However, study findings presented at the National Kidney Foundation 2012 Spring Clinical Meetings suggest that patients with prostate cancer (PCa) might be better served by undergoing transplantation instead of waiting two years to be declared cancer-free.

via PCa Patients on HD Would Benefit from Early Kidney Transplantation – Renal and Urology News.

This study looked at patients how had prostate cancer diagnosed within 6 months after transplantation.  Most patients were doing well after 2 years.  This is relevant since patients on dialysis need to wait 2 years after having surgery for cancer to be disease free prior to transplantation.  The risk to patients of being on hemodialysis for 2 years is higher than the risk of having prostate cancer in a transplant patient.  Studies like this should be done to see if patents with certain cancers, like kidney and prostate, may not need to wait the 2 years that they traditionally have.

In nearly 1,000 men undergoing initial or repeat biopsy, these investigators found that urinary PCA3 prior to a prostate biopsy improved the prediction of PCa and high-grade disease with a high positive predictive value 90% in the initial biopsy setting and a high negative predictive value 88% in the repeat biopsy setting. The investigators conclude that counseling men undergoing prostate biopsy in the context of PCA3 would reduce the burden of prostate biopsies.

via Prostate Cancer Screening: Moving Beyond PSA – Renal and Urology News.

I have been using PCA-3 tests in a variety of ways.  I perform it yearly for men at high risk of prostate cancer, to determine if men need repeat prostate biopsies, and also in my active surveillance prostate cancer patients.

Four neocystostomies, four psoas hitches, and two Boari flaps were performed in the RAUR group. Estimated blood loss 30.6 vs 327.5 mL, P=0.001 and length of hospital stay 2.4 vs 5.1 d, P=0.01 were significantly reduced in the robotic group. Median BMI 29.4±5.3 vs 26.5±5.2, P=0.130 and operative time in minutes 306.6 vs 270.0 min, P=0.316 were higher in the robotic group, although these were not statistically significant.

via Robotic versus open distal ureteral reconstruction and reimplantation for benign stricture disease.

This article reports on 10 robotic ureteral reimplants.  I have performed several of these with similar results.  Patients tend to recover faster and go home from the hospital sooner.  The connection between the ureter and bladder is magnified, so the robotic approach is easier than the open approach for this part.

I have performed this operation for ureteral cancer in the distal ureter as well.

After a median follow-up of 11 years in the core age group, the relative reduction in the risk of death from prostate cancer in the screening group was 21% rate ratio, 0.79; 95% confidence interval [CI], 0.68 to 0.91; P=0.001, and 29% after adjustment for noncompliance. The absolute reduction in mortality in the screening group was 0.10 deaths per 1000 person-years or 1.07 deaths per 1000 men who underwent randomization. The rate ratio for death from prostate cancer during follow-up years 10 and 11 was 0.62 95% CI, 0.45 to 0.85; P=0.003. To prevent one death from prostate cancer at 11 years of follow-up, 1055 men would need to be invited for screening and 37 cancers would need to be detected. There was no significant between-group difference in all-cause mortality.

via Prostate-Cancer Mortality at 11 Years of Follow-up — NEJM.

This NEJM published study is a 2 year update from the European Randomized Study of Screening for prostate cancer.  This is a timely article given the debate in this country as to the utility of prostate cancer screening.

Prostate cancer is a slow growing cancer that rarely cause mortality in months.  As more time goes by I would expect the updated version of this study to show a larger amount of people being helped by the treatment of their prostate cancer.

“Over-expression of the PCA3 gene is highly specific to cancerous prostate tissue,” John Wei, MD, MS, Professor of Urology at the University of Michigan Health System in Ann Arbor, said in a company-issued statement. “When evaluated with other risk factors, the PROGENSA PCA3 assay fills an important unmet clinical need by helping physicians identify which men suspected of having prostate cancer should undergo a repeat prostate biopsy.”

via PCA3 Test Okayed to Help Decide Need for Repeat Prostate Biopsy – Renal and Urology News.

I’ve been using the PCA-3 test for a few years.  I have used it for this indication, as well as for patients who opt for active surveillance for their prostate cancer.  I am glad the test was approved for this use by the FDA.

The 5-alpha-reductase inhibitor dutasteride Avodart appears to delay disease progression and the initiation of active treatment in men with low-risk, localized prostate cancer, results of a 3-year international clinical trial indicate.Treatment with dutasteride also reduces cancer-related anxiety, study authors found.”The results prove that using active surveillance plus dutasteride is a viable, safe, and effective treatment option for men who often undergo aggressive local treatment despite low risk of dying from the disease,” said first author Neil Fleshner, MD, of the University of Toronto’s Princess Margaret Hospital.

via 5-ARI delays prostate cancer progression in men with low-risk disease – - ModernMedicine.

This is the first study I’ve seen that shows that 5-alpha-reductase inhibitors may help slow the progression of prostate cancer.  These medicines are tolerated well by most patients and treatment with avodart can be considered.

But a new study finds that counseling helped married men and women figure out what sorts of treatments for erectile dysfunction worked for them and how to incorporate those methods during sex. In doing so, they returned some luster to their love lives.

via Couples Counseling Boosts Sex Lives After Prostate Cancer.

Couples often have a hard time dealing with the emotional and physical changes after prostate cancer surgery.  There are ways to help men have erections after surgery if oral medicines are not working.

I try to bring up the need to have erections and the impact on the couple at most visits.  This article states counseling for couples if sexual function is important is helpful as well.

via Statins During Radiotherapy for High-Risk Prostate Cancer Improve Outcomes – Renal and Urology News.

Statins are medicines that are taken to lower cholesterol.  Many studies have shown they are beneficial in preventing heart disease and many diseases.  Some experts believe that these medicines help prevent prostate  cancer and this study shows that patients with HIGH risk prostate cancer receiving radiation therapy had a better result when they were on statins.

Incontinence during sex is a long-lasting problem for roughly one in eight men who have had their prostate removed due to cancer, a study of more than 1,400 patients has found.

via After prostate surgery, some men leak during sex | Reuters.

This article describes that some men will have loss of urine during sexual intercourse.  This usually happens during climax.  The article refers to this problem as climacturia.  I have seen men that recover normal erectile function, but have this problem of leaking urine during intercourse.  It usually improves with time but not always.  I have not kept accurate statistics on this problem, but have a feeling that it is less with robotic surgery for my patients.

Among patients with stage T1b, T1c, T2a, or T2b prostate adenocarcinoma and a PSA level of 20 ng per milliliter or less, the use of short-term ADT for 4 months before and during radiotherapy was associated with significantly decreased disease-specific mortality and increased overall survival. According to post hoc risk analysis, the benefit was mainly seen in intermediate-risk, but not low-risk, men. Funded by the National Cancer Institute; RTOG 94-08 ClinicalTrials.gov number, NCT00002597.

via Radiotherapy and Short-Term Androgen Deprivation for Localized Prostate Cancer — NEJM.

This study revealed a reduction in overall survival at 10 years and disease-specific mortality at 10 years.  Patients studied were low and moderate risk prostate cancer patients receiving radiotherapy as definitive therapy.

Only the moderate risk patients were shown to have a benefit.