Nov 1. ED After Prostatectomy has become a highly accessed post so it is marked with a black dot in the Key Posts list to the right.
On the Community Resources page there is a pointer to the Observations page of the Wichita, Kansas USToo chapter listing a number of interesting articles by Charles Maack on ADT, its side effects and other advanced prostate cancer topics.
Nov 10. Added a link in How Healthy Men Can Reduce Their Risk to the WCRF/AICR Diet and Cancer Report and slightly cleaned up the page.
Nov 13. Added to the Historical Developments post:
1998 - First laparascopic prostatectomy using modern techniques [PMID: 10799152] (according to Rodrigues and Pow-Sang)
Nov 14. Added tooltips (small popups that appear when you place the mouse over the link without clicking it) on all square bracketed links to the right.
Nov 14. In Lycopene, Selenium and Vitamin E in Combination we added:
A Purdue in vitro (test tube) study concluded that mixing green tea with citrus juice (and to a lesser extent with citric acid, BHT, EDTA, ascorbic acid, milk, soy milk or rice milk) increased the catechin, i.e. active anti-cancer ingredient, recovery significantly. See Purdue press release and [PMID: 17688297] .
Nov 15. Added a Basics line in the Links section to the right giving links to Uptodate.com's patient summaries on detection, diagnosis, local disease and advanced disease. This is normally a pay service aimed at doctors bu they do provide these free patient summaries.
Nov 18. Added to the AUA 2007 Conference Summaries page:
Since the above appeared, summaries also appeared on Urotoday, Medscape.com and on Pubmed Central .
Nov 19. In Vitamin D and Prostate Cancer we added some additional information on dosage.
In [Full Text] [PMID: 10232622] , Reinhold Vieth suggests that 4,000 IU/day may be a safe dose and, in fact shows a dose-response curve in which he has marked the levels at which various studies observed toxicity. One study observed toxicity at 10,000 IU per day but all other studies did not observe toxicity until even higher levels suggesting that even an intake of 10,000 IU might be safe. In a response Muskiet et al (2001) [PMID: 11722970] question whether there is evidence that more than 4000 IU is needed to prevent disease and suggest that as the excess is stored in fat tissue, that level might be safe in the short run but a "potential time bomb with an as yet poorly understood detonator" in the long run. ... See the dose response curve in Vieth's paper (the same one cited above) for insight.
Nov 20. In Bradford Hill Criteria of Causation we added:
The confusion between association and causation can often be seen in media reports. The headline to a news article Excess Weight Increases Prostate Cancer Mortality makes such an error. The report itself (and even the text of the news item) make no claim of causation but the headline, which may have been written by a different person, jumps to the unwarranted conclusion of causation. The investigators correctly avoided assuming that simply because excess weight and prostate cancer were associated that prostate cancer was caused by excess weight. For example, if any of these were true then we might see this association even in the absence of such causality: (1) obese men delay longer in seeking treatment, (2) diagnostic procedures are less accurate for obese men so their condition is missed more often and they do not receive timely treatment -- in fact it is known that obesity reduces PSA levels making it less likely that cancer will be detected in the obese [Full Text] [Journal Watch comment], (3) genes which predispose one to prostate cancer also predispose one to obesity or (4) men with prostate cancer respond by over-eating (i.e. causality works in reverse).
Nov 20. In Pubmed Front Ends we added a paragraph on pubmed keywords:
One can simply enter words into the Pubmed search box at the top of the Pubmed screen or special keywords can be used to direct the search. For example,and also in the Linking to Pubmed section:would find all papers whose full text is freely available on the net and authored by Alexandre R. Zlotta and where the date published is 1999.
free full text[sb] "Zlotta AR"[Au] 1999[dp]
The http://pmid.us/ site makes it easy to create links to pubmed articles using only the PMID. For example,
which jumps to a link of this form:
The http://www.bioinfo.pl/ site also has an easy linking format:
This takes you to a bioinfo page with the abstract with a link to the original pubmed version below it.
