tag:blogger.com,1999:blog-31148339740127571652024-03-14T00:49:22.467-07:00Prostate SnatchersProstate Oncology Specialistshttp://www.blogger.com/profile/12308174937988133133noreply@blogger.comBlogger255125tag:blogger.com,1999:blog-3114833974012757165.post-73803083541696369342016-07-26T20:01:00.000-07:002021-01-21T16:02:36.147-08:00<br />
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<blockquote class="tr_bq">
<b><span style="font-family: Arial, Helvetica, sans-serif;">Dr. Scholz is the prostate cancer expert on veryWELL.com (an ABOUT.COM brand) </span></b><span style="font-family: Arial, Helvetica, sans-serif;">Check out his articles at www.verywell.com</span> </blockquote>
<blockquote class="tr_bq">
<i><a href="https://www.verywell.com/what-about-sex-after-prostate-surgery-2782250"><span style="font-family: Arial, Helvetica, sans-serif;">https://www.verywell.com/what-about-sex-after-prostate-surgery-2782250</span></a></i></blockquote>
<blockquote class="tr_bq">
<i><a href="https://www.verywell.com/prostate-size-matters-2781991"><span style="font-family: Arial, Helvetica, sans-serif;">https://www.verywell.com/prostate-size-matters-2781991</span></a></i></blockquote>
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<br />Prostate Oncology Specialistshttp://www.blogger.com/profile/12308174937988133133noreply@blogger.com0tag:blogger.com,1999:blog-3114833974012757165.post-19475890026922691672016-05-10T11:49:00.003-07:002016-05-10T11:49:49.621-07:00A BETTER PROSTATE CANCER TEST?<strong style="color: #606060; font-family: Helvetica; font-size: 18px;">FEATURED TODAY IN THE WALL STREET JOURNAL - HEALTH</strong><br />
<strong style="color: #606060; font-family: Helvetica; font-size: 18px;"><br /></strong>
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<strong style="color: #606060; font-family: Helvetica; font-size: 18px;">by </strong><a href="https://www.blogger.com/redir.aspx?REF=32oO3lkOoIHofchv3Uphj0oOP15K16jhF0_DYNtf_iLrAkZSAnnTCAFodHRwOi8vcHJvc3RhdGVvbmNvbG9neS51czcubGlzdC1tYW5hZ2UxLmNvbS90cmFjay9jbGljaz91PWViYjE4NDQ0YzZkOWMyNTEzZTk0NTYwZWMmaWQ9NzUzZTM1ZTkwZSZlPTIzMjA0ZGYwNzE." style="color: #6dc6dd; font-family: Helvetica; font-size: 18px;" target="_blank">@melindabeckWSJ </a> <span style="background-color: white; color: #606060; font-family: Helvetica; font-size: 12px;">READ FULL ARTICLE </span><a href="https://www.blogger.com/redir.aspx?REF=y-j75J77FES1wcCd7ffWCUv5MzjsiA7zHRUXbuc-ZB8LUUZSAnnTCAFodHRwOi8vcHJvc3RhdGVvbmNvbG9neS51czcubGlzdC1tYW5hZ2UuY29tL3RyYWNrL2NsaWNrP3U9ZWJiMTg0NDRjNmQ5YzI1MTNlOTQ1NjBlYyZpZD00N2I4ZmIyNWM3JmU9MjMyMDRkZjA3MQ.." style="color: #6dc6dd; font-family: Helvetica; font-size: 12px;" target="_blank">HERE</a><br style="color: #606060; font-family: Helvetica; font-size: 18px;" /><br style="color: #606060; font-family: Helvetica; font-size: 18px;" /><span style="background-color: white; color: #606060; font-family: Helvetica; font-size: 18px;">A BETTER </span><strong style="color: #606060; font-family: Helvetica; font-size: 18px;">PROSTATE CANCER</strong><span style="background-color: white; color: #606060; font-family: Helvetica; font-size: 18px;"> TEST?</span><br style="color: #606060; font-family: Helvetica; font-size: 18px;" /><span style="background-color: white; color: #606060; font-family: Helvetica; font-size: 18px;">Distinguishing aggressive disease from slow-growing tumors means more patients can forgo treatment. </span><br style="color: #606060; font-family: Helvetica; font-size: 18px;" /><em style="color: #606060; font-family: Helvetica; font-size: 18px;"><span style="font-family: times new roman, times, baskerville, georgia, serif;">Several new <a href="https://www.blogger.com/redir.aspx?REF=kUHQhFprO6pIFmdbvLJMTho8squ1EIUc_01iyZpFyNnrAkZSAnnTCAFodHRwOi8vcHJvc3RhdGVvbmNvbG9neS51czcubGlzdC1tYW5hZ2UuY29tL3RyYWNrL2NsaWNrP3U9ZWJiMTg0NDRjNmQ5YzI1MTNlOTQ1NjBlYyZpZD0yOTY0MWYxNThiJmU9MjMyMDRkZjA3MQ.." style="color: #6dc6dd;" target="_blank">prostate-cancer tests</a> aim to reduce needless biopsies and unnecessary treatments by sorting out harmless from aggressive tumors. <strong>30 MILLION</strong> U.S. men will have a PSA test. <strong>6 MILLION</strong> of them will be found to have elevated PSA levels. <strong>1 MILLION</strong> of them will undergo a prostate biopsy. <strong>180,000</strong> men who have biopsies will be diagnosed with prostate cancer. Another <strong>180,000</strong> men will have prostate cancer the biopsy missed.<strong>100,000</strong> men with prostate cancer will have low-risk tumors that are unlikely to spread or cause symptoms. <strong>60,000</strong> men with low-risk cancers will undergo surgery or radiation anyway, probably unnecessarily.</span></em><br style="color: #606060; font-family: Helvetica; font-size: 18px;" /><strong style="color: #606060; font-family: Helvetica; font-size: 18px;"><br /></strong><br />
<strong style="color: #606060; font-family: Helvetica; font-size: 18px;">mpMRI </strong><span style="background-color: white; color: #606060; font-family: Helvetica; font-size: 18px;">vs</span><strong style="color: #606060; font-family: Helvetica; font-size: 18px;"> BIOPSY</strong><br />
<span style="color: #606060; font-family: 'times new roman', times, baskerville, georgia, serif; font-size: 18px;"><a href="https://www.blogger.com/redir.aspx?REF=WltLKsF5ebtaakNk6GwR06dVtJsCiSb_V3wgYq7LTcH7KUZSAnnTCAFodHRwOi8vcHJvc3RhdGVvbmNvbG9neS51czcubGlzdC1tYW5hZ2UxLmNvbS90cmFjay9jbGljaz91PWViYjE4NDQ0YzZkOWMyNTEzZTk0NTYwZWMmaWQ9MmZlNTMxZDRlYiZlPTIzMjA0ZGYwNzE." style="color: #6dc6dd;" target="_blank">Mark Scholz</a>, a prostate oncology s</span><span style="color: #606060; font-family: 'times new roman', times, baskerville, georgia, serif; font-size: 18px;">pecialist in Marina del Rey, Calif., maintains that an mpMRI can yield much of the same information as a biopsy and far less invasively. Low-risk prostate cancers barely register, he says, adding, “When patients find out they have a choice between 12 harpoon sticks to the prostate through the rectum or an MRI, they are on board big time.” </span><br style="color: #606060; font-family: Helvetica; font-size: 18px;" /><br style="color: #606060; font-family: Helvetica; font-size: 18px;" /><span style="color: #606060; font-family: 'times new roman', times, baskerville, georgia, serif; font-size: 18px;"><a href="https://www.blogger.com/redir.aspx?REF=tC9s7ixwYPqhDGPIn0ERJ_tDPhPuyY5Bedu-KzOaKDL7KUZSAnnTCAFodHRwOi8vcHJvc3RhdGVvbmNvbG9neS51czcubGlzdC1tYW5hZ2UuY29tL3RyYWNrL2NsaWNrP3U9ZWJiMTg0NDRjNmQ5YzI1MTNlOTQ1NjBlYyZpZD1kZWE1MjhlMmYwJmU9MjMyMDRkZjA3MQ.." style="color: #6dc6dd;" target="_blank">Joel Copeland</a>, 62 years old, has been monitoring his PSA closely for a decade; his two brothers were diagnosed with prostate cancer. He opted for an MRI instead of a biopsy when his PSA bounced up in 2013. “I don’t like needles, but that’s not the point,” Mr. Copeland says. “The point is, biopsies can cause infection and miss cancers</span><span style="background-color: white; color: #606060; font-family: Helvetica; font-size: 18px;">.”</span><br />
<span style="background-color: white; color: #606060; font-family: Helvetica; font-size: 18px;"><br /></span>
<a href="http://goo.gl/38Y44Z" style="font-family: Arial, Helvetica, sans-serif;" target="_blank"><span style="color: #b45f06;">SEE</span></a><span style="font-family: Arial, Helvetica, sans-serif;"> Prostate Vanguard Mailing List about Active Surveillance + Prostate Imaging</span>Prostate Oncology Specialistshttp://www.blogger.com/profile/12308174937988133133noreply@blogger.com0tag:blogger.com,1999:blog-3114833974012757165.post-29463786220203012472016-03-22T12:07:00.000-07:002016-03-22T12:07:32.734-07:00Testosterone Replacement Therapy (TRT) <span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;"><strong>BY JEFFREY TURNER, MD</strong></span><br />
<strong><span style="font-family: Arial; font-size: x-small;"><br /></span></strong><br />
<span style="font-family: Arial; font-size: x-small;"><span style="font-family: "Arial","sans-serif";"><span style="font-size: small;">Testosterone
(T) preparations have been available for more than 70 years.<span style="mso-spacerun: yes;"> </span></span><span style="font-size: small;">In 2013, over 2.2 million Americans were
prescribed testosterone.</span><span style="mso-spacerun: yes;"><span style="font-size: small;"> </span></span><span style="font-size: small;">Interestingly
enough, about 1 in 4 men prescribed testosterone do not have a baseline
testosterone level drawn as primary care physicians may write the prescription
without ordering a blood test first.</span><span style="mso-spacerun: yes;"><span style="font-size: small;"> </span></span><span style="font-size: small;">In
a study of 63,000 men from the Truven Health Marketscan Commercial and Medicare
Supplemental Insurance database between 2010 and 2012, 71% of men had their
testosterone level checked once, 40% twice, and 29% had no measurement at
baseline.</span><span style="mso-spacerun: yes;"><span style="font-size: small;"> </span></span><span style="font-size: small;">Physicians need to do a better
job following men on testosterone replacement. Is testosterone replacement
therapy really all that good for anything aside from rejuvenation and virility?</span><span style="mso-spacerun: yes;"><span style="font-size: small;"> </span></span></span><br />
<span style="font-family: Times New Roman; font-size: small;">
</span><br />
<div style="line-height: normal; margin: 0in 0in 0pt; text-align: justify;">
<span style="font-family: "Arial","sans-serif";"><span style="font-size: small;">Let’s
break this down to risks and benefits below:</span></span></div>
<span style="font-family: Times New Roman; font-size: small;">
</span><br />
<div style="line-height: normal; margin: 0in 0in 0pt; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif";"><span style="font-size: small;">Risks of Prostate Cancer </span></span></b></div>
<span style="font-family: Times New Roman; font-size: small;">
</span><span style="font-family: "Arial","sans-serif";"><span style="font-size: small;">The
most universal risk which has been the controversy of much discussion is the
association with prostate cancer.<span style="mso-spacerun: yes;">
</span></span><span style="font-size: small;">Clinicians remain concerned that Testosterone Replacement Therapy (TRT) can cause or stimulate prostate carcinogenesis
and therefore they are reluctant to prescribe it for the aging male who has a
higher risk of prostate cancer.</span><span style="mso-spacerun: yes;"><span style="font-size: small;"> </span></span><span style="font-size: small;">In the
1940s, Huggins and Hodges discovered the association of testosterone with
prostate cancer by demonstrating that castration causes the disease to regress.
