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Sunday, November 29, 2009

Blog Updates for November 2009

Nov 18/09. In Choosing a Surgeon - Part I. Considerations, Choosing a Surgeon - Part I. Considerations we added: Savage and Vickers determined the typical annual radical prostatectomy caseloads of surgeons in the United States by analyzing "data from 2 independent data sets for 2005, that of a nationally representative sample (Nationwide Inpatient Sample) and a complete record of all hospital discharges from New York State (Statewide Planning and Research Cooperative System). They found that "more than 25% of United States surgeons conducting radical prostatectomy in 2005 performed only a single procedure. Approximately 80% of surgeons performed fewer than 10 procedures per year and, thus, are unlikely to reach the plateau of the learning curve during their surgical career." [PMID: 19836787]

Nov 11/09. In reference to lycopene studies, the following was added to Bradford Hill Criteria of Causation: A 2009 review by researchers also assessed the evidence as inconclusive. [Abstract] [PMID: 19901932].

Nov 8/09. In Advice to the Newly Diagnosed we added: The following summary table is a slightly expanded version of Table 2 in the 2008 Canadian Journal of Urology paper [Full text] [PMID:18700060] by Mark LaSpina (papers) and Gabriel Hass (papers).
Conservative treatment
- Watchingful waiting
- Active surveillance
Lowers risk of treatment-related complicationsCan delay aggressive treatment for potentially curable disease
- External beam radiation
- Brachytherapy
Minimally invasive
Reduces risk of surgical complications
Option for poor surgical candidates
Gradual erectile dysfunction
Radical prostatectomy
- Retropubic
- Robotic/laparoscopic
Removes source of disease
Standard of care
Highest risk of morbidity and mortality
Urinary incontinence or retention
Delayed recovery of erectile function
inguinal hernia
Hormonal treatment
- Androgen ablation
- Orchiectomy
Options for poor surgical candidates
Recurrence is common
Symptoms similar to that of low testosterone
High-intensity focused ultrasound (HIFU)Precise
Minimally invasive
Can be repeated
Unknown long term data
CyroablationMinimally invasive
Reduces risk of surgical complications
Option for poor surgical candidates
More long term data needed
Erectile dysfunction

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