Nov 20. In PSA Screening and Early Detection - Part 2. Key Points on PSA we added that PSA is:
decreased by obesity thought to be due to the larger amount of blood in obese men diluting the PSA. Thus for a given PSA the greater the Body Mass Index (BMI) the higher the likelihood of prostate cancer. See [Journal Watch comment].
Nov 20. On the Case Histories page we have added pointers to over 100 additional case histories including some by doctors:
- Surgery. This case study of a surgery patient by his doctor includes substantial useful material on assessment of options.
- Surgery. In this 21 page article, Dr. Paul H. Lange, a Uro Oncologist, discusses his own prostate surgery : [link]. There are also additional comments from Uro Oncologist Dr. Paul F. Schellhammer. Also, Amnon Ben Yehuda discusses his investigation that led him to robotic surgery in [link]
- RT/HT. A useful case study, written by his doctor, on a patient who underwent IMRT and hormone therapy is available [here]. A particular focus of this case was the use of MRI imaging.
- Toshiba has a video on a pilot's experience with Proton Therapy at MD Anderson. Click on Hope in Houston at the site.
- WW. Don Mehlig provides a web site and 30 page case history on his watchful waiting experience [here].
- Advanced. Added bio of Charles Maack to the Case Histories page.
and these collections:
- 4 PMH Videos. The Prostate Centre of the Princess Margaret Hospital in Toronto has 4 video interviews with patients who underwent different treatments: watchful waiting/active surveillance, radiation, surgery and hormone therapy.
- 60 LRP Testimonials. There are 60 video testimonials from patients of laprascopic surgeon Dr. Arnon Krongrad [here].
- 50 UK Interviews. A collection of about 50 case histories is available at DIPEx.org from the UK.
Nov 22. In How Long Can Prostate Cancer Treatment be Delayed After Diagnosis we added:
In a 2007 study of 448 Gleason 6 patients [PMID: 17868725] the investigators conclude that the probability of a Gleason upgrade from 6 to 7 wasand also
- 62% if the pre-surgery PSA is 12 or more (vs. 18% if the pre-surgery PSA was less than 12)
- 22.6% when the greatest percent of cancer in a biospsy core was higher than 5% (vs. a risk of 10.5%% when the greatest percent of cancer in a biopsy core was 5% or lower).
A 2004 study of 1083 men with stage T2 localized prostate cancer concluded that those who waited more than 9 weeks for radiation had poorer outcomes than those who commenced treatment within 9 weeks of diagnosis. See [PMID: 15701266] and this discussion.
Nov 22. Added to Free Monthly Prostate Cancer Magazines and Journals :
Not really a magazine or journal but a collection of presentations given by urologists that appears to be updated regularly with new ones.
Patient-oriented articles by Canadian urologists and medical personnel.
Nature Clinical Practice Urologyand
A couple of papers each month are free.
Canadian Health Magazine
Free easy-to-read patient-oriented health magazine from the Canadian Medical Association (CMA) issued every other month. Not specific to urology but the feature articles can be on cancer or related topics of interest. For example, November/December 2007 issue has a front page article on "How to Cut your Cancer Risk", the September/October 2007 issue has a feature article on Vitamin D which mentions Holick's 2007 NEJM Vitamin D review. (We had previously posted notes on Holick's review [here].) and the July/August 2007 issue has a feature article on interpreting medical statistics.