The reality is that TRT may stimulate the growth of existing prostate cancer
cells, but it will not cause cancer to form.</span><span style="mso-spacerun: yes;"><span style="font-size: small;">
</span></span><span style="font-size: small;">As the general male population grows, so does the risk for prostate
cancer--patients should be closely evaluated with digital rectal
examinations, PSA checks and prostate imaging such as color Doppler ultrasound.</span></span><br />
<span style="font-family: Times New Roman; font-size: small;">
</span><br />
<div style="line-height: normal; margin: 0in 0in 0pt; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif";"><span style="font-size: small;">Risk of Prostate Enlargement </span></span></b></div>
<span style="font-family: Times New Roman; font-size: small;">
</span><span style="font-family: "Arial","sans-serif";"><span style="font-size: small;">Another
controversial topic is the assumption that supplemental testosterone leads to
a prostate growth, benign prostate hypertrophy, which leads to worse quality of
life due to worsening urinary symptoms.<span style="mso-spacerun: yes;">
</span></span><span style="font-size: small;">It has long been assumed that high T levels induce prostate overgrowth,
but most studies failed to find the correlation between circulating T levels
and BPH.</span><span style="mso-spacerun: yes;"><span style="font-size: small;"> </span></span><span style="font-size: small;">It has been hypothesized that
dihydrotestosterone (DHT) could be more responsible for prostate growth than T.</span><span style="mso-spacerun: yes;"><span style="font-size: small;"> </span></span><span style="font-size: small;">There have been a number of studies evaluating
TRT in hypo-gonadal men with BPH.</span><span style="mso-spacerun: yes;"><span style="font-size: small;"> </span></span><span style="font-size: small;">The
results have suggested that there is actually a trend toward an improvement in
urinary symptoms.</span></span><br />
<span style="font-family: Times New Roman; font-size: small;">
</span><br />
<div style="line-height: normal; margin: 0in 0in 0pt; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif";"><span style="font-size: small;">Risk of High Red Counts—Polycythemia
or Erythrocytosis</span></span></b></div>
<span style="font-family: Times New Roman; font-size: small;">
</span><span style="font-family: "Arial","sans-serif";"><span style="font-size: small;">Erythrocytosis
is the increase in red blood cell mass production which can be the result of
testosterone replacement therapy.<span style="mso-spacerun: yes;"> </span></span><span style="font-size: small;">This
is the most frequent adverse effect associated with TRT.</span><span style="mso-spacerun: yes;"><span style="font-size: small;"> </span></span><span style="font-size: small;">Recent trials have demonstrated that men on
TRT have a 4 times higher chance of having high red blood cell counts.</span><span style="mso-spacerun: yes;"><span style="font-size: small;"> </span></span><span style="font-size: small;">Some reports have implicated excessively high
red blood cell levels with an increased risk for heart attack or stroke. We
commonly recommend patients remain on a baby aspirin daily and monitor their
blood counts. Some patients may benefit by donating a unit of blood if the
levels are too high.</span></span><br />
<span style="font-family: Times New Roman; font-size: small;">
</span><br />
<div style="line-height: normal; margin: 0in 0in 0pt; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif";"><span style="font-size: small;">Risk of Obstructive Sleep Apnea</span></span></b></div>
<span style="font-family: Times New Roman; font-size: small;">
</span><span style="font-family: "Arial","sans-serif";"><span style="font-size: small;">Frequently
reported in various literature is the association of worsening sleep apnea symptoms for
men on testosterone replacement.<span style="mso-spacerun: yes;"> </span></span><span style="font-size: small;">There
has been only one randomized control trial to date that addresses this association
and it showed that obese men with severe sleep apnea may worsen their
oxygenation with TRT at relatively high doses.</span><span style="mso-spacerun: yes;"><span style="font-size: small;">
</span></span><span style="font-size: small;">This study evaluated injection formulations of testosterone. So far transdermal
formulations have not been similarly implicated.</span></span><br />
<span style="font-family: Times New Roman; font-size: small;">
</span><br />
<div style="line-height: normal; margin: 0in 0in 0pt; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif";"><span style="font-size: small;">Risk of Infertility</span></span></b></div>
<span style="font-family: Times New Roman; font-size: small;">
</span><span style="font-family: "Arial","sans-serif";"><span style="font-size: small;">Testosterone
replacement leads to inhibition of the pituitary gland located at the base of
the brain which can potentially suppress the production of sperm.<span style="mso-spacerun: yes;"> </span></span><span style="font-size: small;">Hence, cases of TRT-induced male infertility
have been reported. This impact appears to be transient and disappears once
TRT is stopped. </span></span><br />
<span style="font-family: Times New Roman; font-size: small;">
</span><br />
<div style="line-height: normal; margin: 0in 0in 0pt; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif";"><span style="font-size: small;">Improved Sexual Function</span></span></b></div>
<span style="font-family: Times New Roman; font-size: small;">
</span><span style="font-family: "Arial","sans-serif";"><span style="font-size: small;">A
decreased libido and/or potency remains one of the most common reasons that men
desire testosterone replacement.<span style="mso-spacerun: yes;"> </span></span><span style="font-size: small;">TRT can
certainly improve sexual function in those who have erectile dysfunction
primarily due to a low level of testosterone.</span><span style="mso-spacerun: yes;"><span style="font-size: small;">
</span></span><span style="font-size: small;">Patients need to recognize that there are a series of other reasons for
being impotent that are unrelated to low levels of testosterone which must also
be investigated as well before concluding that TRT will be the optimal
corrective measure.</span></span><br />
<span style="font-family: Times New Roman; font-size: small;">
</span><br />
<div style="line-height: normal; margin: 0in 0in 0pt; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif";"><span style="font-size: small;">Improved Cardiovascular Effects</span></span></b></div>
<span style="font-family: Times New Roman; font-size: small;">
</span><span style="font-family: "Arial","sans-serif";"><span style="font-size: small;">The
association of TRT with heart attacks has been very controversial. We must not
forget that men with low T levels are at higher risk for poor health due to
being more frail and susceptible to other medical issues including obesity and
diabetes. As a result, they become more prone to adverse cardiovascular
outcomes.<span style="mso-spacerun: yes;"> Four </span></span><span style="font-size: small;">out of five of the most recent
meta-analyses demonstrated neither a protective or harmful effect of TRT on
cardiovascular events. In men with heart failure, it has been demonstrated that
low T levels are an independent risk factor for worse outcomes.</span><span style="mso-spacerun: yes;"><span style="font-size: small;"> </span></span><span style="font-size: small;">Studies also demonstrated that men with
heart failure who supplemented with testosterone had a better exercise capacity,
oxygen levels, and less fatigue.</span></span><br />
<span style="font-family: Times New Roman; font-size: small;">
</span><br />
<div style="line-height: normal; margin: 0in 0in 0pt; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif";"><span style="font-size: small;">Improved Metabolic Effects</span></span></b></div>
<span style="font-family: Times New Roman; font-size: small;">
</span><span style="font-family: "Arial","sans-serif";"><span style="font-size: small;">Large
scale data exists to document the association of low T and worsening blood
sugar levels along with a higher chance of developing diabetes. TRT can improve
body composition and help to reduce fat which can lead to better control of
diabetes.</span></span><br />
<span style="font-family: Times New Roman; font-size: small;">
</span><br />
<div style="line-height: normal; margin: 0in 0in 0pt; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif";"><span style="font-size: small;">Reversal of Osteoporosis</span></span></b></div>
<span style="font-family: Times New Roman; font-size: small;">
</span><span style="font-family: "Arial","sans-serif";"><span style="font-size: small;">Lower
testosterone levels are associated with a higher risk of bone fractures and
worsening bone health.<span style="mso-spacerun: yes;"> </span></span><span style="font-size: small;">TRT has been
demonstrated to have a positive effect on bone mineral density.</span></span><br />
<span style="font-family: Times New Roman; font-size: small;">
</span><br />
<div style="line-height: normal; margin: 0in 0in 0pt; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif";"><span style="font-size: small;">Improvement in Chronic Kidney Disease</span></span></b></div>
<span style="font-family: Times New Roman; font-size: small;">
</span><span style="font-family: "Arial","sans-serif";"><span style="font-size: small;">Low
T is very common (approximately 50%) in men undergoing dialysis for end stage
renal disease. Reduced T levels have in men on hemodialysis have been tied to
higher rates of all-cause cardiovascular mortality.<span style="mso-spacerun: yes;"> </span></span><span style="font-size: small;">Studies suggest that TRT may improve the
levels of a hormone called erythropoeitin (EPO). This hormone stimulates
improved production of red blood cells which in turn increases levels of red
blood cell mass, energy, stamina, and overall well-being.</span></span><br />
<span style="font-family: Times New Roman; font-size: small;">
</span><br />
<div style="line-height: normal; margin: 0in 0in 0pt; text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif";"><span style="font-size: small;">Conclusion</span></span></b></div>
<span style="font-family: Times New Roman; font-size: small;">
</span><span style="font-family: "Arial","sans-serif";"><span style="font-size: small;">It
is clear to see that testosterone replacement offers a multitude of benefits
which span past merely increasing one’s libido or potency.<span style="mso-spacerun: yes;"> </span></span><span style="font-size: small;">The bottom line remains that patients on
testosterone supplementation must have close follow-up including both clinical
and laboratory evaluation to ensure they are gaining benefit and not placing
themselves at increased risk from potential adverse effects.</span><span style="mso-spacerun: yes;"><span style="font-size: small;"> </span></span><span style="font-size: small;">Physicians must clearly discuss the risks and
benefits of supplementation along with employing routine monitoring of PSA,
testosterone levels, blood counts, digital rectal examination, and color
Doppler ultrasound.</span><span style="mso-spacerun: yes;"><span style="font-size: small;"> </span></span></span></span><br />Prostate Oncology Specialistshttp://www.blogger.com/profile/12308174937988133133noreply@blogger.com0tag:blogger.com,1999:blog-3114833974012757165.post-46586223393706862292016-03-08T13:58:00.000-08:002016-03-14T14:00:04.834-07:00Modern Taxotere Chemotherapy for Prostate Cancer<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;"><strong>BY MARK SCHOLZ, MD</strong></span><br />
<span style="font-family: Arial; font-size: x-small;"><br /></span><br />
<span style="font-family: Arial; font-size: x-small;"><span style="font-family: "Arial","sans-serif";"><span style="font-size: small;">In prostate cancer, the word “chemotherapy”
is essentially synonymous with Taxotere (docetaxel). Taxotere is by far the most common
chemotherapy medicine for prostate cancer. Taxotere is an active agent that is
also employed for the treatment of breast cancer and lung cancer.<span style="mso-spacerun: yes;"> </span>Jevtana, which has many similarities to
Taxotere, more than any differences, is the second most commonly used type of
chemotherapy. Taxotere (and Jevtana) are administered intravenously every three
weeks in a cyclical fashion. </span></span><br />
<span style="font-family: Times New Roman; font-size: small;">
</span><br />
<div style="background: white; line-height: normal;">
<span style="font-family: "Arial","sans-serif";"><span style="font-size: small;">These agents are typically used to treat
advanced metastatic prostate cancer. Men with preexisting bone pain usually
notice significant improvement within a week or two of starting therapy.<span style="mso-spacerun: yes;"> </span>Another sign that the Taxotere is working is
PSA levels decline.<span style="mso-spacerun: yes;"> </span>If the PSA
does not decline immediately, Taxotere should still be continued for at least
two or three cycles before concluding the treatment is not working. An initial
increase in PSA for 30-60 days is not an indication to stop Taxotere because on
occasion men have a bump upward in the PSA, a “flare” from the dying cancer
cells.<span style="mso-spacerun: yes;"> </span>However, if the PSA continues to
rise after three cycles, it indicates that the Taxotere is not working. </span></span></div>
<span style="font-family: Times New Roman; font-size: small;">
</span><br />
<div style="background: white; line-height: normal;">
<span style="font-family: "Arial","sans-serif";"><span style="font-size: small;">Cancer response rates can be further improved
by using Taxotere in combination with Carboplatin.<span style="mso-spacerun: yes;"> </span>Carboplatin is also administered
intravenously and can be conveniently administered at the same time as the
Taxotere. In patients who have normally functioning bone marrow and normal
kidney function, a small dose of Carboplatin, say 200 mg, can be safely
administered along with full-dose Taxotere.<span style="mso-spacerun: yes;">
</span>Carboplatin is well-tolerated though occasional side effects include
low-grade nausea, numbness in the hands or feet and tiredness. </span></span></div>
<span style="font-family: Times New Roman; font-size: small;">
</span><br />
<div style="background: white; line-height: normal;">
<span style="font-family: "Arial","sans-serif";"><span style="font-size: small;">Taxotere administered in combination is with
Avastin and Revlimid is another very active combination that will induce a
cancer response in most men. Avastin, which is FDA-approved for colon cancer
but not prostate cancer, is an angiogenesis inhibitor given intravenously every
two weeks. It is generally well-tolerated but requires concomitant blood
thinners due to a higher risk of blood clots. Avastin can also cause slow wound
healing and can't be used before or after surgery. Revlimid oral agent that is FDA-approved
for a type of bone cancer called myeloma. Like Avastin, it also functions by
blocking new blood vessel growth. When using Revlimid in combination with
Taxotere and Avastin we typically limit the Revlimid dosage to 5 mg daily. Side effects
at this dose range are rare though occasionally platelet counts can be
suppressed. </span></span></div>
<span style="font-family: Times New Roman; font-size: small;">
</span><br />
<div style="background: white; line-height: normal;">
<span style="font-family: "Arial","sans-serif";"><span style="font-size: small;">A study using these three agents in
combination that showed very high response rates was published by Dr. Figg from
the National Cancer Institute.<span style="mso-spacerun: yes;"> </span>This same
study also reported a high frequency of fairly notable side effects including
numbness of the hands and feet as well occasional cases of jaw damage, a
condition called osteonecrosis.<span style="mso-spacerun: yes;"> </span>Despite
these significant problem, Dr. Figg reported that the vast majority of the men
achieved significant remissions and that the remissions tended to be quite long
lasting.<span style="mso-spacerun: yes;"> </span></span></span></div>
<span style="font-family: Times New Roman; font-size: small;">
</span><br />
<div style="background: white; line-height: normal;">
<span style="font-family: "Arial","sans-serif";"><span style="font-size: small;">Aggressive combination protocols like these
require various supportive measures to be successful.<span style="mso-spacerun: yes;"> </span>Defending against low white blood cell counts
with an immune stimulator such as Neulasta should be considered routine. Neulasta
is a powerful medicine that stimulates the bone marrow to manufacture white
blood cells more quickly and in greater numbers. Side effects are rare but
occasionally, serious but transient episodes of lower back pain can occur. </span></span></div>
<span style="font-family: Times New Roman; font-size: small;">
</span><br />
<div style="background: white; line-height: normal;">
<span style="font-family: "Arial","sans-serif";"><span style="font-size: small;">Another bone marrow stimulator, Aranesp, can
defend against the development of progressive anemia. Anemia is a common in men
with prostate cancer and can be due to hormone therapy, chemotherapy, or even
from the prostate cancer invading the bone marrow. Symptoms of anemia are
shortness of breath and fatigue. Timely and appropriate use of Aranesp helps to
maintain normal red blood cell counts and can reduce the need for blood
transfusions. </span></span></div>
<span style="font-family: Times New Roman; font-size: small;">
</span><br />
<div style="background: white; line-height: normal;">
<span style="font-family: "Arial","sans-serif";"><span style="font-size: small;">Taxotere usage has been greatly postponed in
men with metastatic prostate cancer ever since the FDA approval of Xtandi and
Zytiga. These agents induce meaningful remissions with far fewer side effect
than Taxotere.<span style="mso-spacerun: yes;"> </span>However, patient tend to
have a rapid and virulent progression of the cancer after Zytiga and Xtandi
stop working.<span style="mso-spacerun: yes;"> </span>Taxotere, possibly in
combination with Carboplatin should probably be implemented quickly in most
cases.<span style="mso-spacerun: yes;"> </span></span></span></div>
</span><br />Prostate Oncology Specialistshttp://www.blogger.com/profile/12308174937988133133noreply@blogger.com0tag:blogger.com,1999:blog-3114833974012757165.post-18742785816770368512016-02-23T17:53:00.000-08:002016-02-29T18:06:21.863-08:00Memorials: Peter Grimm, MD and Jay Cohen, MD<div class="Body" style="line-height: 18pt; margin-bottom: 0pt; margin-top: 0pt;">
<h2>
<div class="MsoNormal" style="line-height: 18.0pt; mso-collapsed-heading: yes; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 2;">
<span style="font-weight: normal;"><span style="font-family: "arial" , sans-serif; font-size: x-small;">BY MARK SCHOLZ, MD</span></span><br />
<span style="font-weight: normal;"><span style="font-family: "arial" , sans-serif; font-size: 12pt;"><br /></span></span>
<span style="font-weight: normal;"><span style="font-family: "arial" , sans-serif; font-size: 12pt;">I am sad to report the passing of two giant
contributors in the prostate cancer realm, Dr. Peter Grimm and Dr. Jay
Cohen. </span><span style="font-family: "times new roman" , serif; font-size: 12pt;"><br />
</span><span style="font-family: "arial" , sans-serif; font-size: 12pt;"><br />
Dr. Grimm was the Director of the Prostate Cancer Center of Seattle which
pioneered seed implantation for prostate cancer. He was instrumental in
establishing the <a href="http://www.seattleprostate.com/"><span style="color: blue;">Seattle Prostate Institute</span></a> in 1997. Along
with his colleagues, Dr. John Blasko and Dr. Haken Ragde, he trained over 6000
physicians worldwide in how to administer seed implants. Their team has treated
over 10,000 patients since 1985. Over one thousand centers now perform seed
implantation, which is now a treatment of choice for many men with prostate
cancer. Dr. Grimm completed his graduate training in radiation
oncology at UCLA. </span><span style="font-family: "times new roman" , serif; font-size: 12pt;"><br />
</span><span style="font-family: "arial" , sans-serif; font-size: 12pt;"><br />
Dr. Grimm’s technical endeavors, such as the development of six US patented
devices, have led to continuous improvements in the equipment widely used in
prostate brachytherapy. He has served as one of fifteen physicians on the
Medicare Practicing Physicians Advisory Board in Washington DC and served on
the American Society of Therapeutic Radiation Oncology economic committee. He
was the CEO of ProQura, and served on advisory boards for many seed implant
companies. As lead editor, Dr. Grimm and members of the Prostate Cancer Results
Study Group published a collaborative book on prostate cancer, <i><a href="http://www.amazon.com/The-Prostate-Cancer-Treatment-Book/dp/0071422560"><span style="color: blue;">The Prostate Cancer Treatment Book</span></a></i>. His
curriculum vitae included over 80 scientific articles and book chapters on
prostate cancer. </span><span style="font-family: "times new roman" , serif; font-size: 12pt;"><br />
</span><span style="font-family: "arial" , sans-serif; font-size: 12pt;"><br />
Dr. Grimm received an Outstanding Achievement awards from the American
Brachytherapy Society, Midwestern University, and the Northwest Osteopathic
Foundation. Born and raised in Seattle, he had a lifelong passion for
preserving wild salmon. He was a board member of Long Live the Kings, a
non-profit organization dedicated to preserving wild salmon in the Northwest.
In a cooperative effort with the Hood Canal Salmon Enhancement Group and
Washington State Department of Wildlife, he has released over 3 million wild
salmon. He also serves as a board member for Pacific Northwest College.
He leaves behind his spouse Dawn Winters, PhD and two children, Robyn Vera, DO
a radiation oncology physician in Olympia Washington and Justin Grimm, an IT
specialist.</span><span style="font-family: "times new roman" , serif; font-size: 12pt;"><br />
</span><span style="font-family: "arial" , sans-serif; font-size: 12pt;"><br />
I am also saddened to report that Dr. Jay S. Cohen passed away in December
2015. My interactions with Dr. Cohen were related to his excellent book on
prostate cancer: <i><a href="http://www.amazon.com/Prostate-Cancer-Breakthroughs-Step---Step/dp/0988710501/ref=sr_1_1?s=books&ie=UTF8&qid=1456797500&sr=1-1&keywords=jay+cohen+prostate"><span style="color: blue;">Prostate Cancer Breakthroughs</span></a></i>. However,
outside of the prostate cancer world, his researching and writing skills were
eclectic and broad. Among his many and varied interests were his extensive
research on the causes of medication side-effects. He published his findings in
eight books, leading medical journals, and<a href="https://www.blogger.com/null" name="_GoBack"></a> articles
and publications such as Newsweek, Bottom Line Health, The New York Times, The
Washington Post, Consumer Reports, Wall Street Journal. Another of his
books, <i>Over Dose: The Case Against the Drug Companies</i> was
favorably reviewed by the Journal of the American Medical Association.
Dr. Cohen was an Adjunct Associate Professor of Psychiatry and the Chairman of
the Medical Advisory Committee of the Erythromelalgia Association, and a Fellow
of the American College of Nutrition. He lived in Del Mar, CA for over 40
years. He is survived by his son Rory Cohen and daughter-in-law Alana Cohen,
and a nephew, Hal Cohen.</span></span></div>
</h2>
</div>
Prostate Oncology Specialistshttp://www.blogger.com/profile/12308174937988133133noreply@blogger.com0tag:blogger.com,1999:blog-3114833974012757165.post-67738616421401153312016-02-09T07:00:00.000-08:002016-02-09T07:00:15.848-08:00Sometimes Going Fishing with the Doctor Isn’t So Much Fun<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: 13.3333px;"><b>BY A PATIENT OF MARK SCHOLZ, MD</b></span></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Arial",sans-serif; font-size: 10.0pt;">When you
go fishing, you can bring up all kinds of things besides fish—old rubber boots,
pieces of a broken net and discarded trash. Once I caught an eel. You never know what you will drag in when you
drop your line overboard. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Arial",sans-serif; font-size: 10.0pt;">The same
analogy holds true for diagnostic testing in the medical world. Investigative
studies can have unintended consequences. Of course the studies seem justified
at the time. We presume that the doctor is being rightfully conscientious by
using all the tools of modern medicine, “fishing” for the right answers.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Arial",sans-serif; font-size: 10.0pt;">Dr.
