Sunday, April 18, 2010

What to do after a diagnosis of prostate cancer

After being diagnosed with prostate cancer, the wide variety of treatment options can be confusing for even the most educated of patients. Advice comes from all angles: your doctor, friends and family, reports in the news, and even doctors’ advertisements, making it difficult to know which is the best treatment for you. I’ll walk you through the most important issues in your decision-making process.

1) Cancer Cure. Almost every patient I see tells me that their primary goal is to cure their prostate cancer. Fortunately, this is possible in over 90 percent of patients. Only two treatments have demonstrated long-term cure rates: surgery and radiation. At this time, all other treatments are considered experimental. Recent evidence suggests that radiation may be associated with increased rates of metastases when compared to surgery. This may be related to two benefits of surgery: the complete removal of all prostate tissue and the removal of lymph nodes. After surgery, the PSA (a blood test that is an excellent indicator of cancer progression in patients known to have cancer) should drop to zero. Subsequent rises in the PSA can trigger immediate action to stop its spread. Following PSA after radiation is much more complicated, which can lead to a dangerous delay in treatment. In addition, a small but significant percentage of patients have prostate cancer in their lymph nodes. These are removed during surgery, but typically are not treated by radiation.

2) Side Effects. Despite what you may hear, any treatment for prostate cancer has its side effects. Radiation and surgery both can result in erectile dysfunction, or difficulty obtaining an erection, and changes to your urination. However, there are surgical “nerve-sparing” techniques that can reduce the risk of erectile problems. Radiation irritates the tissues around the prostate, namely the bladder and rectum. Because of this, it can make it difficult to urinate, or seem like one needs to urinate frequently. Incontinence, or leakage, can also be an issue. After surgery, most men will leak urine for a period of time, although this usually will resolve. Leakage of stool can occur after radiation.

3) Surgery: Open vs. Robotic? Another point of debate and confusion surrounds the two types of surgery. It does not need to be so complicated. In experienced hands, either will cure prostate cancer equally well. The side effects are similar, although patients undergoing robotic surgery are much less likely to need blood transfusions, will spend less time in the hospital after surgery and will have smaller incisions. The key, however, is that the surgeon be experienced. Numerous studies have demonstrated that skilled, busy surgeons have better outcomes – both in cancer control and side effects – than those with less experience. This is true of both open and robotic surgeons. Confusion occurs when the results of inexperienced robotic surgeons are compared with those from experienced open surgeons. When choosing a surgeon, you should always ask what his (or her) experience is and what his outcomes are. The robot is simply another tool that a surgeon uses: the surgeon is the important part!

Prostate cancer is a complex issue: I hope you found this post helpful. A few parting thoughts: be sure to bring a list of questions to ask your doctor, thoroughly explore all available options, and consider traveling to have your treatment. Side effects from poor radiation or surgery can last a lifetime, so you should do everything in your power to minimize them! For further information please visit roboticoncology.com.

David B. Samadi, MD is the Chief of Robotics and Minimally Invasive Surgery at Mount Sinai School of Medicine in New York City. As a board-certified urologist and an oncologist specializing in the diagnosis and treatment of urologic diseases, kidney cancer, bladder cancer, and prostate cancer, he also specializes in many advanced minimally invasive treatments for prostate cancer, including laparoscopic radical prostatectomy and laparoscopic robotic radical prostatectomy. His Web site, Robotic Oncology, has been translated into six different languages and is one of the most popular urology sites on the Internet.

Tuesday, December 15, 2009

Considering a chemotherapy port?


As my chemotherapy winds down -- woohoo! -- the verdict is in on my port: I'm glad I got it.

I had to decide at the start whether I wanted my 2-3 hour infusions to be by an IV in the hand/wrist region, or whether to get a "port-catheter" surgically insplanted in my chest.

The advatage of a conventional IV was the avoidance of surgery. The downside was that the drugs are so toxic they could destroy some of the little veins -- permanently. The removal, during surgery of the lymph nodes in one armpit meant I wasn't ever supposed to have an IV in that arm. So the other arm would have to endure all six chemo infusions.

By the end, the nurses might really be struggling to find a good vein. And that would mean some discomfort.

Installing a port -- a little doohickey under the skin of the chest -- would avoid all that.

Yet here's the thing: The mere mention of the word catheter dug up such a painful memory of my father that I got instanteously teary. And that clouded my decision-making for about a week.

Long story short: My dad had leukemia. He endured two months of chemo so harsh he was required to stay in the hospital the whole time. Shortly before his expected release, they proposed installing something called a Hickman catheter because his veins were truly trashed.

