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Sunday, December 23, 2007

December 2007 Blog Updates

Dec 1. In the Urinary Incontinence post, John Tobin related his experience with urinary incontinence (quoted with permission):
"Getting proactive makes a big difference. I spent two months just waiting for the problem to go away. I'd been using 1 or 2 pads a day. But very slight improvement. Then I bought an electric scale and resorted to weighing the pads each day to get an idea of relating what I was eating and doing and it made a difference. I came to realize there were distinct times of day when most of the flow happened. Anyway, improvement was actually measureable from then on, though it took two more months before I pronounced myself pad free from the stress incontinence."

Also we now reference this Mayo Clinic urinary incontinence overview: [link]. A portion of that overview had been previously linked but this provides a link to the entire article.

Dec 1. Added to the future developments portion of the Historical Developments post:

Prevention Trials Estimated to Complete according to Fleshner and Zlotta (2007)

2008 - 325 person NCIC soy, vitamin E and selenium PCa prevention trial
2010 - GTX toremifene (selective estrogen receptor modulator) PCa prevention trial. 8200 HGPIN men.
2010 - GSK dutasteride PCa prevention trial. 8200 high risk men.
2011 - SWOG selenium PCa prevention trial. 700 men.
2012 - SWOG selenium and vitamin E (SELECT) trial. 32,400 healthy men.

Dec 2. Added to Free Monthly Prostate Cancer Magazines and Journals :
Endocrinology Journal. Primarily about endocrinology but has prostate cancer articles too.

Dec 3. In the Links to the right we have added these Links:

Dec 3. In Choosing a Surgeon - Part I. Considerations we added:
The National Prostate Cancer Coaliation rates the efforts of each US state in fighting prostate cancer in their [report card] on prostate cancer.

Dec 6. In Urinary Incontinence post: In [abstract] [PMID: 17982438], Comiter provides the following summary:
Stress urinary incontinence in men is usually a result of intrinsic sphincter deficiency following prostate cancer surgery. Active conservative management with fluid restriction, medication management and pelvic floor exercises is indicated for the first 12 months. If bothersome incontinence persists, urodynamic evaluation is indicated in order to assess detrusor storage function, contractility and sphincteric integrity. Standard surgical options include urethral bulking agents, artificial urinary sphincter (AUS) and male sling. Periurethral injection of bulking agents is satisfactory in only a minority of patients, leaving AUS and male sling as the most common surgical treatments. In patients with severe urinary incontinence, AUS seems to have a higher rate of success than the male sling. Furthermore, AUS is indicated in men with detrusor hypocontractility as adequate detrusor contractility is needed to overcome the fixed resistance of the sling. In patients with milder levels of stress incontinence, the two techniques have approximately equal efficacy in the short-to-intermediate term. While current reports of the male sling are generally limited to 1-4 years' follow-up, the infection, erosion, and revision rate for the male sling seem somewhat lower than that for the AUS in appropriately chosen patients.

Dec 7. On the Case Histories page we have added:
  • HIFU/Advanced Cancer history of Paul Kinow. Paul also has a HIFU FAQ.
  • Cryoablation. Mike Landess is an ABC News reporter in Denver who developed a 4-part TV news piece on his prostate cancer and his 3D mapping and focal cryoablation therapy. See [link] for all 4 videos and follow up video news.

Dec 7. Added to the Historical Developments post:
1981 - McNeal details zonal anatomy of the prostate. [PMID: 7279811].
Also added to the same post these future expectations:
Robotic surgery will get sensory feedback technology. Intuitive Surgical already has access to the technology. See [this post].

At the AUA 2007 Buenos Aires meeting, Dr. Michael J. Zelefsky of Sloan Kettering mentioned his expectation that Image Guided Radiation Therapy (IGRT), which uses markers placed within the prostate for image guidance, will become the next generation of radiotherapy after IMRT. Being precise to 1 mm it will allow higher dosages of radiation to be delivered to diseased tissue while reducing radiation to healthy tissue.

Greco (2007) forecasts that Proton therapy will be combined with IMRT-like computer control with the combination referred to as IMPT; however, at the AUA 2007 Buenos Aires meeting Michael Zelefsky cautioned that the $100 million cost and space requirements of these platforms will be an obstacle.

There are Phase II/III trials of HIFU (ultrasound therapy which kills prostate cells through the heat action of ultrasound without dangerous radiation) underway which should ultimately lead to availability of this therapy in the US. Currently it is available in many other countries but not the US. Furthermore, "technical improvements in HIFU are pending, including an MRI-guided HIFU treatment. MRI is now able to monitor the temperature achieved in the target volume during a HIFU pulse. An automated adjustment of the treatment parameters according to the temperature measured in the target volume could be done in real time to control the heat extension during the HIFU session, thus optimizing the treatment efficacy." See Murat et al (July, 2007).

Better biomarkers will be developed which may make active surveillance safer enabling more accurate entry and exit criteria.

Dec 7. Added reference to a Nov 2007 PDE-5 review paper by Carson 17983891 [Full Text] which mentions that coffee is a PDE-5 inhibitor; however, coffee may have an adverse affect on incontinence and its pro-inflammatory properties might also promote recurrence.

Dec 7. In Prostate Cancer Calculators we added a reference to the 10 year life expectancy nomogram (based on comorbidity score and age) of [Walz 2007]. This paper [PMID: 17979925] concluded that clinicians have an accuracy of less than 70% whereas Walz claims that his group's nomogram has an 84% accuracy on a validation sample (i.e. using data not employed in constructing the nomogram).

Dec 9. In RP vs. LRP vs. RLRP - Part 2. Laparascopic Surgery we mention a survey reported in the Dec 1, 2007 issue of Urology Times which indicated that "almost half" of all urologists in the survery were seeking additional training in the area of laparascopic or robotic surgery suggesting that urologists themselves view these approaches positively.

Dec 12. In PSA Screening and Early Detection - Part 2. Key Points on PSA there is a list of factors affecting PSA and to that we added that PSA values are lower in summer when there are more hours of sunlight. [PMID: 17174467].

Dec 13. In Choosing a Surgeon - Part 2. Finding a Surgeon we mention that Intuitive Surgical, the maker of the robotic surgery devices used in robotic surgery, has a list of surgeons trained in their device.

Dec 20. In the WCRF/AICR Diet and Cancer Report post we added this link about energy dense foods.

Dec 20. In Vitamin D and Prostate Cancer we added a link to a short bio on Dr. Donald Trump.

Dec 20. In [this post] we add this additional advantage of robotic surgery:
The robot provides additional stability by filtering out surgeon's hand tremors according to [link].

Dec 20. In Part 3 of our 5 part series on PSA we added two other factors which may have accounted for improved prostate cancer outcomes as alternative explanations to PSA screening: (1) the increased number of prostate biopsy cores now employed (see [link]) and (2) the Will Rogers effect. See [link].

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