Scholz asked me to relate the story of an extended medical fishing trip that
started with my dermatologist for my annual, too-much-California-sun screening.
While talking to my dermatologist, I mentioned some itching on my arms. He gave me a few samples of lotion and
referred me to my internist for further evaluation and blood testing to “make
sure” the itching wasn’t a symptom of something more serious. My internist
ordered some lab work (which was normal) but recommended that I have a routine
chest x-ray since itching can be associated with lung cancer. This suggestion may have occurred to him
because he knew that lung cancer caused my mother’s death. Since I hadn’t had a chest x-ray in years, I
thought, “why not?”<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Arial",sans-serif; font-size: 10.0pt;">In
retrospect, the chest x-ray may have been a mistake. Because that’s when the boat left the dock
and the fishing really began in earnest.
Two days later, the chest x-ray revealed a “suspicious” spot on my lung.
So, to identify what it was, a CT was ordered. The spot was benign. “Whew!” It was only a
bone artifact (the end of a rib visible due to the angle of the x-ray). But…. the CT scan showed a suspicious spot in
the liver, which shouldn’t have been there and was large enough to be of
concern. So, an MRI of the abdomen was
ordered. The MRI revealed that the liver
spot was nothing but a harmless hemangioma, a collection of blood vessels that are
common and mean nothing. Another big
relief. But…. guess what else the MRI found?
At the top end of the scan in my lower neck, it showed some
abnormalities in my thyroid “that could not be ignored.” So, a thyroid ultrasound was ordered. It revealed two nodules that looked benign
and would have been ignored completely if there had only been one. <i>But the
only way to really know what types of cells the nodules consisted of was by
doing a needle biopsy or an exploratory surgery.</i> <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Arial",sans-serif; font-size: 10.0pt;">Yikes! When would I get off this merry-go
round? Who could imagine that simply
mentioning some itching to a dermatologist would lead me face to face with the possibility
of thyroid cancer. However, the doctor
was kind enough to offer another alternative.
Because of the known, slow-growth rates of typical thyroid cancers, active
surveillance and re-testing at future intervals was also an option, and the one
I have selected.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Arial",sans-serif; font-size: 10.0pt;">So, six
months later, a second thyroid ultrasound—my fifth imaging test—showed no
changes from the previous test. The
fishing trip finally seems to be over. I
am back in the waiting pool anticipating next year’s medical expedition, much
the same as the next round of prostate screening tests I am scheduled to
undergo early in 2017. Now, routinely
surveilling my thyroid is going to be just like my prostate. If next year’s fishing trip doesn’t run down
any new tributaries and is uneventful, I expect it may even be possible to extend
by a year or two the time the frequency of testing. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<br />
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Arial",sans-serif; font-size: 10.0pt;">My medical
fishing trip was not much fun. Personally,
I’d rather spend my time working, biking or walking, or doing almost anything besides
waiting for the next set of results from the last odd thing that showed up
unexpectedly. But life goes on and it isn’t possible to know precisely how it
will end. My recommendation—Give careful
consideration to your doctor’s invitation to go fishing. Take control over your medical destiny and
ask you doctors if close surveillance is an alternative to further testing. <o:p></o:p></span></div>
Prostate Oncology Specialistshttp://www.blogger.com/profile/12308174937988133133noreply@blogger.com0tag:blogger.com,1999:blog-3114833974012757165.post-71136984353099427882016-01-26T11:59:00.000-08:002016-01-26T11:59:21.922-08:00Crila, A Solution to Old Men’s Urinary Problems?<div style="margin-bottom: .0001pt; margin: 0in;">
<b><span style="font-family: Arial, sans-serif; font-size: 11pt;">BY MARK SCHOLZ, MD</span></b><span style="font-size: 11pt;"><o:p></o:p></span></div>
<div style="margin: 0in 0in 0.0001pt;">
<br /></div>
<div style="margin: 0in 0in 8pt;">
<span class="normalchar"><span style="font-family: Arial, sans-serif; font-size: 11pt;">As we get older, we run into all
kinds of difficulties. Poor hearing, sexual dysfunction, memory problems
and arthritic joints, just to name a few. Bladder issues in particular can be
troublesome, interrupting sleep, making us dread long drives or forcing us to
visit the bathroom at an inopportune time.<o:p></o:p></span></span></div>
<div style="margin-bottom: 8.0pt; margin-left: 0in; margin-right: 0in; margin-top: 0in;">
<span class="normalchar"><span style="font-family: Arial, sans-serif; font-size: 11pt;">As a prostate oncologist taking care of many men who are in their
60s and 70s, it’s no surprise that I hear a lot about urinary difficulties. T<a href="https://www.blogger.com/null" name="_GoBack"></a>hese problems are often thought to result from prostate
enlargement, otherwise known as BPH. The swollen gland ends up pinching the
urinary passage way (called the urethra). Slow urination and incomplete
emptying of the bladder are the result. </span></span><span style="font-size: 11pt;"><o:p></o:p></span></div>
<div style="margin: 0in 0in 8pt;">
<span class="normalchar"><span style="font-family: Arial, sans-serif; font-size: 11pt;">Prostate gland enlargement with
incomplete bladder emptying can frequently be solved with common prescription
medications like Flomax, Rapaflo and Uroxatrol which relax the muscles in the
wall of the urethra and help to open up the passageway. Proscar and
Avodart can shrink the prostate but they also tend to shrink your libido. The
most popular treatment is a nonprescription—<a href="http://www.lifeextension.com/vitamins-supplements/item01790/palmettoguard-saw-palmetto-nettle-root-formula-with-beta-sitosterol" target="_blank">Saw Palmetto</a> an herbal product
that works by relaxing the muscles in the urethra.</span></span><span style="font-family: Arial, sans-serif; font-size: 11pt;"><o:p></o:p></span></div>
<div style="margin-bottom: 8.0pt; margin-left: 0in; margin-right: 0in; margin-top: 0in;">
<span class="normalchar"><span style="font-family: Arial, sans-serif; font-size: 11pt;">However, after doing thousands of color Doppler ultrasound
examinations, which by the way is the most precise way to measure the size of
the prostate, I have learned that BPH is a less common cause of men’s urinary
problems. So what is the primary reason for men’s urinary frustrations?
Prostatitis—low grade inflammation of the gland with secondary irritation.
What causes prostatitis? In a minority of cases it is due to bacterial
infection. When this type of prostatitis occurs it may improve with
antibiotics. But for the vast majority of cases we simply don’t know the
cause. Virus or autoimmune causes have been theorized but nothing has
been proven. Our ignorance, however, has nothing to do with its prevalence. It
is not widely realized, but <i>almost all</i> <i>men</i> have
some degree of chronic inflammation in their prostate glands.</span></span></div>
<div style="margin-bottom: 8.0pt; margin-left: 0in; margin-right: 0in; margin-top: 0in;">
<span style="font-family: Arial, sans-serif; font-size: 11pt;"><span class="normalchar">Though we don’t know the precise etiology, anti-inflammatory
medications can be quite effective at alleviating the symptoms of prostatitis.
Over the counter products like Aleve and Motrin are effective. Celebrex, is a
prescription anti-inflammatory agent that is billed as having less stomach
irritation. However, unless the pills are used continuously, the inflammation
comes back.</span><o:p></o:p></span></div>
<div style="margin-bottom: 8.0pt; margin-left: 0in; margin-right: 0in; margin-top: 0in;">
<span class="normalchar"><span style="font-family: Arial, sans-serif; font-size: 11pt;">Recently, I have been introduced to a natural anti-inflammatory
substance discovered in the flower of the <a href="https://crilahealth.com/prostate-health-herb-supplement.html" target="_blank">Crila </a>plant. Several of our patients
tried Crila with notable improvement to their urinary symptoms. So far we have
not observed any side effects. To investigate Crila’s effectiveness
further, I have petitioned the manufacturer to provide a 3-month supply of
Crila to 15 of our patients at no cost. Patients who have problems with frequent
urination, a strong sense of urinary urgency or have to get up frequently at
night to urinate may want to consider contacting <a href="mailto:sabrina@prostateoncology.com" target="_blank">Sabrina</a> in our <a href="http://www.prostateoncology.com/" target="_blank">office </a>about
their eligibility for participating in this clinical trial. </span></span></div>
Prostate Oncology Specialistshttp://www.blogger.com/profile/12308174937988133133noreply@blogger.com5tag:blogger.com,1999:blog-3114833974012757165.post-3796366475967235662016-01-12T14:37:00.000-08:002016-01-12T14:37:33.791-08:00The Amazing Gleason Score<span style="font-family: "Arial","sans-serif"; font-size: 11pt;"><strong>BY MARK SCHOLZ, MD</strong></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;"><br /></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Everyone is
excited about the latest craze in medical technology—genetic analysis of tumor
cells, which I’ll call GAT for short. The scientific progress that has been
made with GAT in my opinion is the <i style="mso-bidi-font-style: normal;">second</i> most
exciting area of advancement in medical technology today (see further below for
more about the first most exciting area). GAT technology is already being
commercialized for use in the medical marketplace in products like <a href="https://prolaris.myriad.com/" target="_blank"><span style="color: blue;">Prolaris</span></a>
and <a href="http://www.genomichealth.com/oncotype_iq_products/oncotype_dx/oncotype_dx_prostate_cancer" target="_blank"><span style="color: blue;">Oncotype</span></a>. This technology is able to
predict the aggressiveness of prostate cancers, enabling us to differentiate
between the men who need immediate treatment and those who can postpone
treatment safely.</span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;"><br />
The predictive power of GAT is certainly exciting, but there is already an
effective form of genetic testing available that has been around for more
than 40 years, the Gleason scoring system. The Gleason system relies on the
visual appearance of cells under the microscope to draw conclusions about their
inner genetic makeup. In the medical world, using the visual appearance of the
cancer cells is called <i style="mso-bidi-font-style: normal;">phenotypic</i>
analysis. GAT is <i style="mso-bidi-font-style: normal;">genotypic</i>
analysis. Drawing conclusions about underlying genetic makeup by simple
visual assessment is a pervasive in human experience. In courtship, we
rely on phenotypic analysis of the underlying genetic make-up of potential
spouses to form an opinion about their suitability as potential mates.
Perusal of the genetic pool of immediate family members provides further
insight.</span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;"><br />
So how can Gleason score draw conclusions about the underlying genetic
potential for tumor aggressiveness simply by looking at the appearance of cells
under a microscope? The answer is to do a comparison of the visual
appearance of cancer cells with the appearance of normal prostate cells. Normal
cells in the prostate perform varied functions but still work together as a
team. Specifically, healthy cells form into definable structures called
glands. In these glands some cells manufacture prostatic fluid, a complex
liquid comprising the ejaculate for the sperm to swim in. Other cells
organize to form ducts, a piping system to drain the fluid from the outer
periphery of the gland and channel it into the middle of the prostate so that a
large quantity of fluid can be expelled through the urethra at just the right
moment. All of these different cells work as a team and coexist in the
prostate functioning together in a structured glandular arrangement. </span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;"> </span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">When a
trained pathologist looks at tumor cells under the microscope he grades them by
the degree of cellular disorder. He is asking himself the question, “How
much do these cells retain the normal glandular characteristics of the prostate
gland?” If a cross section of the tumor looks like an unbroken sheet of
uniform cells, the cancer is high-grade; the cells have lost their ability to
cooperate with each other and form glands. The cancer cells have been honed
down into little race cars with only one mission, to aggressively pursue its
own replicative destiny. When tumors have this appearance they are graded as a
Gleason 9 or 10. On the other hand, if the appearance of the tumor shows
residual glandular components, it is less aggressive, perhaps a Gleason 7.
Gleason 6 “cancer,” the type the one that never spreads, looks almost like
normal prostate gland tissue. </span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;"> </span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Predicting
future tumor behavior is obviously very important. How fast will it grow?
Is it likely to spread? How well can it be expected to respond to treatment? As
a result of decades of experience, doctors have learned to use the Gleason
scoring system to accurately predict the long-term outcome in individual
patients. The new GAT tests represent an important additional refinement,
further enhancing our ability to predict the future behavior of an individual
cancer. GAT holds one even bigger promise. In the future we believe GAT
testing will be a powerful aid in the selection of targeted therapy, i.e.,
picking cancer treatments with anticancer activity tailored to individual tumor
types. This hope, however, will have to be postponed until our limited
armamentarium of effective treatments is further expanded.
</span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;"> </span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Now, what is
it that I consider to be the <i style="mso-bidi-font-style: normal;">most</i> exciting
area of medical progress? Since I am an impatient type of guy, someone who is
looking for quick results, I find immunotherapy more exciting than GAT. To
fully exploit the potential of GAT we will need to invent new pills for each of
the myriad of genetically different tumor types. Immunotherapy on the other
hand comes with its own “built-in” GAT system that enables it to target the
unique genetic signature of individual cancer cells. The immune system is so
smart, all we have to do is “flip the switch on” and starts cranking out
genetically targeted anticancer therapy. Recent developments in the field of
immunology are truly mind-boggling and hold promise for a big revolution in
cancer therapy within the next 5-10 years. I’ll try to address some of
these recent advances in an upcoming blog. </span><br />
Prostate Oncology Specialistshttp://www.blogger.com/profile/12308174937988133133noreply@blogger.com0tag:blogger.com,1999:blog-3114833974012757165.post-92144600988509071502015-12-29T15:12:00.000-08:002015-12-31T08:58:56.905-08:00Predicting Prostate Cancer’s Future Behavior<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;"><strong>BY MARK SCHOLZ, MD</strong></span><br />
<strong><span style="font-family: Arial; font-size: x-small;"><br /></span></strong><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Developing an accurate prognosis, i.e., predicting how a man’s cancer is likely to behave in the future, is the first and most important step toward optimal care. Future predictions are often looked at with some suspicion. With prostate cancer, however, our power to anticipate future cancer behavior is quite accurate unless there is a lack of thoroughness in gathering information.<br />
<br /><strong>
The Size of the Tumor</strong></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Tumor size is a universally important prognostic sign for almost all types of cancer including prostate cancer. The method for incorporating tumor size into the Anthony D’Amico’s staging system relies on the degree of PSA elevation, the tumor grade and on how the prostate "feels" with the finger of a trained practitioner. These indicators are useful but don’t incorporate information from modern imaging. Imaging provides accurate information about tumor size and the presence or absence of extracapsular extension. These are very powerful prognostic predictors and it would be foolish to disregard their importance. As things stand presently these indicators are often used to divide the low, intermediate and high risk categories into "favorable" and "unfavorable" subcategories, each with a different spectrum of recommended treatment options.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><br />
<strong><span style="font-family: Arial, Helvetica, sans-serif;">Knowing Past Treatments Tells Something about Future Prognosis</span></strong><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Historically, since the total number of available treatments is relatively limited, practitioners have used a sequential "trial and error" treatment methodology that administers the standard treatment options in a fairly predictable sequence. For example, it is not uncommon for men to start with surgery or radiation. When a relapse occurs, standard hormone therapy (Lupron) is often started and given intermittently or continuously. Hormone therapy usually controls the disease for an average of 10 years. When Lupron stops working, immunotherapy with Provenge is usually follows. After Provenge, more potent hormone therapy with Xtandi or Zytiga is started. If these two agents prove ineffective, chemotherapy with Taxotere or radiation with Xofigo would be considered next.<br />
<br />The whole point of presenting the treatment sequence described in the previous paragraph is to convey the idea that the number of previous treatments communicates important information about that patients’ future prognosis. Having "failed" Lupron, for example, bespeaks of a much more worrisome prognosis compared to the situation where Lupron continues to be effective.</span><br />
<strong><br /><span style="font-family: Arial, Helvetica, sans-serif;"></span></strong><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><strong>Response to Lupron, The Mother of All Metrics</strong><br />
The quality of the "response" to Lupron is actually one of the most powerful prognostic metrics available. The degree of PSA decline after Lupron is incredibly important. How low the PSA drops after starting Lupron is called the "PSA nadir." The specific PSA threshold used to determine a "good response" is less than 0.1. Believe it or not, there is a huge difference in prognosis between a man on Lupron for six months who has a PSA of 0.1 versus a man whose PSA levels off at 1.0.
<br /><br /><strong>
An Established History is also a Prognostic Indicator</strong><br />
Another somewhat obvious prognostic indicator that is often overlooked and almost never discussed in textbooks has to do with the prognosis of men who have been diagnosed years ago -- over time it is apparent that things are turning out much better than what might have been expected based on their initial indicators. For example, take the case of a man who started off with a panoply of bad indicators—tumor is in the lymph nodes and Gleason 10—but after aggressive treatment remains in remission for 5 years. The fact that things have gone well for five years counts bigtime in his favor going forward. Remember, the original prognostic predictors of a Gleason 10 were just that, predictors. No predictor is 100% accurate. Five years of established history is a stronger predictor than the original Gleason score. The fact that things have gone well for five years, strongly indicates that the future is for that individual is bright. Such individuals have "beaten the odds."
