Patients with newly diagnosed low-risk prostate cancer—and their urologists—need to know the aggressiveness of their tumor. The Oncotype DX Prostate Cancer Assay can help. This genomic test performed on a patient’s needle biopsy provides essential insight into the underlying biology of that patient’s prostate cancer. The result is reported as the Genomic Prostate Score or GPS, and provides a more precise, accurate, and individualized risk assessment that can help a patient and his urologist make a confident choice between active surveillance and immediate treatment.
Visit http://prostate-cancer.oncotypedx.com/ for more information on test.

Congratulations, Drs Knoedler and Gaertner, on the 10 year anniversary of performing the first private practice robotic prostatectomy in Minnesota and the five state area. Since May 17th, 2004 they have completed over 3000 robotic cases establishing themselves as one of the leading robotic prostatectomy teams in the United States.

Drs Knoedler and Gaertner continue to perfect their technique and share them with visiting surgeons. Their best source of referrals is from their own patients and other urologist. They strive to make the next 10 years as successful as the first 10 years.

Meir J. Stampfer, Jaquelyn L. Jahn and Peter H. Gann
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Author Affiliations
Affiliations of authors: Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA (MJS, JJ); Departments of Epidemiology and Nutrition, Harvard School of Public Health, Boston, MA (MJS); Department of Pathology, University of Illinois at Chicago, Chicago, IL (PG).
Correspondence to: Meir J. Stampfer, MD, DrPH, Harvard School of Public Health and Brigham and Women’s Hospital, Departments of Epidemiology and Nutrition, Channing Division of Network Medicine, 677 Huntington Ave, 3rd Fl, Boston, MA 02115 (e-mail: stampfer@hsph.harvard.edu).

Prostate-specific antigen (PSA) screening remains a focus of intense controversy, despite decades of clinical experience and several randomized trials. In this issue of the Journal, Stattin et al. (1) take advantage of a natural experiment in Sweden and use sophisticated statistical modeling techniques to provide further persuasive evidence for the benefits of PSA-based detection to reduce prostate cancer–specific mortality. Sweden has not endorsed a PSA screening program, but considerable “opportunistic” PSA screening has caused an apparent increase in rate of overall prostate cancer detection. This increase, of course, is primarily due to the identification of latent tumors, which are age-related, and in autopsy studies, are prevalent in about 36% of US and European men aged 70 to 79 years (2). Stattin et al. (1) used this effect of PSA screening to identify counties in Sweden with higher rates of PSA screening by categorizing the counties according to the increase in overall prostate cancer rates in recent decades after introduction of the PSA test. As expected, these high-incidence counties had greater usage of PSA testing, and the case patients had characteristics tending to be slightly more typical of screened populations, with somewhat lower levels of PSA at diagnosis and earlier-stage disease (3). Over the time period studied, the authors noted a 19% reduction in prostate cancer–specific mortality in the counties with more PSA screening as compared with less.
The authors note that this is not a randomized trial, and the conclusions, as in any observational study, rest on the assumption that the control counties with lower screening are truly comparable and represent the counterfactual—what would …

Nagging back pain. Indigestion. Frequent urination. You may assume these are minor health issues that don’t need a doctor visit. But think again.

Cancer symptoms are often vague. In fact, prostate cancer — the most common cancer in men — has some of the least obvious symptoms.

“Men shouldn’t ignore their health,” says Therese Bevers, M.D., medical director of MD Anderson’s Cancer Prevention Center. “It’s vital to stay informed, pay attention to changes in your body and report unusual symptoms to your doctor right away.”

Knowing what symptoms to look for can help your doctor find cancer early when it’s most treatable.

Bevers shares some of the most common cancer symptoms in men.