It was a brand new device to be installed in his chest, with little tubes coming out. It had to remain sterile, because any infection would go straight to the heart. And here's the kicker: They said he could care for it himself at home! My sisters and I balked: How would a notoriously unmechanical 76-year-old man who wore old-fashioned bifocals do this on his own?

To make matters worse, the device was so new that no nursing or rehab center in town would accept him; their staffs simply weren't trained to care for the damn thing. (None of us daughters lived nearby.) Our only choice was to have him move out-of-state, away from all his friends and familiar surroundings, to a nursing home close to my sister.

As we wrestled with this, I ended up talking with the hospital social worker. And I posed a logical question: Might he be better off without the damn catheter? And get this: The social worker actually told me she thought it would be "cruel" to deny him the catheter and subject him to more IVs.

No, lady. You were wrong then and you remain forever wrong. (And wow, I hope you went into real estate or something besides social work!) What ended up being cruel was uprooting my father in the sunset of his life -- the whole decision driven by a medical device so new nobody knew what to do with it.

OK, so that wasn't such a short story. Sorry.

Those memories had to wash over me and recede before I was able to make a rational decision about my own chemotherapy.

At first I thought I'd try the veins, and if that didn't work, get the port installed. The oncology nurse shook her head. What happens, she said, is that people get through three treatments before things become painful and troublesome, but by that time, they say, "Well, I already made it through three, I'll keep going." And then the final treatments get kind of ugly.

So I flipped that logic on its head: I decided I'd get the port, and if I didn't like it, I'd give myself permission to have it removed.

It was an....interesting surgery. It takes place without general anesthesia, and right under your nose. I felt there should be organ music playing while my surgeon maniacally laughed. There were wires involved, and pliers, and at one point some cauterizing that caused smoke to rise from my chest. Yikes! (If you're squeamish, ask for blindfolds, or maybe one of those curtain they use to block the view.)

I ended up with a little bulge under the skin -- about the size of a nickel -- roughly where I'd place my hand when saying the Pledge of Allegiance.

Since then, it has given me not a moment's worry. It doesn't hurt, and it has made my chemo sessions truly painless. I feel somewhat Borg-like when they plug in my tube, but then I'm able to put it out of my mind. It also has the benefit of being a bit less icky for my visitors. (I've used my sessions to catch up with old friends, kind of like a ladies' lunch minus the lunch.) It was a rocky road to make that decision, but I've been pleased with my choice.

Now that I've had my last session though, I'm anxious to have it removed. I want my body back.

By Kathleen O'Brien/The Star-Ledger
December 14, 2009, 7:18PM

Saturday, September 26, 2009

Can prostate cancer be found early?

Screening refers to testing to find a disease such as cancer in people who do not have symptoms of that disease. For some types of cancer, screening can help find cancers in an early stage when they are more easily cured. Prostate cancer can often be found early by testing the amount of prostate-specific antigen (PSA) in the blood. Another way to find prostate cancer is the digital rectal exam (DRE), in which your doctor inserts a gloved finger into the rectum to feel the prostate gland. If the results of either one of these tests are abnormal, further testing is needed to see if there is a cancer. If you have routine yearly exams and either one of these test results becomes abnormal, then any cancer you might have has likely been found at an early, more treatable stage. The DRE and the PSA test are both discussed in more detail later in this document.

Since the use of early detection tests for prostate cancer became fairly common (about 1990), the prostate cancer death rate has dropped. But it isn't yet clear if this drop is a direct result of screening or caused by something else, like improvements in treatment.

Unfortunately, there are limits to the current screening methods. Neither the PSA test nor the DRE is 100% accurate. Abnormal results of these tests don't always mean that cancer is present, and normal results don't always mean that there is no cancer. Uncertain or false test results could cause confusion and anxiety. Some men might have a prostate biopsy (which carries its own small risks, along with discomfort) when cancer is not present, while others might get a false sense of security from normal test results when cancer is actually present.

There is no question that the PSA test can help spot many prostate cancers early, but another important issue is that it can't tell how dangerous the cancer is. Finding and treating all prostate cancers early may seem like a no-brainer. But some prostate cancers grow so slowly that they would likely never cause problems. Because of an elevated PSA level, some men may be diagnosed with a prostate cancer that they would have never even known about at all. It would never have caused any symptoms or lead to their death. But they may still be treated with either surgery or radiation, either because the doctor can't be sure how aggressive the cancer might be, or because the men are uncomfortable not having any treatment. These treatments can have side effects that seriously affect a man's quality of life. Doctors and patients are still struggling to decide who should receive treatment and who might be able to be followed without being treated right away (an approach called "watchful waiting" or "expectant management").

source: American Cancer Society

Monday, July 27, 2009

Anatomy of the male reproductive and urinary systems, showing the prostate, testicles, bladder, and other organs.