</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">
<br /><strong>
The Location of the Tumor in the Body</strong><br />
Another extremely important indicator of prognosis, something that even laypeople anticipate by simple common sense, is the location of the cancer in the body. Location says volumes about how things are likely to progress in the future. For example, consider the following sequence of progressively more serious cancer sites:<br />
<br />
•Contained within the prostate<br />
•Extended into the seminal vesicle<br />
•Spread to the lymph nodes<br />
•Bone metastases<br />
•Liver metastasis<br />
<br />
Each of these locations is very important for determining prognosis.<br />
<br />
This short blog is just an introduction to some of the "profiling" methods utilized in generating an accurate prognosis. Space limitations preclude discussion here about other known prognostic factors such as the size of the prostate gland (<a href="http://prostatesnatchers.blogspot.com/2012/01/prostate-size-matters.html" target="_blank">discussed in a previous blog</a>), genetic tests and PSA doubling time. The D’Amico risk categories constitute the backbone of useful prognostic information. However, the additional prognostic information beyond the D’Amico risk categories that are discussed in this blog, provide additional useful information necessary for determining an accurate prognosis. An accurate prognosis is the starting point for accurate selection of treatment. <br />
</span><br />
<h2>
</h2>
<span style="font-family: Arial; font-size: x-small;">
</span><span style="font-family: Arial, Helvetica, sans-serif;"></span>Prostate Oncology Specialistshttp://www.blogger.com/profile/12308174937988133133noreply@blogger.com2tag:blogger.com,1999:blog-3114833974012757165.post-2781257182636746532015-12-15T14:31:00.000-08:002015-12-15T14:31:10.648-08:00Androgen Deprivation Therapy for Prostate Cancer Causes Alzheimer’s Disease?<span style="font-family: "arial" , "helvetica" , sans-serif; font-size: x-small;"><strong>BY MARK SCHOLZ, MD</strong></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span><br />
<a href="https://www.linkedin.com/in/kevin-nead-ba0407a2" target="_blank"><span style="font-family: "arial" , "helvetica" , sans-serif;">Dr.Kevin Nead</span></a><span style="font-family: "arial" , "helvetica" , sans-serif;"> authored an article published in the </span><a href="http://jco.ascopubs.org/content/early/2015/12/07/JCO.2015.63.6266" target="_blank"><span style="font-family: "arial" , "helvetica" , sans-serif;">Journal of Clinical Oncology</span></a><span style="font-family: "arial" , "helvetica" , sans-serif;"> this month.<span style="mso-spacerun: yes;"> </span>It created a media
sensation and generated multiple calls to the </span><a href="http://www.pcri.org/" target="_blank"><span style="font-family: "arial" , "helvetica" , sans-serif;">PCRI</span></a><span style="font-family: "arial" , "helvetica" , sans-serif;"> Helpline. <span style="mso-spacerun: yes;"> </span>Last week, three separate articles about this
topic were posted on the Yahoo home page at the same time.</span><br />
<span style="font-family: "arial";"><br /></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">It’s
no surprise that an article on this topic generates wide-spread interest. About
500,000 thousand men in the United States are undergoing prostate cancer
treatment with androgen deprivation therapy (</span><a href="http://prostatesnatchers.blogspot.com/2013/05/preventing-hormone-therapy-side-effects.html" target="_blank"><span style="font-family: "arial" , "helvetica" , sans-serif;">ADT</span></a><span style="font-family: "arial" , "helvetica" , sans-serif;">). This treatment works by blocking
the male hormone levels delivering notable anticancer efficacy and also proven
to prolong life in men with prostate cancer. Despite it’s known effectiveness, a
variety of side effects can occur, including memory problems.<span style="mso-spacerun: yes;"> </span>The previously reported studies evaluating this
phenomenon seem to indicate that when memory deficits occur, they usually
reverse after ADT is stopped.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">The
research published in the Journal of Clinical Oncology, relied on a new method
of searching through patient’s medical charts with computers. No human review
of these medical charts were performed. The computer software searched the medical
records in an attempt to determine if men on ADT had a higher incidence of
Alzheimer’s. The authors report that this new computer searching methodology in detecting a specific medical diagnosis is 74% accurate.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">Review
of all the charts at Stanford and Mount Sinai hospital unearthed 16,888 prostate
cancer patients of which 2,397 were treated with ADT.<span style="mso-spacerun: yes;"> </span>After the fancy computer analysis, designed to
compensate for multiple factors such as patient age and underlying heart disease
(both of which lead to Alzheimer’s more frequently), the conclusion was that
the ADT-treated men were twice as likely to have developed Alzheimer’s. A total
of about 9 cases would have been expected from normal causes, but 18 were
actually detected. <span style="mso-spacerun: yes;"> </span>If these conclusions
are accepted as gospel truth, an additional 9 out of 2,397 men treated with ADT
would equate to an increased risk of less than half of 1%.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="mso-spacerun: yes;">T</span>he
conclusion that there is tiny increase risk of Alzheimer’s with ADT, needs to
be put in context based on what we already know about prostate cancer. First,
is it possible that these men have reversible
memory problems while still taking ADT? There was no attempt in the study made
to determine if the “Alzheimer’s” patients were still on ADT when the diagnosis
of Alzheimer’s was made. Second, men treated with ADT are substantially sicker
than men who don’t need ADT.<span style="mso-spacerun: yes;"> </span>There is no
way for the computer analysis to compensate for how this may have impacted mental
performance. Third, patients getting ADT receive closer medical surveillance
and visit physicians more frequently than men who are not receiving ADT.<span style="mso-spacerun: yes;"> </span>As such, memory problems are more likely to
come to medical attention and be diagnosed when men are on ADT. Fourth, general
anesthesia (from surgery) is known to cause long-term memory problems.<span style="mso-spacerun: yes;"> </span>This study did not perform any analysis to
determine if surgery was performed with equal frequency in both groups.</span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span><br />
<span style="font-family: "arial" , "sans-serif";"><span style="font-family: "arial" , "helvetica" , sans-serif;">In
summary, it is not clear from this JCO article whether the men labeled having Alzheimer’s
disease had memory problems while still receiving ADT or whether they had true
Alzheimer’s, i.e., long-term irreversible memory problems continuing after the
ADT was stopped. There is one thing, however, this study does show: At worst,
memory problems serious enough to be labeled as “Alzheimer’s” occur in in less
than one out of every 200 men treated with ADT.</span></span>Prostate Oncology Specialistshttp://www.blogger.com/profile/12308174937988133133noreply@blogger.com0tag:blogger.com,1999:blog-3114833974012757165.post-57959454932997292572015-12-01T14:21:00.000-08:002015-12-02T17:00:26.147-08:00Sir Spheres for Liver Metastases from Prostate Cancer<br />
<div style="line-height: normal; margin: 0in 0in 8pt;">
<span style="font-family: "arial" , "sans-serif";"><strong><span style="font-size: x-small;">BY MARK SCHOLZ, MD</span></strong></span></div>
<div style="line-height: normal; margin: 0in 0in 8pt;">
<span style="font-family: "arial" , "sans-serif";">Cancer
that spreads outside the prostate gland is what makes prostate cancer
dangerous. Metastatic prostate cancer cells cause malfunction by impeding
normal function. Some organs, like <i style="mso-bidi-font-style: normal;">lymph
nodes</i> for example, continue to function quite nicely, even if the degree of
cancer spread is extensive.<span style="mso-spacerun: yes;"> </span>Lymph node
spread, therefore, is the least dangerous form of prostate cancer
metastases.<span style="mso-spacerun: yes;"> </span>At the other end of the spectrum
is the <i style="mso-bidi-font-style: normal;">liver</i>, which is far less
tolerant.<span style="mso-spacerun: yes;"> </span>The seriousness of <i style="mso-bidi-font-style: normal;">bone</i> metastases, the most common site of
prostate cancer spread, lies about half way between that of node metastases and
liver metastases.</span><br />
<br /><br />
<span style="font-family: "arial" , "sans-serif";">The
earliest stages of metastases are microscopic and therefore invisible even with
the best available technology. To be detected with the best available PET scan
technology, small tumors must measure more than 1/8 of an inch across. For
detection with standard CT scans and MRI scans, more than a half-inch sized
tumor is necessary. Since the presence of metastases is such a defining issue
when describing a cancer’s character, men who are newly-diagnosed are labeled
as low, intermediate or high-risk depending on their <i style="mso-bidi-font-style: normal;">estimated</i> <i style="mso-bidi-font-style: normal;">likelihood</i> of
micro-metastatic disease. Liver metastases are extremely rare at the time of
initial diagnosis of prostate cancer. When they occur it is usually after many
years of ongoing treatment for known metastatic disease in the bone.</span><br />
<span style="font-family: "arial" , "sans-serif";"><br /></span><br />
<span style="font-family: "arial" , "sans-serif";">P</span><span style="font-family: "arial" , "sans-serif";">rophylactic
treatment with hormone therapy, chemotherapy or radiation to treat the <i style="mso-bidi-font-style: normal;">possibility</i> of micro-metastases is
common for high-risk prostate cancer and occurs maybe half the time in
intermediate-risk prostate cancer. The goal is to cure the micro-metastases at
an early stage when they are most susceptible to eradication, thus preventing
the future development of detectable metastases which is what makes cancer life
threatening.</span><br />
<br /><br />
<span style="font-family: "arial" , "sans-serif";">When
talking about prostate cancer, even though this is a blog about metastases, it
should always be remembered that many common types of prostate cancer never
spread. These low grade “cancers” are genetically distinct and represent a
totally different category of disease.<span style="mso-spacerun: yes;"> </span>However,
when discussing the type of prostate cancer that is capable of metastasis, the
following factors impact how dangerous it is:</span></div>
<br />
<ol style="direction: ltr; list-style-type: decimal;">
<li style="color: black; font-family: "Arial","sans-serif"; font-size: 11pt; font-style: normal; font-weight: normal;"><div style="color: black; font-family: "Calibri","sans-serif"; font-size: 11pt; font-style: normal; font-weight: normal; line-height: normal; margin-bottom: 0pt; margin-top: 0in; mso-list: l0 level1 lfo1;">
<span style="font-family: "arial" , "sans-serif";">The site of spread.</span></div>
</li>
<li style="color: black; font-family: "Arial","sans-serif"; font-size: 11pt; font-style: normal; font-weight: normal;"><div style="color: black; font-family: "Calibri","sans-serif"; font-size: 11pt; font-style: normal; font-weight: normal; line-height: normal; margin-bottom: 0pt; margin-top: 0in; mso-list: l0 level1 lfo1;">
<span style="font-family: "arial" , "sans-serif";">The extent of spread</span></div>
</li>
<li style="color: black; font-family: "Arial","sans-serif"; font-size: 11pt; font-style: normal; font-weight: normal;"><div style="color: black; font-family: "Calibri","sans-serif"; font-size: 11pt; font-style: normal; font-weight: normal; line-height: normal; margin-bottom: 0pt; margin-top: 0in; mso-list: l0 level1 lfo1;">
<span style="font-family: "arial" , "sans-serif";">The tumor cell growth rate</span></div>
</li>
<li style="color: black; font-family: "Arial","sans-serif"; font-size: 11pt; font-style: normal; font-weight: normal;"><div style="color: black; font-family: "Calibri","sans-serif"; font-size: 11pt; font-style: normal; font-weight: normal; line-height: normal; margin-bottom: 8pt; margin-top: 0in; mso-list: l0 level1 lfo1;">
<span style="font-family: "arial" , "sans-serif";">The efficacy of available treatment </span></div>
</li>
</ol>
<br />
<div style="line-height: normal; margin: 0in 0in 8pt;">
<span style="font-family: "arial" , "sans-serif";">As
noted above, the liver is far less tolerant to metastatic invasion than bone or
lymph nodes. In addition, because liver metastases tend to occur in men with advanced
disease, tumor growth rates tend to be brisk. Also, the most commonly
administered treatments, hormone therapies and chemotherapy, have often already
been tried before liver metastases first develop. The advent of liver
metastases, therefore, usually represents a very serious and life threatening
issue.</span><br />
<br /><br />
<span style="font-family: "arial" , "sans-serif";">Liver
metastases may first be suspected when standard blood tests such as ALT, <a href="http://www.medicinenet.com/liver_blood_tests/page4.htm" target="_blank">AST</a> or
ALP which are components of a hepatic panel blood test, register outside the
normal range. Investigation into their cause often leads to doing a CT scan or
MRI scan of the abdomen and pelvis to confirm the presence of disease in the
liver. Alternatively, a scan may detect abnormal spots in the liver during
routine periodic scanning that is being performed as regular surveillance.</span><br />
<br /><br />
<span style="font-family: "arial" , "sans-serif";">Hormone
therapy with Lupron, Zytiga and Xtandi, or chemotherapy with Taxotere, Jevtana
and Carboplatin, is the standard approach to treatment for liver
metastasis.<span style="mso-spacerun: yes;"> </span>However, these treatments
may have already been tried or may no longer be effective.<span style="mso-spacerun: yes;"> </span>Since liver failure is tantamount to death,
prostate cancer growth in the liver needs to be stopped immediately, regardless
of how the disease is faring in the bones or nodes.</span><br />
<br /><br />
<span style="font-family: "arial" , "sans-serif";">Much
that has been learned about the treatment of liver metastases comes from
reviewing common methods for managing metastatic colon cancer. The liver is the
cancer’s preferred site of metastatic spread for colon cancer. Treatments that
have been employed include surgery, radiation and blockage of the blood supply
to the liver by embolization of the arteries, all with variable success.<span style="mso-spacerun: yes;"> </span>More recently, radioactive microspheres
injected directly into the tumor, called SIR-Spheres, have shown notable
efficacy with very tolerable side effects.</span><br />
<br /><br />
<span style="font-family: "arial" , "sans-serif";">Prostate
cancer and colon cancer are similar in that they are both adenocarcinomas which
means they are derived from glands. Therefore, they are likely to have similar
susceptibility to radiation. As such, we have been administering <a href="http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/DeviceApprovalsandClearances/Recently-ApprovedDevices/ucm083605.htm" target="_blank">SIR-Spheres</a> to
a limited number of prostate cancer patients with liver metastases. Results
have been encouraging with a notable improvement of survival compared to our
historical experience treatment patients with liver metastases without <a href="https://www.youtube.com/watch?v=fCgHA703ufw" target="_blank">SIR-Spheres</a>.<span style="mso-spacerun: yes;"> </span>Our preliminary results using SIR-Spheres in
six patients is being presented at the 2016 Genitourinary Cancers Symposium - San Francisco in January 2016. </span></div>
Prostate Oncology Specialistshttp://www.blogger.com/profile/12308174937988133133noreply@blogger.com1tag:blogger.com,1999:blog-3114833974012757165.post-59668762069051130702015-11-24T13:49:00.000-08:002015-12-15T14:08:00.956-08:00Active Surveillance: Follow-Up Essential<strong><span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">BY RALPH BLUM</span></strong><br />
<strong><span style="font-family: Arial; font-size: x-small;"></span></strong><div>
</div>
<span style="font-family: Arial;"><span style="color: black; font-size: 11pt;">A recent UCLA
study found that a significant percentage of men diagnosed with low-risk
prostate cancer who chose "active surveillance," rather than
aggressive treatment in order to avoid the debilitating side effects of surgery
or radiation, don't follow up with the required tests and office visits.</span></span><br />
<span style="font-family: Arial;"><span style="color: black; font-size: 11pt;"></span></span><div>
</div>
<span style="font-family: Arial;"><span style="color: black; font-size: 11pt;"></span></span><span style="color: black; font-family: "Arial","sans-serif"; font-size: 11pt;">This is
an alarming finding, because not being monitored appropriately puts them in
danger of the cancer progressing or metastasizing without their knowledge.