Abnormal lump. Have you recently felt a mass or lump right below your skin? This may be a sign of cancer. Lumps normally show up in the breast, testicles, lymph nodes and soft tissues, like tendons and ligaments. Here’s what to do: Report it to your doctor immediately, especially if you just found it, or it has grown in size.
Changes in your testicles. Have you noticed changes in the size of your testicles, like one or both have gotten bigger? Maybe you’ve found a lump, or your testicles feel swollen or extra heavy. Any of these signs should send you straight to your doctor. Testicular cancer is most common in young and middle-aged men.
Changes in your restroom habits. Suddenly need to use the restroom all the time? Or have pain when you go? This may be a sign of bladder or prostate cancer. Other signs to look out for are blood in your urine or stool. Changes in your bowel habits, like constipation or diarrhea that won’t go away, matter too.
Changes in your skin. If you work long hours outside or have a history of blistering sun burns, check your skin more closely. What you think are signs of hard work might actually be skin cancer. Look for unusual bleeding, scaling or sores that do not heal. Other signs include warts as well as moles and freckles that change in color, size or shape. Bottom line: If you’ve got a strange spot on your skin, call your dermatologist.
Indigestion or trouble swallowing. A prolonged painful burning sensation in your throat or chest shouldn’t be ignored – even if you suspect it’s from eating spicy food. Don’t think that regular indigestion or trouble swallowing is a normal part of aging either. It can be a sign of esophageal, stomach or throat cancer.
Persistent cough or hoarseness. Do you have a nagging cough? If it lasts more than three weeks, it’s a sign that something’s wrong. And whether you smoke or not, a cough that doesn’t go away can be a sign of lung cancer. Persistent hoarseness, wheezing, shortness of breath or coughing up blood are also signs to call your doctor right away.
Changes in your mouth. If you smoke, chew, dip or spit tobacco, you need to pay close attention to changes inside your mouth. White patches inside your mouth or white patches on your tongue may be pre-cancers. Left untreated, these areas can turn into oral cancer. Sores, unexplained bleeding, numbness or tenderness in the area around your mouth – like your tongue, lips and cheeks – should tell you that it’s time for a check-up.
Unexplained weight loss. Are you dropping pounds without changing your diet or exercise habits? Call your doctor – even if you think they’re pounds you need to lose. Losing ten or more pounds for no known reason can be a sign of pancreatic, stomach, esophageal or lung cancer.
Constant fatigue. Are you too tired to play with your kids? Or hang out with the guys after work? Are you constantly tired no matter how much rest you get? Don’t brush it off. Constant fatigue can be a sign of leukemia as well as some colon and stomach cancers.
Persistent pain. Nagging back pain, a headache that won’t go away, abdominal or stomach pains – your doctor needs to know. “No pain, no gain” doesn’t apply to cancer. And, persistent pain, no matter the location, can be the first sign that something’s wrong.
Remember, having one or more of these symptoms doesn’t mean you have cancer. But if they’re persistent, you need to go in for a checkup.

“See your doctor and get your cancer risk assessed,” Bevers says. This assessment can help you understand whether or not you’re more likely to get cancer. That way you can make better choices to keep your body healthy and cancer-free.

by Brittany Cordeiro

Selenium and vitamin E supplements ‘increase prostate cancer risk”
Monday 24 February 2014 – 12am PST

A new study recently published in the Journal of the National Cancer Institute suggests that taking high doses of selenium and vitamin E supplements may increase the risk of prostate cancer, depending on a man’s selenium levels prior to taking the supplements.
The research team, including first author Dr. Alan Kristal of the Public Health Sciences Division of the Fred Hutchinson Cancer Research Center in Seattle, WA, analyzed 1,739 patients with prostate cancer and 3,117 matched controls from the Selenium and Vitamin E Cancer Prevention Trial (SELECT).
According to the investigators, previous research has suggested that men who already have an adequate intake of selenium would not benefit from supplements of the nutrient.
Therefore, the researchers took selenium measurements from the toenails of participants at the baseline of the study.
Selenium is a chemical element most commonly found in seafoods and organ meats, such as liver. Other food sources of selenium include muscle meats, cereals and dairy products.
The National Institutes of Health state that selenium is nutritionally essential for humans and plays roles in reproduction, thyroid hormone metabolism and DNA syntheses, as well as protects against oxidative damage and infection.
According to the Food and Nutrition Board, the recommended dietary allowance for both males and females aged 14 years and over is 55 mcg per day.
For the study, the researchers wanted to determine whether taking daily high doses of vitamin E (400 IU) and/or selenium (200 mcg) may reduce the risk of prostate cancer.
Vitamin E is a group of fat-soluble compounds that act as an antioxidant in the body. The vitamin is commonly found in foods such as nuts, seeds, vegetable oils, green leafy vegetables and fortified cereals.
Dietary supplements ‘not necessarily helpful or innocuous’SELECT began in 2001 and was scheduled to carry on for 12 years. But in 2008, the study was called to a halt on the grounds that no protective effects were found from selenium supplements and vitamin E supplements were thought to increase the risk of prostate cancer.
However, although the men stopped taking the supplements in 2008, the researchers continued following them in order to monitor their prostate cancer risk.
The findings revealed that men who had high selenium levels at the beginning of the study had a 91% increased risk of high-grade prostate cancer. According to the researchers, the levels of selenium for these men became toxic.
The investigators also found that for men with low selenium levels at the baseline of the study, vitamin E increased total prostate cancer risk by 63%, while high-grade prostate cancer risk increased by 111%.
“Many people think that dietary supplements are helpful or at the least innocuous. This is not true,” says Dr. Kristal.
“We know from several other studies that some high-dose dietary supplements – that is, supplements that provide far more than the daily recommended intakes of micronutrients – increase cancer risk.
We knew this based on randomized, controlled, double-blinded studies for folate and beta carotene, and now we know it for vitamin E and selenium.”
He adds that people taking vitamin E or selenium supplements should stop because there is no evidence that they produce any health benefits – only risks.
Dr. Kristal says that even standard multivitamins – which he says have yet to demonstrate any risk – could be harmful in high doses.
“Taking a broad view of the recent scientific studies, there is an emerging consistency about how we think about optimal intake of micronutrients,” he adds.
“There are optimal levels, and these are often the levels obtained from a healthful diet, but either below or above the levels there are risks.”
Of late, there have been many studies questioning the health benefits of vitamin supplements. Medical News Today recently reported on a study suggesting that vitamin C and E supplements may hinder athletes’ training, while other research suggests that multivitamins are a waste of money and have no health benefits.
Written by Honor Whiteman


