after surgery or radiation therapy, drinking pomegranate juice or taking a pomegranate extract may slow the time it takes for the PSA level to double. Larger studies are now looking for possible effects of pomegranate juices and extracts on prostate cancer growth.
Some encouraging early results have also been reported with flax seed supplements. One small study in men with early prostate cancer found that daily flax seed seemed to slow the rate at which prostate cancer cells multiplied. More research is needed to confirm this finding.
A recent study showed that taking soy supplements after surgery (radical prostatectomy) for prostate cancer did not lower the risk of the cancer coming back.
One study has found that men who choose not to have treatment for their localized prostate cancer may be able to slow its growth with intensive lifestyle changes. The men in the study ate a vegan diet (no meat, fish, eggs, or dairy products) and exercised frequently. They also took part in support groups and yoga. After one year the men saw, on average, a slight drop in their PSA level. It isn’t known if this effect will last since the report only followed the men for 1 year. The regimen may also be hard for some men to follow.
Doctors agree that the prostate-specific antigen (PSA) blood test is not a perfect test for finding prostate cancer early. It misses some cancers, and in other cases the PSA level is high even when prostate cancer can’t be found. Researchers are working on strategies to address this problem.
One approach is to try to improve on the test that measures the total PSA level.
Another approach is to develop new tests based on other forms of PSA, or other tumor markers. Several newer tests seem to be more accurate than the PSA test, including:
The phi, which combines the results of total PSA, free PSA, and proPSA to help determine how likely it is that a man has prostate cancer that might need treatment
The 4Kscore test, which combines the results of total PSA, free PSA, intact PSA, and human kallikrein 2 (hK2), along with some other factors, to help determine how likely a man is to have prostate cancer that might need treatment
Tests such as Progensa that look at the level of prostate cancer antigen 3 (PCA3) in the urine after a digital rectal exam (DRE). (The DRE pushes some of the prostate cells into the urine.) The higher the level, the more likely that prostate cancer is present.
Tests that look for an abnormal gene change called TMPRSS2:ERG in prostate cells in urine collected after a DRE. This gene change is found in some prostate cancers, but it is rarely found in the cells of men without prostate cancer.
ConfirmMDx, which is a test that looks at certain genes in the cells from a prostate biopsy sample
These tests aren’t likely to replace the PSA test any time soon, but they might be helpful in certain situations. For example, some of these tests might be useful in men with a slightly elevated PSA, to help determine whether they should have a prostate biopsy. Some of these tests might be more helpful in determining if men who have already had a prostate biopsy that didn’t find cancer should have another biopsy. Doctors and researchers are trying to determine the best way to use each of these tests.
Researchers continue to look for foods (or substances in them) that can help lower prostate cancer risk. Scientists have found some substances in tomatoes (lycopenes) and soybeans (isoflavones) that might help prevent prostate cancer. Studies are now looking at the possible effects of these compounds more closely.
Scientists are also trying to develop related compounds that are even more potent and might be used as dietary supplements. So far, most research suggests that a balanced diet including these foods as well as other fruits and vegetables is probably of greater benefit than taking these substances as dietary supplements.
One vitamin that may be important in prevention is vitamin D. Some studies have found that men with high levels of vitamin D seem to have a lower risk of developing the more lethal forms of prostate cancer. Overall though, studies have not found that vitamin D protects against prostate cancer.
Many people assume that vitamins and other natural substances are safe to take, but recent research has shown that high doses of some may be harmful, including those in supplements marketed specifically for prostate cancer. For example, one study found that men who take more than 7 multivitamin tablets per week may have an increased risk of developing advanced prostate cancer. Another study showed a higher risk of prostate cancer in men who had high blood levels of omega-3 fatty acids. Fish oil capsules, which some people take to help with their heart, contain large amounts of omega-3 fatty acids.
Some research has suggested that men who take a daily aspirin for a long time might have a lower risk of getting and dying from prostate cancer. Still, more research is needed to confirm this, and to confirm that any benefit outweighs potential risks, such as bleeding.
Scientists have also tested certain hormonal medicines called 5-alpha reductase inhibitors as a way of reducing prostate cancer risk
Genetics
New research on gene changes linked to prostate cancer is helping scientists better understand how prostate cancer develops. This could make it possible to design medicines to target those changes. Tests to find abnormal prostate cancer genes could also help identify men at high risk who might benefit from screening or from chemo-prevention trials, which use drugs to try to keep them from getting cancer.
Most of the gene mutations that have been studied as factors that might increase prostate cancer risk are from chromosomes that are inherited from both parents. Some research has found that a certain variant of mitochondrial DNA, which is inherited only from a person’s mother, might also raise a man’s risk of developing prostate cancer.