Before patients decide on active surveillance as a management option for
prostate cancer they should agree with their physician on a strict follow-up
schedule to closely monitor the cancer.</span><br />
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 11pt;"></span><div>
</div>
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 11pt;"></span><span style="color: black; font-family: "Arial","sans-serif"; font-size: 11pt;">There is
no doubt in my mind that active surveillance is the smart treatment option for
low-risk prostate cancer. With other cancers, or if the prostate
cancer is aggressive, the main issue is survival. But with low-risk prostate
cancer, since long survival is the norm, the most important consideration
is quality of life. Having said that, with active surveillance regular
check-ups are essential, because when men are watched closely, treatment can be
started at the first sign of cancer progression.</span><br />
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 11pt;"></span><div>
</div>
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 11pt;"></span><span style="color: black; font-family: "Arial","sans-serif"; font-size: 11pt;">So what
does active surveillance require? How exactly is it carried out?</span><br />
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 11pt;"></span><div>
</div>
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 11pt;"></span><span style="color: black; font-family: "Arial","sans-serif"; font-size: 11pt;">Different
centers have different requirements. At a 2007 Active Surveillance Conference,
attended by over 200 of the world's leading prostate cancer experts, the
attendees recommended a biopsy after one year, subsequently repeating it every
two to three years. But as I have often said, I am not a fan of biopsies. So I
prefer to recommend doing a repeat targeted biopsy only on the basis of a PSA and
prostate imaging with either color Doppler ultrasound or 3T <a href="http://www.prostatevanguard.com/" target="_blank">multi-parametric MRI</a>.</span><br />
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 11pt;"></span><div>
</div>
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 11pt;"></span><span style="color: black; font-family: "Arial","sans-serif"; font-size: 11pt;">Here is
an Active Surveillance Protocol that Dr. Mark Scholz recommends:</span><br />
<div>
</div>
<ul>
<li><div style="background: white; margin: 0in 0in 0pt; tab-stops: 427.5pt;">
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 11pt;">PSA every three months</span></div>
</li>
<li><div style="background: white; margin: 0in 0in 0pt; tab-stops: 427.5pt;">
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 11pt;"></span><span style="color: black; font-family: "Arial","sans-serif"; font-size: 11pt;">Rectal examination every 12 months</span></div>
</li>
<li><div style="background: white; margin: 0in 0in 0pt; tab-stops: 427.5pt;">
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 11pt;"></span><span style="color: black; font-family: "Arial","sans-serif"; font-size: 11pt;">Color Doppler ultrasound annually</span></div>
</li>
<li><div style="background: white; margin: 0in 0in 0pt; tab-stops: 427.5pt;">
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 11pt;"></span><span style="color: black; font-family: "Arial","sans-serif"; font-size: 11pt;">Multi-parametric MRI annually</span></div>
</li>
</ul>
<div style="background: white; margin: 0in 0in 0pt; tab-stops: 427.5pt;">
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 11pt;"></span><div>
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 11pt;">Whatever
protocol your urologist recommends you need to be committed to following it. It
may be inconvenient or uncomfortable but the alternative is aggressive
treatment that has the potential to leave you with erectile and urinary
dysfunction.</span></div>
<div style="background: white; margin: 0in 0in 0pt; tab-stops: 427.5pt;">
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 11pt;"></span><div>
</div>
<div style="background: white; margin: 0in 0in 0pt; tab-stops: 427.5pt;">
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 11pt;"></span><span style="color: black; font-family: "Arial","sans-serif"; font-size: 11pt;">There is
always the consideration to just treat the cancer and be rid of it. But having
lived with this disease for over two decades, with my prostate intact, I am a
firm believer in <a href="http://www.keepmyprostate.com/" target="_blank">avoiding radical treatment</a> and preserving quality of life as
long as possible. And if you have low-risk prostate cancer, bear in mind
that the longer you can wait before you submit to radical treatment, the better
the odds are that research in the field will have advanced, and treatment will
have become more effective and less
toxic. </span></div>
<br /></div>
</div>
Prostate Oncology Specialistshttp://www.blogger.com/profile/12308174937988133133noreply@blogger.com0tag:blogger.com,1999:blog-3114833974012757165.post-68245416661431332172015-11-17T12:58:00.000-08:002015-12-10T09:40:23.714-08:00What’s Going On at the Prostate Cancer Research Institute<span style="font-family: "arial" , "sans-serif"; font-size: 10pt;"><strong>BY MARK SCHOLZ, MD</strong></span><br />
<span style="font-family: "arial" , "sans-serif"; font-size: 10pt;"></span><span style="font-family: "arial" , "sans-serif"; font-size: 10pt;">In 2016, the <a href="http://www.pcri.org/" target="_blank">PCRI</a> will celebrate its 20<sup>th</sup>
anniversary.<span style="mso-spacerun: yes;"> </span>The PCRI, founded in 1996
by Dr. Stephen Strum and I, was originally funded by a generous grant from the
Daniel Freeman Medical Foundation.<span style="mso-spacerun: yes;"> </span>This
initial grant was spent on hiring <a href="https://www.youtube.com/watch?v=aiPtV2JGKxQ" target="_blank">Harry Pinchot</a>, aka Helpline Harry. The
helpline format adopted at the PCRI was modeled after the work of Lloyd Ney,
the founder of PAACT.<span style="mso-spacerun: yes;"> </span>PCRI’s <a href="http://pcri.org/helpline/" target="_blank">helpline</a> presently has four counselors: Jonathan Levy, Silvia Cooper, Bob Each and
<a href="https://www.youtube.com/watch?v=4wvaSVaIkys&list=PLYO0nFfzY0fpVmSIxpX8jnWjtnSmxPhb0&index=2" target="_blank">Charles Kokaska</a>, all who provide unbiased prostate-cancer-related information,
free of charge to the public.</span><br />
<span style="font-family: "arial" , "sans-serif"; font-size: 10pt;"><br /></span><br />
<span style="font-family: "arial" , "sans-serif"; font-size: 10pt;">PCRI started doing patient-focused
<a href="http://pcri.org/2015-prostate-cancer-conference/" target="_blank">conferences</a> in 2006. Since 2006 this has become an annual meeting. The conference
has grown in stature through the years by attracting world-renowned prostate
cancer experts who are invited to present the latest information on optimal
diagnosis and therapy. DVDs of the presentations are distributed throughout the
world. Partly due to the wonderful moderating presence of <a href="http://www.amazon.com/Supplement-Handbook-Trusted-Worthless-Conditions/dp/1623360358/ref=sr_1_1?s=books&ie=UTF8&qid=1449695912&sr=1-1" target="_blank">Dr. Mark Moyad</a>, the
conference has grown to be the largest patient-orientated prostate cancer
conference in the world.</span><br />
<span style="font-family: "arial" , "sans-serif"; font-size: 10pt;"><br /></span><br />
<span style="font-family: "arial" , "sans-serif"; font-size: 10pt;">PCRI makes its biggest impact via its online
presence by providing <a href="http://www.pcri.org/" target="_blank">articles</a> and blogs authored by prostate cancer experts
from every specialty. But more importantly, PCRI is presently in entering into
a new phase, the development of the SHADEs of Blue organizational format, a
methodology to help patients sort through the overwhelming amount of information
by reducing it into a more manageable bite-sized format.<span style="mso-spacerun: yes;"> </span>As we all know, the internet has solved the
problem of getting access to information.<span style="mso-spacerun: yes;">
</span>Now the biggest problem patients face is information overload. How does
one sort through the deluge of unfiltered information?</span><br />
<span style="font-family: "arial" , "sans-serif"; font-size: 10pt;"><br /></span><br />
<span style="font-family: "arial" , "sans-serif"; font-size: 10pt;">The development of the SHADES of Blue program
will address this problem of information overload by segregating prostate
cancer information into five large categories. Three are for the
newly-diagnosed, Low, Intermediate and High-Risk, and two are for men with
either relapsed disease or metastatic, hormone-resistant disease. The SHADES
program is a big undertaking for a small organization like the PCRI, especially
considering that we have expanded our conference schedule by now doing two
conferences annually with the addition of the <a href="http://pcri.org/2016-mid-year-update/" target="_blank">Mid-Year Update</a> in March.</span><br />
<span style="font-family: "arial" , "sans-serif"; font-size: 10pt;"><br /></span><br />
<span style="font-family: "arial" , "sans-serif"; font-size: 10pt;">Looking to the immediate future, I never been
more excited by the PCRI’s potential for making a positive impact in the lives
of men with prostate cancer. <span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>If my suspicious are correct, PCRI’s
visibility is truly on the verge of taking a big jump. </span>Prostate Oncology Specialistshttp://www.blogger.com/profile/12308174937988133133noreply@blogger.com0tag:blogger.com,1999:blog-3114833974012757165.post-6709072891529403712015-11-10T12:52:00.000-08:002015-12-15T13:37:43.129-08:00Photons or Protons? You Choose<strong><span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">BY RALPH BLUM</span></strong><br />
<br /><br />
<span style="color: black; font-family: "Arial","sans-serif";">Following in the footsteps
of robotic surgeons, prostate cancer continues to go high-tech. Radiation, for
instance, is no longer just radiation. There are now numerous different ways to
deliver it. But the two methods I want to write about here are Intensity
Modulated Radiation Therapy (IMRT), and Proton Beam Therapy (PBT).</span><br />
<span style="color: black; font-family: "Arial","sans-serif";"><br /></span><br />
<span style="color: black; font-family: "Arial","sans-serif";"></span><span style="color: black; font-family: "Arial","sans-serif";">The predominant method in
the U.S. for the past decade is IMRT, a complex procedure that precisely
targets the prostate gland with multiple beams of high energy light (photons)
at different angles and intensities while significantly lowering the risk of
damage to the surrounding tissues and organs. This greater accuracy
in targeting also allows the therapist to maximize the radiation dose to the
tumor. IMRT has at least as effective a cure rate as surgery, and without the
risks and side effects of a major surgical procedure.</span><br />
<span style="color: black; font-family: "Arial","sans-serif";"><br /></span><br />
<span style="color: black; font-family: "Arial","sans-serif";"></span><span style="color: black; font-family: "Arial","sans-serif";">Having said that, I have
recently been checking out Proton Beam Therapy, a form of radiation that
targets the tumor with charged particles called protons. Several decades ago,
Loma Linda University in California was the first to begin administering PBT.
At that time, I had a friend who, at 55, developed prostate cancer and was one
of the first patients at Loma Linda when proton therapy was at a very early
stage. Bill has been free of cancer for over twenty years, and only recently
had a rise in PSA and is discussing further treatment.</span><br />
<span style="color: black; font-family: "Arial","sans-serif";"><br /></span><br />
<span style="color: black; font-family: "Arial","sans-serif";"></span><span style="color: black; font-family: "Arial","sans-serif";">Since then, thanks in part
to marketing hype, PBT is becoming increasingly popular. Now, M.D. Anderson,
Harvard, and the University of Florida in Jacksonville, are among the major
medical centers that have made PBT available. And The Mayo Clinic is
building two proton therapy centers (one in Rochester, one in Arizona) at
a cost of $380 million. Naturally PBT costs considerably more than IMRT.</span><br />
<span style="color: black; font-family: "Arial","sans-serif";"><br /></span><br />
<span style="color: black; font-family: "Arial","sans-serif";"></span><span style="color: black; font-family: "Arial","sans-serif";">When weighing treatment
options, patients generally consider two main factors: potential side-effects,
and successful outcome. So how do these two therapies measure up? Well, there
is considerable controversy in the urologic community. The good news is both
therapies have a high cure rate. Studies that have tried to compare IMRT with Proton
therapy indicate that the outcomes are quite similar and that the side effects
are comparable. No large randomized trials have been published that directly
compare patient outcomes with the different techniques. So in the end, a
treatment decision usually depends on such variables as patient preference and
doctor preference. </span><br />
<span style="color: black; font-family: "Arial","sans-serif";"><br /></span><br />
<span style="color: black; font-family: "Arial","sans-serif";">I</span><span style="color: black; font-family: "Arial","sans-serif";">t is reasonable,
therefore, to keep in mind that any medical center that has invested an
astronomical amount of money on equipment will end up wanting to use it.</span><br />
<br />Prostate Oncology Specialistshttp://www.blogger.com/profile/12308174937988133133noreply@blogger.com0tag:blogger.com,1999:blog-3114833974012757165.post-72376985559258000052015-11-03T21:21:00.000-08:002015-11-30T12:08:18.197-08:00Biopsy, Not PSA, Leads to Prostate Cancer<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;"><strong>BY MARK SCHOLZ, MD</strong></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span>
<span style="font-family: "arial" , "helvetica" , sans-serif;">
</span><span style="font-size: 12pt; mso-bidi-font-size: 11.0pt;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Prostate
cancer is way over treated, and the problem starts with over diagnosis.<span style="mso-spacerun: yes;"> </span>Once men are diagnosed, the fear of cancer
naturally drives them toward radical treatment. In 2011 the US Preventive
Services Task Force intervened, trying to stop overtreatment, argued that PSA
testing causes more harm than good.</span><br />
<span style="font-size: 12pt; mso-bidi-font-size: 11.0pt;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></span>
<span style="font-size: 12pt; mso-bidi-font-size: 11.0pt;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Some have
questioned the expertise of the panel because of the lack of representation by
urologists, radiation therapists or medical oncologists --the types of doctors
usually responsible for treating prostate cancer.<span style="mso-spacerun: yes;"> </span>Actually, the credentials of the panel
constituents appear entirely appropriate to comment on screening, because this
is an area of medicine usually handled by primary care doctors.<span style="mso-spacerun: yes;"> </span>The panel members consisted of twelve MD’s
and four PhD’s trained in primary care, public health and statistics.</span></span><br />
<br />
<span style="font-size: 12pt; mso-bidi-font-size: 11.0pt;"></span><span style="font-size: 12pt; mso-bidi-font-size: 11.0pt;"><span style="font-family: "arial" , "helvetica" , sans-serif;">The Task Force
agrees that PSA screening may save lives. Their judgment, however, was that too
few lives are saved to justify thousands of men getting unnecessary radical
treatment. One statistic indicates that a thousand men must be screened to save
one life within the next 12 years.</span></span><br />
<br />
<span style="font-family: "arial";"><span style="font-size: 12pt; mso-bidi-font-size: 11.0pt;">P</span><span style="font-size: 12pt; mso-bidi-font-size: 11.0pt;">ersonally, I
agree with the panel in regards to over diagnosis is a root cause of over
treatment. However, simply discarding PSA is an oversimplification. PSA can
detect a variety of problems infection and benign prostate enlargement. Actually,
the majority of men with elevated PSA, don’t have prostate cancer.</span></span><br />
<span style="font-family: "arial";"><span style="font-size: 12pt; mso-bidi-font-size: 11.0pt;"><br /></span></span>
<span style="font-family: "arial";"><span style="font-size: 12pt; mso-bidi-font-size: 11.0pt;"></span></span><span style="font-size: 12pt; mso-bidi-font-size: 11.0pt;"><span style="font-family: "arial" , "helvetica" , sans-serif;">No, the real
problem is <i style="mso-bidi-font-style: normal;">after</i> a PSA test rises. Every
year, a million men are advised to have a dozen, large-bore needles jabbed into
their rectums “Just to be sure there is no cancer.”<span style="mso-spacerun: yes;"> </span>Such behavior sounds ridiculous, but really,
it is just the survival instinct in action. People will do practically anything
when they fear for their lives.</span></span><br />
<span style="font-size: 12pt; mso-bidi-font-size: 11.0pt;"><br /></span>
<span style="font-size: 12pt; mso-bidi-font-size: 11.0pt;"></span><span style="font-size: 12pt; mso-bidi-font-size: 11.0pt;"><span style="font-family: "arial" , "helvetica" , sans-serif;">So if not a
biopsy to evaluate an elevated PSA, what’s next? </span></span><br />
<span style="font-size: 12pt; mso-bidi-font-size: 11.0pt;"><br /></span>
<span style="font-size: 12pt; mso-bidi-font-size: 11.0pt;"></span><span style="font-size: 12pt; mso-bidi-font-size: 11.0pt;"><span style="font-family: "arial" , "helvetica" , sans-serif;">First, the
fear must be faced. Ralph Waldo Emerson says “Knowledge is the antidote to
fear.” So let’s look at some basic facts:</span></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">
</span>
</span></span><br />
<ul style="direction: ltr; list-style-type: disc;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: 12pt; mso-bidi-font-size: 11.0pt;">
<li style="color: black; font-size: 12pt; font-style: normal; font-weight: normal;"><div style="color: black; font-size: 11pt; font-style: normal; font-weight: normal; line-height: normal; margin-bottom: 0pt; margin-top: 0in; mso-add-space: auto; mso-list: l0 level1 lfo1;">
<span style="font-size: 12pt; mso-bidi-font-size: 11.0pt;"><span style="font-family: "arial" , "helvetica" , sans-serif;">One out of 38 men die of prostate cancer</span></span></div>
</li>
<li style="color: black; font-size: 12pt; font-style: normal; font-weight: normal;"><div style="color: black; font-size: 11pt; font-style: normal; font-weight: normal; line-height: normal; margin-bottom: 0pt; margin-top: 0in; mso-add-space: auto; mso-list: l0 level1 lfo1;">
<span style="font-size: 12pt; mso-bidi-font-size: 11.0pt;"><span style="font-family: "arial" , "helvetica" , sans-serif;">One out of seven men are diagnosed with prostate cancer</span></span></div>
</li>
<li style="color: black; font-size: 12pt; font-style: normal; font-weight: normal;"><div style="color: black; font-size: 11pt; font-style: normal; font-weight: normal; line-height: normal; margin-bottom: 0pt; margin-top: 0in; mso-add-space: auto; mso-list: l0 level1 lfo1;">
<span style="font-size: 12pt; mso-bidi-font-size: 11.0pt;"><span style="font-family: "arial" , "helvetica" , sans-serif;">In men who are “diagnosed”</span></span></div>
<ul style="list-style-type: circle;">
<li style="color: black; font-size: 12pt; font-style: normal; font-weight: normal;"><div style="color: black; font-size: 11pt; font-style: normal; font-weight: normal; line-height: normal; margin-bottom: 0pt; margin-top: 0in; mso-add-space: auto; mso-list: l0 level2 lfo1;">
<span style="font-size: 12pt; mso-bidi-font-size: 11.0pt;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Five-year survival is 100%</span></span></div>
</li>
<li style="color: black; font-size: 12pt; font-style: normal; font-weight: normal;"><div style="color: black; font-size: 11pt; font-style: normal; font-weight: normal; line-height: normal; margin-bottom: 0pt; margin-top: 0in; mso-add-space: auto; mso-list: l0 level2 lfo1;">
<span style="font-size: 12pt; mso-bidi-font-size: 11.0pt;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Ten-year survival is 99%</span></span></div>
</li>
<li style="color: black; font-size: 12pt; font-style: normal; font-weight: normal;"><div style="color: black; font-size: 11pt; font-style: normal; font-weight: normal; line-height: normal; margin-bottom: 0pt; margin-top: 0in; mso-add-space: auto; mso-list: l0 level2 lfo1;">
<span style="font-size: 12pt; mso-bidi-font-size: 11.0pt;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Fifteen-year survival is 94%</span></span><span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></div>
</li>
</ul>
</li>
</span></ul>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: 12pt;">Considering it
is cancer, survival rates are great! At least these numbers should overcome any
urge to rush. Clearly there is plenty of time is to study and learn more. Confusion
arises because a minority of prostate cancers can indeed be dangerous. Not as
dangerous as lung or pancreas cancer which kill within months. However, demise
from prostate cancer certainly qualifies as “dangerous,” even if it is rather
infrequent and much postponed.</span><br />
<span style="font-size: 12pt; mso-bidi-font-size: 11.0pt;"><span style="font-family: Arial, Helvetica, sans-serif;">
<br />
<span style="font-size: 12pt; mso-bidi-font-size: 11.0pt;"><span style="font-family: "arial" , "helvetica" , sans-serif;">These
statistics reveal something else that is quite useful. Prostate management
issues are of <i style="mso-bidi-font-style: normal;">long-range</i> nature, like
saving for college or for retirement. Just as expert financial planners are
limited in the ability to make predictions about economic activity ten years in
the future, doctors should be equally humble in their pronouncements about the
future of prostate cancer. We don’t know for sure, but we strongly suspect
there will be substantial breakthroughs in the diagnosis and treatment of
prostate cancer in the next ten years.</span></span><br />
<br />
<span style="font-size: 12pt; mso-bidi-font-size: 11.0pt;"><span style="font-family: "arial" , "helvetica" , sans-serif;">For the short
term, I think the best way to proceed is with imaging the prostate with a <a href="http://www.prostatevanguard.com/" target="_blank">3Tmulti-parametric MRI</a> or color Doppler ultrasound. Scans are about as accurate
as a random biopsy for detecting aggressive cancers and they usually fail to
detect the harmless low grade types, which is a good thing. However, if there
