Surgery Offers Prostate Cancer Patients Better Survival Odds

Prostate cancer patients with clinically localized tumors are more likely to die if they undergo radiotherapy rather than radical prostatectomy.

Radiotherapy for clinically-localized prostate cancer (PCa) is associated with an increased risk of overall and PCa-specific mortality compared with radical prostatectomy, according to a new systematic review and meta-analysis.

Dr. Nam’s group stated that, to their knowledge, their study represents the most comprehensive and up-to-date review of the literature comparing survival outcomes associated with radiotherapy and surgery.

Source: Surgery Offers Prostate Cancer Patients Better Survival Odds

 

This issue is frequently asked by patients.  In the short run, surgery and radiation are both effective at controlling prostate cancer.  Over time, most studies have shown that prostate cancer surgery is more effective than radiation at curing cancer.

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Exercise Training May Delay PCa Progression – Renal and Urology News

PSA doubling time, a marker of cancer progression, increased from 28 to 76 months in prostate cancer patients performing exercise training.

“The exercise intervention resulted in marked physiological adaptations that aided weight regulation and increased fitness levels,” Dr. Hojman told Renal & Urology News. “PSA doubling time correlated with improved fitness, but not with weight loss. These findings suggest there is a fitness component that plays a role in the control of prostate cancer that is not related to weight.”

Source: Exercise Training May Delay PCa Progression – Renal and Urology News

I have been recommending exercise for my prostate cancer patients for many years.  I usually recommend 30 minutes of aerobic exercise 3 times a week.  In this study, 45 minutes of exercise 3 times a week led to the PSA going up slowly for patients that had regular exercise.

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U.S. Food and Drug Administration Approval Summary: Enzalutamide for the Treatment of Patients With Chemotherapy-Naïve Metastatic Castration-Resistant Prostate Cancer.

The U.S. Food and Drug Administration approved enzalutamide for the treatment of patients with chemotherapy-naïve metastatic castration-resistant prostate cancer (mCRPC). At the prespecified interim analysis, a statistically significant improvement in overall survival was demonstrated for patients

Source: U.S. Food and Drug Administration Approval Summary: Enzalutamide for the Treatment of Patients With Chemotherapy-Naïve Metastatic Castration-Resistant Prostate Cancer.

I have been using enzalutamide in my patients who have metastatic disease proven by imaging or pathology and have progressed where hormonal therapy isn’t enough to keep the PSA near 0.

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Sexual Intercourse May Clear Distal Ureteral Stones

Having sex 3-4 times a week was associated with a significantly greater stone passage rate than tamsulosin or standard medical therapy.

Source: Sexual Intercourse May Clear Distal Ureteral Stones

This was an interesting study that compared men that had stones that they were trying to pass.  Some of the men were treated with flomax, which is commonly prescribed to help pass stones by allowing the ureter (kidney drainage tube) to relax and allow the stone more room to pass.  Other men were not given anything and some of the men had regular sexual intercourse.

The men that had regular sexual relations had the highest rate of passing stones.

I will start advising my patients to increase sexual activity when trying to pass stones based on this study.

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Latest Dietary Advice for Prostate Cancer – Renal and Urology News

A range of foods, nutrients, and dietary patterns are being studied for prostate cancer prevention or treatment, according to a 2015 research review.

Source: Latest Dietary Advice for Prostate Cancer – Renal and Urology News

While the ideal diet prescription has yet to be determined, the investigators suggest counseling men with these tips, in line with emerging research and a heart healthy diet:

  • Increase fruits and vegetables.
  • Replace refined carbohydrates with whole grains.
  • Reduce total and saturated fat intake.
  • Avoid overcooked meats (such as charred barbecue).
  • Consume fewer calories (by reducing carbohydrates, for example) to achieve a healthy body weight.

Men often ask about dietary changes if they have prostate cancer.  I have been telling them for years to follow a heart healthy diet, which also will help with their prostate cancer.

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Renal cell carcinoma growing into the renal pelvis and mimicking transitional cell carcinoma: A case report and literature review – Abstract

Renal cell carcinoma growing into the renal pelvis and mimicking transitional cell carcinoma: A case report and literature review – Abstract.

My partner and I had a similar patient that presented with a large kidney tumor that was growing into the renal pelvis and ureter. We performed a ureteroscopy and the tumor appeared as a large bulge growing down the ureter that reminded me of renal cancer growing into the renal vein. A biopsy came back as benign urothelium.

On these rare cases, I have developed a protocol to perform a robotic radical nephrectomy and transect the ureter by stapling it. I obtain pathological analysis at the time of surgery, and if the diagnosis is transitional cell cancer, I proceed to remove the rest of the ureter and a bladder cuff with robotic surgery at the same time.

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