Prostate cancer is found mainly in older men. As men age, the prostate may get bigger and block the urethra or bladder. This may cause difficulty in urination or can interfere with sexual function. The condition is called benign prostatic hyperplasia (BPH), and although it is not cancer, surgery may be needed to correct it. The symptoms of benign prostatic hyperplasia or of other problems in the prostate may be similar to symptoms of prostate cancer.

Anatomy of the male reproductive and urinary systems, showing the prostate, testicles, bladder, and other organs.
Transperineal biopsy: The removal of tissue from the prostate by inserting a thin needle through the skin between the scrotum and rectum and into the prostate. A pathologist views the tissue under a microscope to look for cancer cells.
Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

The stage of the cancer (whether it affects part of the prostate, involves the whole prostate, or has spread to other places in the body).
The patient’s age and health.
Whether the cancer has just been diagnosed or has recurred (come back).
Prognosis also depends on the Gleason score and the level of PSA.

Monday, May 25, 2009

Asparagus for Cancer? Why not?

Several years ago, I had a man seeking asparagus for a friend who had cancer. He gave me a photocopied copy of an article entitled, `Asparagus for cancer´ printed in Cancer News Journal, December 1979. I will share it here, just as it was shared with me:I am a biochemist, and have specialized in the relation of diet to health for over 50 years.Several years ago, I learned of the discovery of Richard R. Vensal, D.D.S. that asparagus might cure cancer.
Since then, I have worked with him on his project. We have accumulated a number of favorable case histories. Here are a few examples:
Case No. 1, A man with an almost hopeless case of Hodgkin's disease (cancer of the lymph glands) who was completely incapacitated. Within 1 year of starting the asparagus therapy, his doctors were unable to detect any signs of cancer, and he was back on a schedule of strenuous exercise.
Case No. 2. A successful businessman 68 years old who suffered from cancer of the bladder for 16 years. After years of medical treatments, including radiation without improvement, he went on asparagus. Within 3 months, examinations revealed that his bladder tumor had disappeared and that his kidneys were normal.
Case No. 3, a man who had lung cancer. On March 5th 1971, he was put on the operating table where they found lung cancer so widely spread that it was inoperable. The surgeon sewed him up and declared his case hopeless. On April 5th he heard about the asparagus therapy and immediately started taking it. By August, x-ray pictures revealed that all signs of the cancer had disappeared. He is back at his regular business routine.
Case No. 4, a woman who was troubled for a number of years with skin cancer. She finally developed different skin cancers which were diagnosed by the acting specialist as advanced. Within 3 months after starting on asparagus, her skin specialist said that her skin looked fine and no more skin lesions. This woman reported that the asparagus therapy also cured her kidney disease, which started in 1949. She had over 10 operations for kidney stones, and was receiving government disability payments for an inoperable, terminal, kidney condition. She attributes the cure of this kidney trouble entirely to the asparagus.
I was not surprised at this result, as `The elements of Materia Medica', edited in 1854 by a Professor at the University of Pennsylvania, stated that asparagus was used as a popular remedy for kidney stones. He even referred to experiments, in1739, on the power of asparagus in dissolving stones. Note the dates!We would have other case histories but the medical establishment has interfered with our obtaining some of the records.
I am therefore appealing to readers to spread this good news and help us to gather a large number of case histories that will overwhelm the medical skeptics about this unbelievably simple and natural remedy.For the treatment, asparagus should be cooked before using, and therefore canned asparagus is just as good as fresh. I have corresponded with the two leading canners of asparagus, Green Giant and Stokely, and I am satisfied that these brands contain no pesticides or preservatives.
Place the cooked asparagus in a blender and liquefy to make a puree, and store in the refrigerator. Give the patient 4 full tablespoons twice daily, morning and evening.Patients usually show some improvement in from 2-4 weeks. It can be diluted with water and used as a cold or hot drink. This suggested dosage is based on present experience, but certainly larger amounts can do no harm and may be needed in some cases.As a biochemist I am convinced of the old saying that `what cures can prevent'. Based on this theory, my wife and I have been using asparagus puree as a beverage with our meals. We take 2 tablespoons diluted in water to suit our taste with breakfast and with dinner. I take mine hot and my wife prefers hers cold.
For years we have made it a practice to have blood surveys taken as part of our regular checkups. The last blood survey, taken by a medical doctor who specializes in the nutritional approach to health, showed substantial improvements in all categories over the last one, and we can attribute these improvements to nothing but the asparagus drink.As a biochemist, I have made an extensive study of all aspects of cancer, and all of the proposed cures.
As a result, I am convinced that asparagus fits in better with the latest theories about cancer.Asparagus contains a good supply of protein called histones, which are believed to be active in controlling cell growth. For that reason, I believe asparagus can be said to contain a substance that I call cell growth normalizer. That accounts for its action on cancer and in acting as a general body tonic.In any event, regardless of theory, asparagus used as we suggest, is a harmless substance. The FDA cannot prevent you from using it and it may do you much good.
It has been reported by the US National Cancer Institute, that asparagus is the highest tested food containing glutathione, which is considered one of the body's most potent anticarcinogens and antioxidants.Please spread the news... the most unselfish act one can ever do is paying forward all the kindness one has received, even to the most undeserved person.Janice Sellers Department Secretary University of South Alabama Department of Physical Therapy1504 Springhill Ave, Rm 1214 Mobile, AL 36604(251) 434-3575 fax# (251) 434-3822