Invivo brings the power of MRI to the urology suite with the introduction of the UroNav Fusion Biopsy System – the next generation of prostate care.

Targeted MR/ultrasound biopsy is poised to become the new standard in prostate care. UroNav fuses pre-biopsy MR images of the prostate with ultrasound-guided biopsy images in real time, for excellent delineation of the prostate and suspicious lesions, as well as clear visualization of the biopsy needle.

UroNav fusion biopsy system from Invivo enables easy clinical use of this powerful MR/US fusion technique. It combines electromagnetic tracking and navigation with an onboard computer and a real-time imaging interface in one easy-to-use, mobile workstation.

The combination of UroNav with Invivo’s powerful MR image analysis system, DynaCAD for Prostate, creates a comprehensive, next-generation MR ultrasound solution for the detection and biopsy of suspicious prostate lesions. DynaCAD for Prostate provides the diagnostic MR information needed for the fusion biopsy by automatically transferring the relevant prostate images and lesion location data over your computer network for lesion identification and guidance during the TRUS biopsy procedure.

UroNav is designed to work the way you work. There is no need for complex mechanical devices or complicated, time-consuming set-up routines. UroNav’s simple, guided workflow follows the same TRUS biopsy procedure you are used to. UroNav is powerful, fast, and simple.
 

Features

Next step in Invivo’s Clinical Solutions for Prostate Oncology
Clinically validated and supported by several published studies
Based upon six (6) years of clinical R & D
More than 1000 men biopsied to date
Compatible with DynaCAD for Prostate
Simple, guided workflow
DICOM Compliant

….SUNNYVALE, Calif., Dec. 19, 2013 (GLOBE NEWSWIRE) — A national, multi-institutional database study found readmission and complication rates were significantly lower for robotic-assisted prostate surgery than for open prostate surgery.1 The full study results were published in the November 19 electronic edition of the Journal of Endourology.

“Readmissions for Medicare patients alone currently add $17.4 billion each year in health care spending,” said Lead Investigator Robert Nadler MD, Northwestern Medicine Vice Chair of Urology. “The findings from this study show that beyond the patient benefit, robotic-assisted surgery may be relevant to reducing health care costs as it results in reduced readmission rates compared to open surgery.”

This retrospective study used the National Surgical Quality Improvement (NSQIP) database to analyze data on patients who received a prostatectomy in 2011. A total of 5,471 patients and more than 400 hospitals were included in the study. Of those patients, 1,097 (20 percent) had an open procedure and 4,374 (80 percent) had a minimally invasive robotic-assisted procedure. No patients had a laparoscopic procedure.

Overall, the robotic-assisted group experienced significantly lower overall complication rates, surgical complication rates, and unplanned readmission rates. Although the operative time was significantly longer for the robotic-assisted group than for the open group, this did not result in higher complications during or after surgery. A full comparison between the two procedures showed:1

Robotic-assisted Prostatectomy(n=4374) versus Open Prostatectomy(n=1097)
Overall Complication Rate : 5.62% versus 23.25%
Surgical Complication Rate : 0.91% versus 3.37%
Unplanned Readmission Rate : 3.48% versus 5.47%
Operative Time : 212.3 minutes versus 174.0 minutes

When you’re being treated for cancer, it’s more important than ever to eat right and get adequate nutrition — but it can also be more difficult than ever to adhere to a balanced cancer diet. Your body is working overtime to fight the cancer, while it’s also doing extra duty to repair healthy cells that may have been damaged as a side effect of treatments like chemotherapy and radiation. At the same time, many cancer treatments — especially chemotherapy — come with side effects that drain your strength and sap your appetite. So how can you make sure you’re getting all the essential nutrients, vitamins, and minerals you need to keep a balanced cancer diet?