is a worrisome abnormality, a targeted biopsy with just a couple cores is
needed.</span></span><br />
<br />
<span style="font-size: 12pt; mso-bidi-font-size: 11.0pt;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Over-diagnosis
and <a href="http://www.keepmyprostate.com/" target="_blank">over-treatment</a> is not due to PSA. It’s the misguided policy of rushing into
an immediate random biopsy whenever there is a slight elevation. <span style="mso-spacerun: yes;"> </span>.The random biopsy procedure should be
abandoned. <span style="mso-spacerun: yes;"> </span>PSA abnormalities should be
evaluated with prostate imaging A targeted biopsy can be considered in men who
have a distinct abnormality detected by imaging. <span style="mso-spacerun: yes;"> </span></span></span></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;">
</span></span>Prostate Oncology Specialistshttp://www.blogger.com/profile/12308174937988133133noreply@blogger.com0tag:blogger.com,1999:blog-3114833974012757165.post-90743469936247163202015-10-27T12:22:00.000-07:002015-12-01T12:23:13.256-08:00Reforming Old Behaviors<span style="font-family: Arial, Helvetica, sans-serif;"><strong>BY RALPH BLUM</strong></span><br />
<br /><br />
<span style="font-family: Arial, Helvetica, sans-serif;">Back into the mists of time, year after
year, in our unending struggle to protect ourselves against sinister and deadly
invaders, we expend our energies, our wealth and our physical strength to
survive and maintain our health. One mysterious and potent ally is the Anger
Response. The Anger Response system is not unique to our bodies. Parallel forms
of this “homeland defense” can be identified at all societal levels: of the
family, the community, of nations.</span><br />
<br /><br />
<span style="font-family: Arial, Helvetica, sans-serif;">However, like any effective and powerful
resource, over-reliance is a potential pitfall. Over dependency on the use of
anger as a problem-solving-mechanism leads to an angry persona. “As a people
thinketh” certainly applies. <span style="mso-spacerun: yes;"> </span>So the
loose bundle of platitudes and commonplace aphorisms pertaining to sending healing,
loving messages, really needs<i style="mso-bidi-font-style: normal;"> </i>to
become SOP, “Standard operating procedure.”</span><br />
<br /><br />
<span style="font-family: Arial, Helvetica, sans-serif;">What a daunting privilege! Swing high
enough on that swing and you are led, inevitably, inexorably, to thoughts of
Our Creator, to the God of our Understanding . . . in whose image we are said
to be fashioned. We have the free choice to send messages of hate and fear or
messages of healing and love. And so we communicate with the rest of the planet.
Words come back to me, my mother frustrated and distressed, me about 25, her
launching, “Your whole modus operandi is rotten to the core.” Not even certain
she could define <i style="mso-bidi-font-style: normal;">modus operandi. </i>It
was a phrase she picked up from my father.</span><br />
<br /><br />
<span style="color: black; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: minor-fareast;"><span style="font-family: Arial, Helvetica, sans-serif;">As advice for Rageaholics, I
remember various of my elders advising me to “stop and think” before I blasted
off. Well, here are five questions to teach small boys to ask themselves, to
determine, or “profile” who they are at any given moment. Five questions to
answer when they can catch themselves in the act of feeling angry:</span></span><br />
<br /><br />
<span style="color: black; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: minor-fareast;"><span style="font-family: Arial, Helvetica, sans-serif;">1) Is it true?</span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"></span><span style="color: black; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: minor-fareast;"><span style="font-family: Arial, Helvetica, sans-serif;">2) Is it helpful?</span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"></span><span style="color: black; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: minor-fareast;"><span style="font-family: Arial, Helvetica, sans-serif;">3) Does it inspire?</span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"></span><span style="color: black; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: minor-fareast;"><span style="font-family: Arial, Helvetica, sans-serif;">4) Is it necessary?</span></span><br />
<div style="line-height: 150%; margin: 0in 0in 0pt; text-align: justify;">
<span style="color: black; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: minor-fareast;"><span style="font-family: Arial, Helvetica, sans-serif;">5) Is it kind?</span></span></div>
<span style="color: black; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: minor-fareast;"><br /></span><br />
<span style="color: black; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: minor-fareast;"></span><span style="color: black; mso-fareast-font-family: "Times New Roman"; mso-fareast-theme-font: minor-fareast;"><span style="font-family: Arial, Helvetica, sans-serif;">A tremendous communication
tool, serves as a referee for our impulses, and allows an opportunity for us to
work through a kind of a checklist re. <i style="mso-bidi-font-style: normal;">who
we want to be</i>—what compliment of qualities would we want present in this
moment, qualities that will allow us to operate (and “cooperate” to match our
destiny) in most positive and uplifting way. I have a growing taste for
acronyms. Well there’s a good one: The acronym (what a pleasant surprise) is
THINK.</span></span><br />
<br />Prostate Oncology Specialistshttp://www.blogger.com/profile/12308174937988133133noreply@blogger.com0tag:blogger.com,1999:blog-3114833974012757165.post-54847142514084804002015-10-20T14:57:00.000-07:002015-10-28T15:00:10.293-07:00Let the Buyer Beware<strong><span style="font-family: Arial, Helvetica, sans-serif;">BY MARK SCHOLZ, MD</span></strong><br />
<br />
<span style="font-family: "Arial","sans-serif"; font-size: 12pt;">It</span><span lang="FR" style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-ansi-language: FR;">’</span><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">s time to change our
preconceptions about prostate cancer and “</span><span lang="NL" style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-ansi-language: NL;">reboot</span><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">”
the way we think about what typically is a non-life-threatening disease. Ever
since the FDA first approved PSA testing in 1987, prostate cancer has grown
into an aggressive multibillion dollar industry. Marketing hype has created the
impression that treatments like Proton therapy and robotic surgery are
universally desirable, even though well-informed patients know this is hardly
the case.<span style="mso-spacerun: yes;"> </span>How did the prostate cancer
world deviate so far off the originally intended tract of helping patients? And
what can be done to set things straight?</span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 12pt;"></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 12pt;">Ten years ago the experts believed that
immediate curative treatment was needed for every man with prostate
cancer.<span style="mso-spacerun: yes;"> </span>Today, after 20 years of
vigorously detecting and treating every case of prostate cancer, it has become
clear that almost <i style="mso-bidi-font-style: normal;">half</i> of the 230,000
men diagnosed every year are undergoing radical treatment for a cancer that is <i>incapable
of metastasizing</i>.<span style="mso-spacerun: yes;"> </span>Now it’s time for the
medical community to come to grips with the fact that over a million men in the
United States are living with impotence and incontinence <i>for no justifiable
reason</i>. This is a disaster of gargantuan proportions.</span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 12pt;"></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 12pt;"></span><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">Shockingly, even though we can now readily
identify these harmless cancers, the problem of rampant overtreatment continues.
In 2015 another 50,000 men will undergo unnecessary radical treatment. The
medical industrial complex that has been gaining momentum for 25 years refuses
to confess its tragic errors.<span style="mso-spacerun: yes;"> </span>The huge
investments in enormously expensive medical equipment need to be paid off. No
one is willing to accept responsibility, make apologies or confess wrongdoing
for all the overtreatment.<span style="mso-spacerun: yes;"> </span>The existing system
is entrenched and the doctors are too comfortable with the status quo.</span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 12pt;"></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 12pt;"></span><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">Reversing the momentum of twenty-five years
of recommending unnecessary radical treatments is going to require the patients
to protect themselves.<span style="mso-spacerun: yes;"> </span>They need to become
far more medically sophisticated consumers.<span style="mso-spacerun: yes;">
</span>Five years ago, Ralph Blum and I fired the first salvo by writing <a href="http://www.amazon.com/Invasion-Prostate-Snatchers-Unnecessary-Treatment/dp/1590513428/ref=sr_1_1?ie=UTF8&s=books&qid=1285642620&sr=8-1-catcorr" target="_blank"><em>Invasion of the Prostate Snatchers: No More Unnecessary Biopsies, Radical Treatment or Loss of Sexual Potency</em></a>. In our
book, we attempted to defang the poisonous and fear-inducing word <i>cancer</i>
by renaming the low-risk type that does not metastasize<i> “The UnCancer</i>.”<span style="mso-spacerun: yes;"> </span>Our book has been helpful at revamping the
gross misconception that every prostate cancer is potentially deadly.<span style="mso-spacerun: yes;"> </span><i>Invasion </i>provides an excellent introduction
to men with newly-diagnosed cancer by presenting the important concept that
prostate cancer comes in three broad types: low, intermediate and high-risk. <span style="mso-spacerun: yes;"> </span><o:p></o:p></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 12pt;"></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 12pt;">One of the important <a href="http://markscholz.com/media" target="_blank">themes</a> introduced by <i>Invasion</i>
is a healthy mistrust of physician motives. For protection against patients
receiving the wrong treatment, <i>Invasion</i> argues strongly for patient
empowerment through <i style="mso-bidi-font-style: normal;">education</i>. The term,
“prostate cancer” is merely an umbrella term for a broad spectrum of illnesses
that behave very differently. The book simplifies the treatment decision making
process by clearly identifying the three major subtypes of prostate cancer,
low, intermediate and high-risk.<span style="mso-spacerun: yes;"> </span>Once patients
have gained an accurate understanding of where they fit into this
individualized schema, an informed treatment decision can be made. As a medical
oncologist, rather than a surgeon, the information provided in the book is unbiased
with clear presentation of all the risks and benefits associated with all the
different treatments that are available.</span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 12pt;"></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 12pt;"></span><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">In an era now past, physicians were trained
to put their patient</span><span lang="FR" style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-ansi-language: FR;">’</span><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">s interests ahead of their own.<span style="mso-spacerun: yes;"> </span>Today, patients need to adopt defensive
tactics that are realistic about how prostate cancer care has become a highly
lucrative business. The patient who assumes that their counseling physician
represents his best interests, is on the cusp of making a dangerous mistake. Bluntly,
the prostate cancer world has evolved into a sophisticated and well-oiled
business and the buyer better be on guard. <span style="mso-spacerun: yes;"> </span><o:p></o:p></span><br />
Prostate Oncology Specialistshttp://www.blogger.com/profile/12308174937988133133noreply@blogger.com1tag:blogger.com,1999:blog-3114833974012757165.post-42025387155127527192015-10-13T12:16:00.000-07:002015-11-30T12:18:37.326-08:00The Faces of Stress<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;"><b>RALPH BLUM</b></span><br />
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<br /></div>
<div class="Normal" style="line-height: 18pt; margin-bottom: 0pt; margin-top: 0pt;">
<span class="Normal__Char"><span style="font-family: Arial, Helvetica, sans-serif;">Whether you are newly diagnosed with prostate cancer, or coping with bone metastases, learning about chronic stress and its negative impact on your body is almost as critical to your healing as whatever treatment you choose.</span></span></div>
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<br /></div>
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<span class="Normal__Char"><span style="font-family: Arial, Helvetica, sans-serif;">Short-term stress, a single episode of acute stress, generally doesn't cause problems. However, chronic emotional stress, caused by situations or events that last over a period of time, takes a significant toll on the body. Furthermore, this kind of prolonged stress suppresses the immune system, profoundly affecting its ability to detect defective or cancerous cells and destroy them.</span></span></div>
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<br /></div>
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<span class="Normal__Char"><span style="font-family: Arial, Helvetica, sans-serif;">Persistent feelings of fear, anxiety and unrelieved stress trigger the fight-or-flight response system that our ancestors relied upon. When a threat is recognized, heart rate and blood pressure skyrocket, sugar pours into the blood, muscles tense for quick action, and the whole metabolism goes into survival mode. This is great if you're on the African savannah and you hear a lion growling outside your tent. However, Nature never intended this "On your mark! Get set! Go!" response to last more than a moment or two. So when the brain sends a threat message for which there is no swift resolution, the fight-or-flight system stays stuck on "Get set!." As a result, the immune system is locked into protection mode and is no longer capable of performing the remedial function that is our most powerful defense against cancer.</span></span></div>
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<br /></div>
<div class="Normal" style="line-height: 18pt; margin-bottom: 0pt; margin-top: 0pt;">
<span class="Normal__Char"><span style="font-family: Arial, Helvetica, sans-serif;">So when we feel unable to manage or control the changes in our lives caused by prostate cancer, it not only reduces our quality of life, but it is associated with poorer clinical outcomes. In fact, studies in mice, and in tests in human cancer cells grown in the laboratory have found that prolonged psychological stress can enhance a tumor's ability to grow and spread.</span></span></div>
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<br /></div>
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<span class="Normal__Char"><span style="font-family: Arial, Helvetica, sans-serif;">There is always the temptation to alleviate the stress overload of a potentially life-threatening diagnosis with risky behaviors such as drinking alcohol in excess, taking drugs, and over-eating. But this kind of "stress management" only further inhibits immune function. However, maintaining a healthy lifestyle—which means eating well and staying physically active--supports the immune system. As do coping strategies such as relaxation techniques, meditation, yoga, and visualization. And don't forget laughter—the ultimate antioxidant.</span></span></div>
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<br /></div>
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<span class="Normal__Char"><span style="font-family: Arial, Helvetica, sans-serif;">Here's how the Discovery Health Web describes the impact of laughter on the immune system: "When we laugh, natural killer cells which destroy tumors and viruses increase, along with Gamma-interferon (a disease-fighting protein), T cells (important for our immune system) and B cells (which make disease-fighting antibodies). As well as lowering blood pressure, laughter increases oxygen in the blood, which also encourages healing."</span></span></div>
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<br /></div>
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<span class="Normal__Char"><span style="font-family: Arial, Helvetica, sans-serif;">So find out what works for you so that stress does not get the best of you. If you can’t seem to get a handle on it, <a href="" name="_GoBack"></a>laugh your way back to health!</span></span></div>
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Prostate Oncology Specialistshttp://www.blogger.com/profile/12308174937988133133noreply@blogger.com0tag:blogger.com,1999:blog-3114833974012757165.post-24763197292597538252015-10-06T14:00:00.000-07:002015-10-20T14:03:38.746-07:00A Midlife Crisis Avoided<strong><span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">BY MARK SCHOLZ, MD</span></strong><br />
<strong><span style="font-family: Arial; font-size: x-small;"></span></strong><br />
<span style="font-family: Arial; font-size: x-small;"><span style="font-family: "Arial","sans-serif";"><span style="font-size: small;">Building
up a medical practice and getting a late start with a family, my midlife crisis
was delayed past the usual occurrence for men in their early 40s.<span style="mso-spacerun: yes;"> </span>However, by the time I hit 50, self-questioning was starting to surface. My life had meaningful pursuits but
it was time to take a deep breath and do the traditional life inventory of the
“mid-years,” to reassess my goals for the last third of my existence here on
planet earth.</span></span><br />
<span style="font-family: "Arial","sans-serif";"></span><br />
<span style="font-family: "Arial","sans-serif";"></span><span style="font-family: "Arial","sans-serif";"><span style="font-size: small;">After
reflection, I realized that I really didn’t have any great ideas to reinvigorate
my passion for the last lap. I couldn’t sell my wife on the idea of buying a
Lamborghini (I already owned a small boat).<span style="mso-spacerun: yes;">
</span>I didn’t have any specific desire to travel.<span style="mso-spacerun: yes;"> </span>I had given up on golf due to a terrible and
uncorrectable slice.<span style="mso-spacerun: yes;"> </span>I have never been
successful playing the stock market. <span style="mso-spacerun: yes;"> </span>All
these considerations were going through my head about ten years ago.<span style="mso-spacerun: yes;"> </span>Now ten years later, I turned
60 and I feel revitalized and reinvigorated.<span style="mso-spacerun: yes;">
</span>So what turned things around? <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></span><br />
<span style="font-family: Times New Roman; font-size: small;">
</span><span style="font-family: "Arial","sans-serif";"><span style="font-size: small;"></span></span><br />
<span style="font-family: "Arial","sans-serif";"><span style="font-size: small;">Many
of you have come to know Ralph, my coauthor in the <a href="http://prostatesnatchers.blogspot.com/" target="_blank">Snatchers Blog</a>. He is as a
sensible dispenser of advice and knowledge about life and about prostate
cancer. I first met Ralph almost fifteen years ago, first as a patient,
subsequently as a writing teacher and now as a writing partner. As I reflect
back over the years that we have worked together I am convinced that its Ralph who
spared me from my mid-life crisis.<span style="mso-spacerun: yes;"> </span>Don’t
get me wrong, I have a lovely family. My wife Juliet is a bulwark of
truth.<span style="mso-spacerun: yes;"> </span>My children are delightfully sensible, talented and hard-working. I am also blessed
with an amazing medical practice with wonderful coworkers and extra-special
patients.</span></span><br />
<span style="font-family: "Arial","sans-serif";"></span><br />
<span style="font-family: "Arial","sans-serif";"></span><span style="font-family: "Arial","sans-serif";"><span style="font-size: small;">Even
so, visiting with a dozen men a day, five days a week, year after year, decade
after decade can wear you down. Getting paid less and less every year while the
work load steadily increases is hardly inspiring either. <span style="mso-spacerun: yes;"> </span>A midlife crisis was in the wings and I had no
idea how my passion for the medical profession could be restored. So back in
2005, I was looking for a new challenge when Ralph first approached me to write
a book . I even agreed after he told me the zany title, “<a href="http://www.amazon.com/Invasion-Prostate-Snatchers-Essential-Managing/dp/1590515153" target="_blank">Invasion of the Prostate Snatchers</a>.”</span></span><br />
<span style="font-family: "Arial","sans-serif";"></span><br />
<span style="font-family: "Arial","sans-serif";"></span><span style="font-family: "Arial","sans-serif";"><span style="font-size: small;">Fortunately,
when Ralph invited me to be a cowriter, he didn’t give a second thought to the
paucity of writing skills.<span style="mso-spacerun: yes;"> </span>(Ralph has so
much confidence in his own writing skills he believes he could train a monkey
to write). Over the next four years we clashed on many occasions. Considering that
English was my worst subject in school I have to give myself some credit for
having the courage to accept his proposal.</span></span><br />
<span style="font-family: "Arial","sans-serif";"></span><br />
<span style="font-family: "Arial","sans-serif";"></span><span style="font-family: "Arial","sans-serif";"><span style="font-size: small;">Back
then I had little interest I had in developing the craft of writing.<span style="mso-spacerun: yes;"> </span>Writing is hard to do.<span style="mso-spacerun: yes;"> </span>In addition, with limited free time in a busy
medical practice, it’s no surprise that developing writing skills was a low
priority to me. But I was also starting to get upset about the injustice of so
many men’s sexual identities being robbed by unnecessary surgery.<span style="mso-spacerun: yes;"> </span>The dawning realization, that men, rather
than being helped by surgery are actually being tremendously <em>harmed</em>, is what
motivated me to finally confront the painful task of developing some writing
skills so I could convey my observations to the naïve and unsuspecting patients.