Tuesday, April 14, 2009

What is prostate cancer?

According to the National Cancer Institute, Prostate cancer is a disease in which malignant (cancer) cells form in the tissues of the prostate. Prostate cancer is found mainly in older men. As men age, the prostate may get bigger and block the urethra or bladder. This may cause difficulty in urination or can interfere with sexual function. The condition is called benign prostatic hyperplasia (BPH), and although it is not cancer, surgery may be needed to correct it. The symptoms of benign prostatic hyperplasia or of other problems in the prostate may be similar to symptoms of prostate cancer.

Possible signs of prostate cancer include a weak flow of urine or frequent urination.
These and other symptoms may be caused by prostate cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:
Weak or interrupted flow of urine.
Frequent urination (especially at night).
Trouble urinating.
Pain or burning during urination.
Blood in the urine or semen.
A pain in the back, hips, or pelvis that doesn't go away.
Painful ejaculation.

Wednesday, February 4, 2009

Music Therapy helps relieve anxiety of cancer

Music “has Charms to sooth a savage Breast,” wrote playwright William Congreve, “To soften Rocks, or bend a knotted Oak.” But can it soothe those mired in the grief, confusion and pain of cancer diagnosis and treatment?
Music therapist Megan Gunnell at the University of Michigan Comprehensive Cancer Center thinks so. She uses music to help heal cancer patients’ spirits as well as their bodies.

UM Music therapist Megan Gunnell
You can listen to one of her music therapy sessions. You’ll need QuickTime music player . As an example of the importance music can have in a cancer’s patient’s life, University of Michigan Cancer Center invites us to consider Gisele Bigras. One day she was a college student finishing up another year of school. The next day, she was a cancer patient faced with having one of her fingers removed. Gisele, at 19, had epithelioid sarcoma in her finger. Finding out she had cancer put her in a state of shock and panic. But music brought her back.
“Music has always played a huge part in my life. Music therapy helped me focus on something else other than the traumatic events of the cancer diagnosis, and just forget for an hour or so, to just go into a different world for a little bit,” Bigras says.
Bigras is one of many patients at the University of Michigan Comprehensive Cancer Center who participates in music therapy. The idea is to use music to help patients cope with physical symptoms, such as pain, reduce their anxiety and find an outlet for their emotions.
“We find that patients are trying to cope with many things. They’re trying to keep it all together, and sometimes if you give them a safe environment and permission to let go, a lot can come out through that,” says music therapist Megan Gunnell. Music therapy can be as straightforward as listening to recorded or live music. It could mean playing a guitar, piano or even just shaking a tambourine. It could mean writing songs or discussing the meaning behind lyrics.
For Gisele Bigras, music therapy turned into an opportunity to write and record her own song. The song, “Back on the Ground,” covers three stages: the happiness before cancer, the chaos of diagnosis and the realization afterward that she could move on.
“Listening to it helps me realize I’m coming out of this. Everything’s fine and I can move on from here,” Bigras says. Research in music therapy shows that in addition to helping with emotional expression, music helps reduce anxiety and perceptions of pain. Controlled studies also found that patients having music therapy show improved immune system functioning.
“You don’t have to have any musical background to experience music therapy,” Gunnell says. “You’re able to participate because you are naturally rhythmical. You have a lot of rhythms and melody already going on in your own system.”
Getting started
There are simple ways to enjoy the calming benefits of music. Start with these suggestions:
• Listen to soothing music. Your heart rate can change based on the tempo of what you’re listening to.
• Bring an iPod or mp3 player to doctors’ appointments to help pass the wait time and reduce anxiety. • Listen to live music. Seek out local performances.
• Analyze the lyrics to a favorite song and consider what is meaningful to you at this time in your life.
• Find music that matches your mood. Music can support you through a multitude of emotions.