1.Participate in regular exercise. Walking is best.
2.Limit your calorie intake. Excess calories are bad for cancer growth. Eat what you need to get to the next meal, not the usual American style of eating all you can as if you are never going to eat again.
3.Get sunshine daily. Darker-skinned people need more sunshine.
4.Don’t follow these or any guidelines to excess. Moderation is the key.
5.Heart healthy is prostate healthy. Heart disease is still the No. 1 killer, even in men with prostate cancer.
6.Variety in the foods you eat is important. Increase the diversity.
7.Remember supplements are supplements. They are not intended to replace an intelligent diet; their purpose is to supplement an intelligent diet. Supplements are a poor alternative to eating foods that are high in the desired nutrients.
8.See a doctor regularly for early detection and preventative care. Be proactive rather than reactive.

Nutritional Recommendations
The two diets known to be associated with longevity and reduced risks for prostate cancer are the traditional Japanese diet and a Southern Mediterranean diet. The Japanese diet is high in green tea, soy, vegetables, and fish, as well as low in calories and fat. The Mediterranean diet is high is fresh fruits and vegetables, garlic, tomatoes, red wine, olive oil, and fish. Both are low in red meat.

Specifically, you should incorporate these principles when reevaluating your daily diet:

1.Reduce animal fat in your diet. Studies show that excess fat, primarily red meat and high-fat dairy, stimulates prostate cancer to grow.
2.Avoid trans fatty acids, which are known to promote cancer growth. These are high in margarines, and fried and baked foods.
3.Increase your fresh fish intake, which is high in the very beneficial alpha omega-3 fatty acids. Ideally eat cold-water fish such as salmon, sardines, mackerel, and trout, at least two to three times a week. The fish should be poached, baked, or grilled (not burned or charred). Avoid fried fish.
4.Significantly increase your fresh fruit, herb, and vegetable consumption daily. Powerful anticancer nutrients are being discovered regularly in colorful fruits and vegetables, fresh herbs, leafy green vegetables, nuts, berries, and seeds.
5.Avoid high-calcium diets, which have been shown to stimulate prostate cancer growth.
6.Take a multivitamin with B complex and folic acid daily.
7.Avoid high-dose zinc supplements.
8.Increase your natural vitamin C consumption — this includes citrus, berries, spinach, cantaloupe, sweet peppers, and mango.
9.Drink green tea several times each week.
10.Avoid excess preserved, pickled, or salted foods.
11.at red grapes, drink red grape juice, or red wine regularly.
12.Eat leafy dark-green vegetables frequently.
13.Cruciferous vegetables are cancer protective. These include cabbage, broccoli, and cauliflower.
14.Tomatoes and especially tomato products are very high in lycopene, a powerful anticancer substance. This includes pizza sauce, tomato paste, and ketchup.
15.Avoid flax seed oil. This can stimulate prostate cancer to grow. You can obtain the very healthy alpha omega-3 fatty acids you need through fresh fish and nuts.
16.Use olive oil, which is very healthy and rich in vitamin E and antioxidants. Avocado oil is also good. Avoid oils high in polyunsaturated fats such as corn, canola, or soybean.
17.Take vitamin E, 50 to 100 IU of gamma and d-alpha, only with the approval of your doctor. Some recent studies have raised concerns over serious risks with vitamin E intake. Natural sources include nuts, seeds, olive oil, avocado oil, wheat germ, peas, and nonfat milk.
18.Selenium is a very powerful antioxidant and the backbone molecule of your body’s immune system. Most studies support a daily selenium supplement of 200 micrograms a day. The benefits appear to be only for those who have low selenium levels, which is difficult and expensive to measure. Since it only costs about 7 cents a day and is not toxic at these levels, it is reasonable for all men to take selenium. Natural sources include Brazil nuts, fresh fish, grains, mushrooms, wheat germ, bran, whole-wheat bread, oats, and brown rice.

WebMD expert and urologist Sheldon Marks, MD, shares his thought on how men can help prevent prostate cancer through nutrition.