Nov 19/20/22. In Prostate Cancer Calculators we updated the information on the Steyerberg/Kattan Indolent Cancer calculator adding Jon Nowlin's version which corrects for the number of biopsy cores:
Probability of Indolent Cancer based on diagnosis variables. Steyerberg et al published a scoring system in Jan 2007 [PMID: 17162015] (based on updating the original work by Katan et al [PMID: 14532778]) which gives the for probability of indolent cancer. It uses the ultrasound and biopsy results (PSA, prostate volume, Gleason score, mm of cancer tissue in cores, mm non-cancer tissue in cores) each of which gives a number which are summed and looked up on a chart showing the probability of indolent cancer. If this probability is high then delay to treatment or active surveillance/watchful waiting could be considered. See page 2 of http://www.pcngcincinnati.org/2007/2007_02.pdf. As noted by Jon Nowlin the original nomogram assumed 6 biopsy cores and could give misleading results if a different number of cores were used. Nowlin has provided an Excel spreadsheet to perform this calculation which corrects for the number of cores [here] and provides explanation of it use [here].and we also added information on the decision tree of Garzotto et al for suspected cancer patients with PSA:
Probability of Cancer in Suspected Patients After Ultrasound. Focusing on patients with PSA < 10 who are suspected of having cancer and so have had an ultrasound, Garzotto et al (2005) [Full Text] [PMID: 15781880&dopt] develop a [decision tree] model. Unlike scoring systems and nomograms the decision tree is particularly easy to describe. The probability of cancer was less than 5 percent except for the 4 high risk groups illustrated in the decision tree diagram or in words in the abstract. No calculator is really required since the decision tree format is so simple to describe. The variables used are PSA, PSA density (PSAD), existence of hypoechoic lesions, age and prostate volume in cubic centimeters. Existence of hypoechoic lesions and prostate volume are items that are available from the ultrasound. PSA density is PSA divided by prostate volume and therefore also depends on the ultrasound.and information on BMI calculators:
Body Mass Index Calculator.The WHO chart shown here (also found in Box 12.3 on page 375 of the WCRF/AICR diet and cancer report and on Wikipedia) uses height and weight and gives an assessment of underweight/normal/overweight. Chapter 8 of the aforementioned WCRF/AICR diet and cancer report discusses fatness in general and associated risks for various cancers. An alternative to the charts is this BMI calculator.
and added this to the discussion of the CAPRA score and Cooperberg's recurrence after RP study:
A November 2007 study, [PMID: 17868719], validated the CAPRA score on an independent set of patients from Germany.and added Stephenson's recurrence after RT calculator:
Recurrence after Salvage Radiotherapy In his ASCO 2006 presentation, Stephenson presented a nomogram for predicting the 6-year progression-free probability after salvage radiotherapy based on prostatectomy PSA, Gleason Score, SV invasion, Extracapsular Extension, Surgical Margins, lymph node mets, persistantly elevated post-prostatectomy PSA, pre-RT PSA, PSADT and radiation dose. See slide 15 of [link]. In slide 17 he shows that this model predicts better than competing models (actually he shows it has a higher concordance score which is not completely identical but it is suggestive). Also see this video of his presentation [link], his 2004 paper [PMID: 15026399] [Full Text] and his May 2007 paper [PMID: 17513807].
Nov 22. Added to the Post RP Urinary Incontinence Progression post:
Lepor and Kaci (2004) [PMID: 14767305] followed 500 men with localized prostate cancer after prostatectomy and using a self-reported questionnaire and found that 33.7%, 63.5%, 76.2% and 80% were not using pads at 3,6, 12 and 24 months respectively. (The figures cited here are taken from the slide on page 6 of [link]).
Nov 23. Added to the Urinary Incontinence post:
Observation. A relatively simple step that can make a material difference is simple observation. In Stop the Leak (pages 8 and 9) Emmi Champion, a urodynamic nurse, says: "What if you were told that by using some simple self observation skills that you could cure or improve incontinence?" Keeping an intake and voiding diary (a sample form is shown at the end of Champion's article) "can be an eye-opener and will help you understand how you function."and
In this viewpoint paper [PMID: 16763622] the authors review the literature and conclude that the artificial sphincter is superior to the sling.Also added this more recent reference to the use of stem cells [Urology Times, 2007/11/1] and these references to work of Dr. R. A. Appell of Baylor College of Medicine who is having encouraging results with calcium hydroxylapatite (CaHA; Coaptite). See: [PMID: 17482925] and this BCM News Release. We also added links to these references to presentations on urinary incontinence: