March 1. In PSA Screening and Early Detection - Part 2 added reference to this 2008 review article on early vs. late endocrine therapy.
Mar 1. In Prostate Cancer Calculators we added: There was a 2008 paper on factors making Gleason Score upgrade more likely here: [PMID: 18207180].
March 1. Added to ED After Prostatectomy: A January 2008 paper also suggests that the arteries to the nerve bundles need to be preserved for optimum functionality, not just nerve bundles: [PMID: 18221962].
March 1. In PSADT Part 1 we add: Since linear increase mathematically approximates exponential increase at early stages (but not later stages) the linear increases noted may simply be an early manifestation of an increase which is truly exponential. In fact, at early stages we have the following approximation: PSAV = log(2) / PSADT (where log(2) = 0.6931472). Furthermore, if the kinetics are truly exponential then PSA velocity would be expected to increase over time. This suggests that PSA velocity not only measures aggressiveness but also how long the tumor has been growing. That is, the same high PSA velocity (1) could be due to a less aggressive tumor that has progressed or (2) it could be due to a more aggressive tumor that has not progressed. As a result of these two possibilities Ruth Etzioni [audio interview] [PMID: 17925534] has suggested that PSA velocity is not a pure measure of a single characteristic so PSADT might be a better measure than PSA velocity.
PSA is known to rise by about 3.3% per year in healthy men but will rise faster than that in cancer patients. [PMID:75436] Using the equivalence of PSAV and PSADT at early stages the 3.3% rate implies a PSADT of log(2)/.033 = 21 years in healthy men.
Mar 4. Under Advice to the Newly Diagnosed we add: Particularly insightful discussions of why particular individuals chose specific treatment alternatives include this one by John V who chose surgery, this one by several doctors [PMID: 16902521][Full Text] whose patient chose surgery, this one by Andy Grove who chose radiation and Terry Herbert who has an entire site on active surveillance/watchful waiting where this page summarizes why he chose it.
Added to right side of the page in the Links section on the Guidelines: line this link giving the 2002 American Joint Committee on Cancer (AJCC) prostate cancer staging system as published in [PMID: 18096866]:
Mar 6. Added:
Cancer Journal for Clinicians
This journal, published by the American Cancer Society every other month is entirely free and has articles and news on cancer, in general, not just prostate cancer. For example, the article on the 2002 AJCC TNM Staging guidelines references in the Links section to the right in the Guidelines: line comes from this journal.
March 8. In the Historical Developments post (which also includes future developments) we added: Alan Meyer, a patient, posted this summary of promising developments on March 7, 2007.
March 9. In the post on Urinary Incontinence we add: A March 2008 review [PMID: 18271880] of randomized clinical trials for SUI treatments concluded that Pelvic floor muscle training (PFMT) and other physical treatments, estrogens and duloxetine were better than no treatment. This review did not specifically deal with post-prostatectomy patients but rather SUI patients, in general.
March 10. In Advice to the Newly Diagnosed we add:
March 10. In How Healthy Men Can Reduce Their Risk we add: In the March 2008 Urology Times article Dr. Catalona (papers) discusses the advisability of having a biopsy if PSA > 2.5 ng/mL (rather than the older cutoff of 4.0 ng/mL) and at these lower levels a change in PSA (called PSA velocity) of > 0.3 ng/mL per year should also trigger a biospy. There is further information on PSA screening in this 5 part post.
March 10. In NIH Funded Research to be Open Access we added: Also the NIH has created a new part of their web site devoted to Open Access here.
March 11. In RP vs LRP vs RLRP. Part 3 we add regarding robotic surgery: Recovery time and pain reduction advantages over were found to exist but be small in [PMID: 17919694]. Deceptive marketing giving the impression of the contrary is discussed in this March 2008 Urology Times article.
March 11. In Free Downloadable Materials post we updated the entry for the NCCN Guidelines which are now out in their 2008 version (and now 44 rather than 47 pages long): NCCN Protocols. National Comprehensive Cancer Network, NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer, 2008, 44 pages. Protocols for treating prostate cancer. A news article on outlining the changes in the latest release of the guidelines is available here. The guidelines themselves are here: http://www.nccn.org/professionals/physician_gls/PDF/prostate.pdf
March 12. In the Links section on the right in the Blogs line we added: [Path] which links to a blog written by the pathologist, Dr. Oppenheimer.
March 14. In the post on Urinary Incontinence we add: In a Feb 2008 study Hashim and Abrams [PMID: 18284414] concluded that patients have fewer "urgency, frequency and nocturia episodes if they reduce their fluid input by 25%" and even more so if they reduce fluids by 50% although that latter level is generally hard to achieve. Patients in the study were not prostate cancer patients but more generally patients with overactive bladder; however, there is a possibility that this applies to prostate cancer patients too and its cheap and easy to try.
March 15. In Testosterone Metabolism and Prostate Cancer we added this reference to comments on the expected effect of soy based on the Friedman model: Ed Friedman's comments.
March 16. In Advice to the Newly Diagnosed we add:
Diagnostic Imaging. Radiation involves health risks which increase with dosage of radiation received. Martin and Semelka in a 2007 Medscape article reviewing the BIER VII report and other materials write that a low radiation dosage is regarded to be under 100 mSv. Chest X-rays involve 0.1 mSv, CT Scans of the pelvis and abdomen involve 10 to 20 mSv and a full body PET or CT scan involves 25 mSv. Organ specific radiation from a CT scan is typically 20 to 30 mSv. In comparison, they write that atomic bomb survivors receiving radiation exposure of up to 100 mSv (with mean of 29 mSv) and organ specific exposure of 5 to 125 mSv experienced heightened rates of cancer. (For additional data see wikipedia and for even more in depth information down to the figures for specific models see Shrimpton et al, 2003.) They point out that ultrasound and MRI are safer than methods which use ionizing radiation such as CT Scans; however, MRI is contraindicated for people with embedded metal such as pacemarkers and sometimes stents and even metallic jewellry. Also see this 2007 New York Times article and the American College of Radiology (ACR) patient safety information and white paper [summary].
March 16. Added to the Links section on the right in the Guildelines - US line: [Checkup] which gives guidelines for regular checkups. This is not specific to prostate cancer.
March 18. In Advice to the Newly Diagnosed we add:
According to Dr. Nelson Stone in this March 2008 Washington Post article "more than 60,000 prostate surgeries are performed in the U.S. each year and some 50,000 men receive implanted radiation. About 30,000 men will also undergo external radiation for prostate cancer".
March 19. Added a link to a summary of what is new in the NCCN guidelines to the Guidelines-US line in the Links section to the right marked (new).
March 19. In Testosterone Metabolism and Prostate Cancer we added: in [PMID: 18331646] investigators found that zinc increased bcl-2 which would appear to be bad but it increased pro-apoptotic bax even more, which is good, and the ratio of bax/bcl-2 (higher is better) may be more important than either constituent alone.
March 20. In RP vs. LRP vs. RLRP - Part 2. Laparascopic Surgery we add: see this Feb 2008 study [PMID: 18267330] which compared open surgery to a group which had either laproscopic or robotic surgery (they combined the two groups due to similarity in surgical procedure).
March 20. Added this reference to How Healthy Men Can Reduce Their Risk [PMID: 18279502] which mentions that two thirds of patients with advanced prostate cancer in their study had a PSA over 0.9 before the age of 50.
March 20. In Biochemical PSA Recurrence we added: "There is some question regarding the interpretation of very low PSA levels but it has been hypothesized that a consistent increase in PSA over time as evidenced by a stable PSA velocity or doubling time, even at a low level of PSA, might be an early warning of disease. On the other hand, according to a 1997 paper [PMID: 9338734] by Ellis et al "low but detectable serum PSA levels less than or equal to 30 pg/mL [i.e. 0.03 ng/mL] can be produced by nonmalignant sources of PSA" which could obscure the situation."
March 20. Added this link on the AUA 2000 best practices guideline on PSA testing to the right in the Links section on the Guidelines - US line: [AUA PSA]. Note that it recommends 4.0 ng/mL as the threshold for biopsy but today many feel it should be 2.5 due to the proportion of men who have PCa yet have PSA in the 2.5 to 4.0 range.
March 21. In Pubmed Front Ends we added: Unbound Medicine has the usual search box plus an interesting Best Evidence search and an Advanced search with boxes for author, date of publication, etc.
March 24. Under Advice to the Newly Diagnosed we add: It is also worthwhile to consider other concurrent conditions that may exist. It has been estimated that about 20% of men have overt or subclinical hernias and surgery can repair these at the same time. Urinary obstruction, particularly common among men with large prostates, also tends to be cleared up by surgery according to a 2008 NEJM paper by Sanda et al.
March 25. Added to ED After Prostatectomy - Part 1 a reference to the imperfect nature of the IIEF scores for measuring ED: [PMID: 18336609].