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]

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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].

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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).

Treatment	Advantages	Disadvantages
Conservative treatment - Watchingful waiting - Active surveillance	Lowers risk of treatment-related complications	Can delay aggressive treatment for potentially curable disease
Radiation - External beam radiation - Brachytherapy	Minimally invasive Reduces risk of surgical complications Option for poor surgical candidates	Cystitis Proctitis Gradual erectile dysfunction
Radical prostatectomy - Retropubic - Robotic/laparoscopic	Removes source of disease Standard of care	Invasive Highest risk of morbidity and mortality Urinary incontinence or retention Delayed recovery of erectile function inguinal hernia
Hormonal treatment - Androgen ablation - Orchiectomy	Noninvasive Options for poor surgical candidates	Recurrence is common Osteoporosis Symptoms similar to that of low testosterone Gynecomastia
High-intensity focused ultrasound (HIFU)	Precise Minimally invasive Can be repeated	Unknown long term data
Cyroablation	Minimally invasive Reduces risk of surgical complications Option for poor surgical candidates	More long term data needed Erectile dysfunction