Thank God I had Ralph to tutor me along through this long and arduous journey.</span></span><br />
<span style="font-family: "Arial","sans-serif";"></span><br />
<span style="font-family: "Arial","sans-serif";"></span><span style="font-family: "Arial","sans-serif";"><span style="font-size: small;">Learning
to write about topics that matter to me (such as saving men from the loss their
sexual identity) has saved me from the “meaningless” philosophical wandering
that characterizes a midlife crisis. And as I get older and further polish my
writing skills, I have enjoyed even more satisfaction by helping men to avoid
numerous medical pitfalls. For example, in my next blog I’ll be exposing another
incredibly repugnant policy—men on Active Surveillance who have 12 large
needles plunged through their rectal wall into the prostate gland every year.
Yikes!</span></span><br />
<span style="font-family: "Arial","sans-serif";"></span><br />
<span style="font-family: "Arial","sans-serif";"></span><span style="font-family: "Arial","sans-serif";"><span style="font-size: small;">In
the meantime, let me express my genuine appreciation to <a href="http://www.vimeo.com/prostateoncology" target="_blank">Ralph</a> for having the
patience and skill to draw me down this totally unexpected pathway. At this
point I am happy to report that I see no hint of an existential crisis looming on
the horizon. <span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></span></span>Prostate Oncology Specialistshttp://www.blogger.com/profile/12308174937988133133noreply@blogger.com0tag:blogger.com,1999:blog-3114833974012757165.post-78250390112027694002015-09-29T13:55:00.000-07:002015-10-20T13:40:37.062-07:00Taking Charge of Your Prostate Cancer Recovery: Fast Forward From the Old Model<strong><span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">BY RALPH BLUM</span></strong><br />
<br />
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<span style="color: black; font-family: "Arial","sans-serif"; font-size: 10pt;">In the old model of prostate cancer care, you were rushed into
radical treatment--usually surgery or radiation--often without
fully understanding all your options, or the risks and side effects
involved. The entire process was focused on the tumor; minimal attention was
given to you as a person, and little effort was made to explore the benefits of
healthy lifestyle choices, immune-enhancing treatments, reasonable delays, and
emotional support. <o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="background: white; line-height: 13pt; margin: 0in 0in 0pt; tab-stops: 427.5pt; text-align: justify;">
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 10pt;">The emerging new model of prostate cancer care recognizes the
important role you can, and should, play in your recovery. The emerging model
comprehends that simply attacking the cancer is not enough. Greg Anderson, who
after surviving "terminal" lung cancer founded the<i style="mso-bidi-font-style: normal;"> Cancer Recovery Foundation</i>, has said
that "Retaining a medical team without doing everything you can to help
yourself is like attempting to walk on one stilt."<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="background: white; line-height: 13pt; margin: 0in 0in 0pt; tab-stops: 427.5pt; text-align: justify;">
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 10pt;">So what do you need to know in order to take charge of your
recovery?<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="background: white; line-height: 13pt; margin: 0in 0in 0pt; tab-stops: 427.5pt; text-align: justify;">
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 10pt;">There are three common misperceptions about prostate cancer:<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="background: white; line-height: 13pt; margin: 0in 0in 0pt; tab-stops: 427.5pt; text-align: justify;">
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 10pt;">*The
assumption that the disease is as dangerous as other cancers.<o:p></o:p></span></div>
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 10pt;">*The
assumption that the urologist who did your biopsy is a prostate cancer expert.<o:p></o:p></span><br />
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 10pt;">*The
assumption that a quick treatment decision is necessary before the
cancer spreads.<o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="background: white; line-height: 13pt; margin: 0in 0in 0pt; tab-stops: 427.5pt; text-align: justify;">
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 10pt;">First of all, prostate cancer is unique among cancers because the
mortality rate is so low. Around two hundred thousand men in the U.S. alone are
diagnosed with the disease every year, and less than 15% will eventually die
from it, usually over a decade down the line, while a majority of men who have
the far more common low-risk, slow-growing prostate cancer can anticipate
living a normal life span, or dying of something else.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="background: white; line-height: 13pt; margin: 0in 0in 0pt; tab-stops: 427.5pt; text-align: justify;">
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 10pt;">Your local urologist has a busy medical practice that involves
treating problems like impotence, infections, incontinence, and kidney stones.
He also does biopsies. But the average urologist performs fewer than <i style="mso-bidi-font-style: normal;">five</i> prostate removals (prostatectomies)
a year--far too few to be considered proficient. He may be a talented doctor,
but he is unlikely to be a prostate cancer expert. So once you have your biopsy
results, it is best to consult a prostate cancer specialist, either at a major
medical center, or at a high-volume prostate cancer clinic.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="background: white; line-height: 13pt; margin: 0in 0in 0pt; tab-stops: 427.5pt; text-align: justify;">
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 10pt;">As for the third misperception, it is essential, before committing
to any form of treatment, that you do your own research, and are
convinced the treatment you choose is the right one for you. Do not
let anyone rush you into making a bad decision. Once your category of prostate
cancer is identified (<i style="mso-bidi-font-style: normal;">Low, Intermediate,
or</i> <i style="mso-bidi-font-style: normal;">High Risk</i>), get on the
Internet and learn about every treatment option--including no treatment
whatsoever--for your type of disease. If you are over 70, and have
low-risk disease, my advice to you is to find a doctor who has experience
monitoring an active surveillance protocol.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="background: white; line-height: 13pt; margin: 0in 0in 0pt; tab-stops: 427.5pt; text-align: justify;">
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 10pt;">Your role in your recovery, however, doesn't end with choosing
your treatment. The emphasis on lifestyle changes has been one of the most
significant shifts in cancer care in the last decade. A study at UCSF showed
that improving your nutrition, reducing stress and getting more exercise, can
lower PSA levels. And according to a relatively new field of health
psychology called "illness representation," your beliefs and
expectations also impact the outcome of your disease. So take charge of your
recovery, and<i style="mso-bidi-font-style: normal;"> </i>have faith in your
choice of treatment.<o:p></o:p></span></div>
Prostate Oncology Specialistshttp://www.blogger.com/profile/12308174937988133133noreply@blogger.com0tag:blogger.com,1999:blog-3114833974012757165.post-56985931920493398382015-09-22T09:16:00.000-07:002015-09-24T09:20:03.604-07:00Ah, Yes. . .Your Medical Records<span style="font-family: "Arial","sans-serif";"><strong><span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;">BY RALPH BLUM</span></strong></span><br />
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<span style="font-family: "Arial","sans-serif"; font-size: 11pt;"></span> </div>
<div class="MsoNormal" style="margin: 0in 0in 0pt; text-align: justify;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">When you are diagnosed with prostate cancer,
keeping a folder with all your medical records can be a challenge, especially
when you are working with several doctors and addressing different health
concerns. But that is also when it is most important, both for your own
understanding and safety, and for the use of any specialists you might want to
consult for a second opinion.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt; text-align: justify;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">The following is a list of the variety of information
you need to preserve in your medical folder (MMF):<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt; text-align: justify;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">* A Chronological Log of all your PSA
tests with dates, and note in the log any general health changes that might
impact your PSA.<o:p></o:p></span></div>
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;"><o:p></o:p></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">* A copy of your urologist's notes
that give the results of your Digital Rectal Exam (DRE).<o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt; text-align: justify;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">* A copy of your urologist's Transrectal Ultrasound (TRUS) report that lists the size of your prostate.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt; text-align: justify;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">* A copy of your Biopsy Pathology
Report. This should provide your Gleason Score, how many cores were positive
for cancer, the extent of disease in the cores, and the location of the cancer
in the prostate gland.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt; text-align: justify;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">* Copies of the radiology reports
of any scans (color Doppler ultrasound, bone, CT, MRI), and if available,
digital copies of the actual scans.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt; text-align: justify;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">* Copies of all information
regarding your medical history, including any current (unrelated to the
prostate cancer) health problems you may be dealing with, even if they seem
minor.</span><br />
<br />
<span style="font-family: Symbol; font-size: 11pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;"><span style="font-family: Arial;">*</span> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">A
list of all your medications (including the dosages), and a list of any
over-the-counter supplements you are taking.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt; text-align: justify;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">It is also wise to retrieve your biopsy
slides from the pathologist and send them to a world-class cancer treatment
center, such as <a href="http://www.mdanderson.org/" target="_blank">MD Anderson</a>, <a href="mailto:domerica.nnprocessing@gmail.com" target="_blank">Johns Hopkins</a>, <a href="https://www.mskcc.org/" target="_blank">Sloan Kettering</a>, <a href="http://california.providence.org/saint-johns/" target="_blank">Saint John's</a>, for a second
opinion. In fact if you live in a small town or in the country, if possible you
should get yourself to a urologist or oncologist specializing in prostate
cancer at one of the major centers for a consultation before making a treatment
decision.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt; text-align: justify;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Keeping this medical record not only gives
you a feeling of control, but it is extremely helpful when you consult
different specialists. It is also something your partner can help you create.
Giving your partner something constructive to do can help her (or him) deal
with the worry they inevitably feel over your diagnosis.<o:p></o:p></span></div>
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;"></span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">I personally feel very strongly about the
importance of keeping and organizing all your medical information when dealing
with prostate cancer because I didn't do it. And I know how often I and my
doctors have found the MMF invaluable support. Truly, we are partners with our
oncologists and our urologists. Be an
active partner.<b><o:p></o:p></b></span><br />
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt; text-align: justify;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;"><o:p> </o:p></span></div>
Prostate Oncology Specialistshttp://www.blogger.com/profile/12308174937988133133noreply@blogger.com0tag:blogger.com,1999:blog-3114833974012757165.post-36391935643756556252015-09-15T14:41:00.000-07:002015-09-17T14:45:51.183-07:002015 Conference Recap<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;"><strong>BY MARK SCHOLZ, MD</strong></span><br />
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Every
year’s Conference presents recurring themes.<span style="mso-spacerun: yes;">
</span>This year’s focus was prevention, combination treatment and timeliness
were emphasized. We live in an era of exploding technological progress. It is a
delightful problem to have a wealth of new treatment options and diagnostic
tools.<span style="mso-spacerun: yes;"> </span>However, just like buying a new
car or a new smart phone, it takes a little time to learn the ropes and fully
exploit the complete range and capabilities of the new technology.<span style="mso-spacerun: yes;"> </span>A short blog can’t cover everything from a
three-day conference.<span style="mso-spacerun: yes;"> </span>Here are a few
comments. </span></div>
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;"></span> </div>
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;"></span><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Dr.
Dan Margolis, an expert on prostate imaging from UCLA, presented information on
3 Telsa, multi-parametric MRI’s capacity as a substitute for random needle
biopsy in men with elevated PSA who have never been previously diagnosed with
prostate cancer.<span style="mso-spacerun: yes;"> </span>MRI offers the
advantage of being equally or more accurate than random biopsy without relying
on invasive techniques.</span></div>
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;"></span> </div>
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;"></span><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Dr.
Chuck Drake, from John Hopkins, the preeminent expert in the world on immune
therapy for prostate cancer, presented exciting data on how many of the new
immune drugs work synergistically when given in combination.<span style="mso-spacerun: yes;"> </span>“Synergism” means that when either drug is
given by itself the anticancer effect is rather modest.<span style="mso-spacerun: yes;"> </span>But when the two drugs are given in
combination, the anticancer effect is multiplied.<span style="mso-spacerun: yes;"> </span>Provenge has already been FDA approved for prostate cancer.<span style="mso-spacerun: yes;"> </span>Hopefully Yervoy will also be an approved indication for prostate cancer in the
next six to 12 months.<span style="mso-spacerun: yes;"> </span>The combination
of these two drugs together offers immense hope for jumpstarting immunologic
treatment for prostate cancer.</span></div>
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;"></span> </div>
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;"></span><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Dr.
John Mulhall, the expert in the world on sexuality and prostate cancer from
Memorial Sloan Kettering, spent a lot of time emphasizing mindfulness in the selection
of treatment. In other words, he was saying that it is better to minimize damage
by selecting the least toxic form of prostate cancer treatment than trying to
fix an already established problem.</span></div>
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;"></span> </div>
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;"></span><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">Dr.
Peter Grimm, sometimes called “The Father of Seed Implant Therapy,” delivered a
candid overview of the world of radiation therapy, emphasizing the improved
cure rates and reduced toxicity seed implant therapy offers.<span style="mso-spacerun: yes;"> </span>He also spoke on how increased financial
incentives to do IMRT, Proton therapy and SBRT, distorts the decision making
process and slants treatment away from seed implants.</span></div>
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;"></span> </div>
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;"></span><span style="font-family: "Arial","sans-serif"; font-size: 11pt;">This
is only the briefest of overviews and no words can express all the fun and
games that Dr. Mark Moyad injected into the proceedings. I can only say that
initial feedback from the attendees was extremely positive.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 11pt;">2015
PCRI Conference DVDs, which include all the presentations, will be available in
six weeks at a suggested donation of $150. For more information, email: <a href="mailto:info@pcri.org"><span style="color: windowtext;">info@pcri.org</span></a>. In
addition, the PCRI will be presenting its second annual Mid-Year Update, March
26, 2016, an afternoon of educational sessions in developments in the prostate
cancer world. Laurence Klotz, MD who has been called “The Father of Active
Surveillance” will be one of the speakers. Learn more at: <a href="http://www.pcri.org/2016-mid-year-update"><span style="color: windowtext;">www.pcri.org/2016-mid-year-update</span></a></span><span style="font-size: 11pt;"><o:p></o:p></span></div>
Prostate Oncology Specialistshttp://www.blogger.com/profile/12308174937988133133noreply@blogger.com2tag:blogger.com,1999:blog-3114833974012757165.post-22585363114434457542015-09-09T19:23:00.000-07:002015-09-09T19:24:31.283-07:00Taking Charge of Your Prostate Cancer Recovery:Fast Forward From the Old Model<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;"><strong>RALPH BLUM</strong></span><br />
<strong><span style="font-family: Arial; font-size: x-small;"></span></strong><br />
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 10pt;">In the
old model of prostate cancer care, you were rushed into radical treatment--usually
surgery or radiation--often without fully understanding all your options,
or the risks and side effects involved. The entire process was focused on the
tumor; minimal attention was given to you as a person, and little effort was
made to explore the benefits of healthy lifestyle choices, immune-enhancing
treatments, reasonable delays, and emotional support. <o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="background: white; margin: 0in 0in 0pt; tab-stops: 427.5pt; text-align: justify;">
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 10pt;">The
emerging new model of prostate cancer care recognizes the important role you
can, and should, play in your recovery. The emerging model comprehends that
simply attacking the cancer is not enough. Greg Anderson, who after surviving
"terminal" lung cancer founded the<i style="mso-bidi-font-style: normal;">
Cancer Recovery Foundation</i>, has said that "Retaining a medical team
without doing everything you can to help yourself is like attempting to walk on
one stilt."<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="background: white; margin: 0in 0in 0pt; tab-stops: 427.5pt; text-align: justify;">
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 10pt;">So what
do you need to know in order to take charge of your recovery?<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="background: white; margin: 0in 0in 0pt; tab-stops: 427.5pt; text-align: justify;">
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 10pt;"><o:p> </o:p></span><span style="color: black; font-family: "Arial","sans-serif"; font-size: 10pt;">There are
three common misperceptions about prostate cancer:<o:p></o:p></span></div>
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 10pt;"></span><br />
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 10pt;">*The
assumption that the disease is as dangerous as other cancers.<o:p></o:p></span><br />
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 10pt;">*The
assumption that the urologist who did your biopsy is a prostate cancer expert.<o:p></o:p></span><br />
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 10pt;">*The
assumption that a quick treatment decision is necessary before the
cancer spreads.<o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="background: white; margin: 0in 0in 0pt; tab-stops: 427.5pt; text-align: justify;">
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 10pt;">First of
all, prostate cancer is unique among cancers because the mortality rate is so
low. Around two hundred thousand men in the U.S. alone are diagnosed
with the disease every year, and less than 3% will eventually die from it, while
a majority of men who have the far more common low-risk, slow-growing prostate
cancer can anticipate living a normal life span, or dying of something else.<o:p></o:p></span></div>
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 10pt;"><o:p> </o:p></span><br />
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 10pt;">Your
local urologist has a busy medical practice that involves treating problems
like impotence, infections, incontinence, and kidney stones. He also does
biopsies. But the average urologist performs fewer than <i style="mso-bidi-font-style: normal;">five</i> prostate removals (prostatectomies) a year--far too few to be considered
proficient. He may be a talented doctor, but he is unlikely to be a prostate
cancer expert. So once you have your biopsy results, it is best to consult a
prostate cancer specialist, either at a major medical center, or at a
high-volume prostate cancer clinic.<o:p></o:p></span><br />
<br />
<div class="MsoNormal" style="background: white; margin: 0in 0in 0pt; tab-stops: 427.5pt; text-align: justify;">
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 10pt;">As for
the third misperception, it is essential, before committing to any form of
treatment, that you do your own research, and are convinced the treatment
you choose is the right one for you. Do not let anyone rush you into
making a bad decision. Once your category of prostate cancer is identified (<i style="mso-bidi-font-style: normal;">Low, Intermediate, or</i> <i style="mso-bidi-font-style: normal;">High Risk</i>), get on the Internet and
learn about every treatment option--including no treatment whatsoever--for your
type of disease. If you are over 70, and have low-risk disease, my
advice to you is to find a doctor who has experience monitoring an active
surveillance protocol.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="background: white; margin: 0in 0in 0pt; tab-stops: 427.5pt; text-align: justify;">
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 10pt;">Your role
in your recovery, however, doesn't end with choosing your treatment. The
emphasis on lifestyle changes has been one of the most significant shifts in
cancer care in the last decade. A study at UCSF showed that improving your
nutrition, reducing stress and getting more exercise, can lower PSA levels. And
according to a relatively new field of health psychology called "illness
representation," your beliefs and expectations also impact the outcome of
your disease. So take charge of your recovery, and<i style="mso-bidi-font-style: normal;"> </i>have faith in your choice of treatment.<o:p></o:p></span></div>
Prostate Oncology Specialistshttp://www.blogger.com/profile/12308174937988133133noreply@blogger.com0tag:blogger.com,1999:blog-3114833974012757165.post-16140051624532207262015-09-01T14:30:00.000-07:002015-09-01T14:30:58.517-07:00The September Prostate Cancer Conference<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;"><strong>BY MARK SCHOLZ, MD</strong></span><br />
<strong><span style="font-family: Arial; font-size: x-small;"></span></strong><br />
<span style="color: windowtext; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: "Helvetica Neue";"><span style="font-family: Arial;">PCRI’s <a href="http://prostate-cancer.org/events-calendar/conference-2014/" target="_blank">Prostate Cancer Conference</a> <i style="mso-bidi-font-style: normal;">for Patients </i>is
less than two weeks away.<span style="mso-spacerun: yes;"> </span>The Conference
is a unique event giving opportunity for patients to interact closely with
experts in prostate cancer and leaders in research.<span style="mso-spacerun: yes;"> </span>It is also a great venue to establish a connection
with other patients who have “been there and done that.” This is a weekend to
stay informed about the latest in prostate cancer. <o:p></o:p></span></span><br />
<br />
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<span style="color: windowtext; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: "Helvetica Neue";"><span style="font-family: Arial;">That’s where
the invited <a href="http://pcri.org/2015-prostate-cancer-conference#2015speakerstopics" target="_blank">experts</a> come in - we ask them to present their lectures in a way
that can be understood by patients. This year’s program will stress breakthroughs
in imaging, immunology, new hormone therapy, expanded roles for chemotherapy
and the latest thinking on radiation. <span style="mso-spacerun: yes;"> </span>The
Saturday program will include:<o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<span style="color: windowtext; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: "Helvetica Neue";"></span> </div>
<div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin: 0in 0in 0pt 0.5in; mso-list: l0 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="color: windowtext; font-family: Symbol; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="color: windowtext; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: "Helvetica Neue";"><span style="font-family: Arial;"><a href="http://www.ucsfhealth.org/matthew.cooperberg" target="_blank">Dr. Matthew Cooperberg</a> from UCSF is providing an update on active surveillance .<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0in 0in 0pt 0.5in; mso-list: l0 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="color: windowtext; font-family: Symbol; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="color: windowtext; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: "Helvetica Neue";"><span style="font-family: Arial;"><a href="https://www.mskcc.org/cancer-care/doctors/john-mulhall" target="_blank">Dr. John Mulhall</a><span style="mso-spacerun: yes;"> </span>from Memorial Sloan
Kettering<span style="mso-spacerun: yes;"> </span>will educate us on the latest
methods for maintaining normal sexual function after treatment for prostate
cancer.<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0in 0in 0pt 0.5in; mso-list: l0 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="color: windowtext; font-family: Symbol; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="color: windowtext; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: "Helvetica Neue";"><span style="font-family: Arial;"><a href="http://www.prostatecancertreatmentcenter.com/about-us/physicians-staff/" target="_blank">Dr. Peter Grimm</a>, from Prostate Cancer Center of Seattle, a
world authority on seed implantation reviewing the latest breakthroughs in the
area of radiation therapy.<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0in 0in 0pt 0.5in; mso-list: l0 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="color: windowtext; font-family: Symbol; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> <a href="http://www.mountsinai.org/profiles/william-oh" target="_blank">
</a></span></span></span><!--[endif]--><span style="color: windowtext; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: "Helvetica Neue";"><span style="font-family: Arial;"><a href="http://www.mountsinai.org/profiles/william-oh" target="_blank">Dr. William Oh</a> from
Mount Sinai will discuss breakthroughs
in injectable radiation that targets bone metastases and new roles for
chemotherapy.<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0in 0in 0pt 0.5in; mso-list: l0 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="color: windowtext; font-family: Symbol; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> <a href="http://www.ohsu.edu/xd/health/services/providers/?personid=51" target="_blank">
</a></span></span></span><!--[endif]--><span style="color: windowtext; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: "Helvetica Neue";"><span style="font-family: Arial;"><a href="http://www.ohsu.edu/xd/health/services/providers/?personid=51" target="_blank">Dr. Tomasz Beer</a> from
the University of Oregon will provide the latest thinking on the powerful new
hormonal agents Xtandi and Zytiga.<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin: 0in 0in 0pt 0.5in; mso-list: l0 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="color: windowtext; font-family: Symbol; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="color: windowtext; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: "Helvetica Neue";"><span style="font-family: Arial;"><a href="https://www.uclahealth.org/provider/daniel-margolis-md" target="_blank">Dr. Dan Margolis</a> a
world-renowned prostate imaging expert from UCLA will explain new used for
multiparametric imaging of the prostate.<o:p></o:p></span></span></div>
<br />
<div class="MsoListParagraphCxSpLast" style="line-height: normal; margin: 0in 0in 0pt 0.5in; mso-list: l0 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="color: windowtext; font-family: Symbol; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="color: windowtext; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: "Helvetica Neue";"><span style="font-family: Arial;"><a href="http://www.hopkinsmedicine.org/profiles/results/directory/profile/0003570/charles-drake" target="_blank">Dr. Charles Drake</a> from Johns Hopkins, the world’s preeminent immune expert in prostate cancer will share the latest
breakthroughs in this rapidly advancing field. <o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<span style="color: windowtext; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: "Helvetica Neue";"><span style="font-family: Arial;"><a href="http://www.sprypub.com/authors/mark-moyad/" target="_blank">Dr. Mark Moyad</a>, our moderator, will also be speaking about <a href="http://www.amazon.com/The-Supplement-Handbook-Worthless-Conditions/dp/1623360358/ref=pd_bxgy_14_img_y" target="_blank">supplements</a> and diet and how
they can lead to increased survival and better quality of life.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<span style="color: windowtext; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: "Helvetica Neue";"><span style="font-family: Arial;">Cancer care
is advancing so rapidly that it takes a team effort between you and your
physician to achieve the best care. For the average patient it is overwhelming
to try to stay up to date with the latest clinical studies, journal articles
and protocols. Often the best place for information is an event like this that
specializes in distributing the latest information in a digestible format.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></span></div>
<br />
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<span style="color: windowtext; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: "Helvetica Neue";"><span style="font-family: Arial;"><a href="http://pcri.org/2015-prostate-cancer-conference#2015conferenceagenda" target="_blank">On Sunday morning</a>, most of our Saturday speakers will participate in a smaller group setting and review their presented topics. The conference will end with a speaker
roundtable to see what treatment the experts will recommend when confronted
with actual patient situations.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></span></div>
<br />
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<span style="color: windowtext; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: "Helvetica Neue";"><span style="font-family: Arial;">The PCRI
Conference is for your empowerment. We want it to give you hope and a new
confidence in facing the challenging tasks of making important treatment decisions
that will impact you for the rest of your life. <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></span></div>
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<span style="mso-bidi-font-size: 11.0pt;"><span style="font-family: Arial;">Sign up online: </span><a href="http://prostate-cancer.org/events-calendar/conference-2014/"><span style="color: blue; font-family: Arial;">http://prostate-cancer.org/events-calendar/conference-2014/</span></a><o:p></o:p></span></div>
Prostate Oncology Specialistshttp://www.blogger.com/profile/12308174937988133133noreply@blogger.com0tag:blogger.com,1999:blog-3114833974012757165.post-69619199666981400712015-08-25T14:37:00.000-07:002015-08-27T14:42:53.835-07:00Beware of Medical Witchdoctors<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;"><strong>BY RALPH BLUM</strong></span><br />
<strong><span style="font-family: Arial; font-size: x-small;"></span></strong><br />
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 11pt;">Words
don't just have an impact on our thoughts and feelings, they have direct
implications for our bodies<i style="mso-bidi-font-style: normal;">,</i> a
fact that all of us should keep in mind every time we step into a doctor's
office. What is said to us in times of stress can positively or negatively
affect our health and well being.<o:p></o:p></span><br />
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<span style="color: black; font-family: "Arial","sans-serif"; font-size: 11pt;">Most of
us, as children, are taught to believe in the infallibility of doctors, so the
manner in which a doctor delivers a potentially life-threatening diagnosis can
have a profound effect, and actually has the power to influence the course of
the disease.<o:p></o:p></span></div>
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<span style="color: black; font-family: "Arial","sans-serif"; font-size: 11pt;">The
stress of a cancer diagnosis can throw patients into an "altered
state" in which they are particularly vulnerable to suggestion--both good
and bad. During these critical intake moments, if the doctor's words are
positive, they can plant within us, at a very deep level, positive expectations
that we can beat the cancer, that we will be cured. Unfortunately, the reverse
is equally true. When we are in this altered state the doctor can adversely
affect our healing and, in some cases, literally scare us to death
by quoting negative statistics, relating the gruesome side effects of
treatments, or worse, by using the dreaded word "terminal."<o:p></o:p></span></div>
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 11pt;"></span><br />
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 11pt;">This
latter behavior is a form of "hexing," the medical equivalent of a
voodoo curse. If a witch doctor leapt out of the jungle, pointed a bone at you
and told you that you were going to die in two months, you'd probably laugh,
albeit a trifle nervously. But when a modern-day witch doctor, wearing a white
coat, carrying a stethoscope, and supported by state-of-the-art scans and test
results, tells you that you have only </span><span style="color: black; font-family: "Arial","sans-serif"; font-size: 11pt;">two
months to live, his "curse" can significantly raise the chances that </span><span style="color: black; font-family: "Arial","sans-serif"; font-size: 11pt;">you <i style="mso-bidi-font-style: normal;">will</i> die. And often right on
schedule.<o:p></o:p></span><br />
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<span style="color: black; font-family: "Arial","sans-serif"; font-size: 11pt;">Everyone
has heard of the <i style="mso-bidi-font-style: normal;">placebo effect, </i>the
beneficial results that a little sugar pill can produce if the patient is told
by an authority figure (usually a doctor) that it will bring relief or healing.
The mere <i style="mso-bidi-font-style: normal;">suggestion</i> actually
causes the body to manufacture the chemicals necessary for the desired result.
However, the <i style="mso-bidi-font-style: normal;">placebo </i>(Latin
for "I will please") has a lesser known evil twin, the <i style="mso-bidi-font-style: normal;">nocebo </i>(Latin for "I will
harm"), which can produce equally powerful negative effects. Suggestion
can be a formidable tool, and a significant part of any doctor's job is to
create a relationship with his patients based on trust, confidence and hope.<o:p></o:p></span></div>
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<span style="color: black; font-family: "Arial","sans-serif"; font-size: 11pt;">Hippocrates,
the father of western medicine said, "A patient who is mortally sick may
yet recover from his belief in the goodness of his physician." Although it
is our own thoughts, our own beliefs that can either harm or heal us, it is
often the doctor's words that start the process. And when the doctor arouses
negative expectations, that is medical hexing.</span></div>
Prostate Oncology Specialistshttp://www.blogger.com/profile/12308174937988133133noreply@blogger.com0