Doctor Lotenfoe will be hosting prostate cancer info sessions in the greater Orlando area. He will discuss prostate cancer as well as the advantages and disadvantages of the various prostate cancer treatments, including active surveillance. You will also be able to hear about the most revolutionary way to treat prostate cancer. Afterwards he will be available to answer any questions you may have about prostate cancer.
Wednesday, September 21: Altamonte Springs Hilton at 6:00 PM (350 North Lake Boulevard, Altamonte Springs, FL)
Wednesday, October 23: Celebration Hotel at 6:00 PM (700 Bloom Street, Celebration, FL)
Monday, October 28: Solivita, Poinciana at 2:00 PM
To register for any of the presentations, please RSVP at 407-566-1105
September is Prostate Cancer Awareness Month. Prostate Cancer is the most common cancer found in men and the number two cause of cancer deaths in men. More than 200,000 men will be diagnosed with prostate cancer this year, and than 27,000 men are estimated to die of prostate cancer.
The earlier the prostate cancer is diagnosed, the easier it can be removed. And with newer, outpatient, mini-invasive technologies available, there are significantly less complications such as sexual dysfunction and loss of urinary control, while still obtaining excellent cancer control.
In view of Prostate Cancer Awareness Month, the Rotary Club of Orlando Evening Club is organizing a prostate cancer screening event on Saturday September 19 from 8:00 AM through 12:00 PM at the College Park Baptist Church in Orlando (1914 Edgewatr Drive, Orlando). For a nominal charge of 10 dollars, men 40 years and older will be able to get a prostate screening.
The 10 dollar fee will be fully applied to benefit the Orlando Health Care Center for the Homeless.
A recent article published in the Jacksonville Times-Union newspaper informs us that Cyberknife prostate radiation treatments are being considered for being cut from medicare reimbursement in Florida.
Traditional radiation therapy consists of about 40 daily treatments, 5 days a week. Cyberknife radiation therapy is touted as more precise with less damage to surrounding tissues, and consists of only 5 treatments. However, it is an unproven treatment in the sense that it has not been subjected to randomized clinical trials. The Medicare carrier in Florida finds at this point that Cyberknife has not shown any appreciable benefit over traditional external beam radiation treatment.
It is important to note that HIFU is the first treatment for prostate cancer to undergo randomized clinical trials in the USA, and to seek FDA approval specifically for prostate cancer treatment. Neither Cyberknife nor proton beam treatments have undergone randomized clinical trials for prostate cancer.
The June 9, 2009 Brirtish Journal of Cancer just published a paper by H U Ahmed et al reporting data and outcomes of HIFU for prostate cancer using the Sonablate 500 between 2005 and 2007 in the UK.
The procedure was performed on 172 men with localized prostate cancer. The results show no evidence of disease in 92.4% after one treatment. Potency rate is reported at 70% and an incontinence rate of 0.6%. No rectal injury or recto-urethral fistulae were noted.
Their conclusion: HIFU is a minimally invasive, day-case ablative technique that can achieve good biochemical outcomes in the short term with minimal urinary incontinence and acceptable levels of erectile dysfunction.
One of the latest discussion points in prostate cancer is the concept of "active surveillance". In light of 2 recent studies that suggest that many men are unneccesarily treated for prostate cancer, there have been many inquiries at the office.
Active surveillance is an option for men who are found to have an indolent cancer. The definition of an indolent cancer varies greatly among different institutions. An acceptable definition seems to be: not more than 2 cores positive on a standard 8 to 12 core biopsy, not more than 50 percent involvement of each core, no Gleason grade 4 or 5, and PSA less than 10.
Following these criteria, still a significant amount of men will turn out to have a progression of their cancer and/or have treatment. In a few cases men actually progressed to metastatic disease. At the same time every protocol for active surveillance recommends a second biopsy within a year to confirm the previous findings and/or to evaluate for progression. Then there is also the psychological burden of knowing that you have a cancer, and wondering what will happen.
Currently there is no reliable way to predict who will progress, and who will eventually need treatment. Currently non-traditional diagnostic methods such as PCA-3, 3D mapping biopsy, MRI Spectroscopy and Doppler ultrasound may eventually aid urologists in determining which cancers are truly indolent and will not need treatment.
In view of the above, when deciding to have active treatment for a small, low risk cancer, it is important to realize that almost any treatment will succesfully get rid of the disease. However, it is also important to realize that certain treatments are more invasive and some will have more side effects than others. Sonablate HIFU in these cases will treat the cancer effectively in the vast majority of men while maintaining potency in 90 percent of cases, and maintaining continence in up to 99 percent of men. This is better than any other treatment available at this time. Sonablate HIFU is minimally invasive (only a 4 mm incision), usually without blood loss, creates minimal discomfort and is an outpatient same day procedure.
At the recent yearly meeting of the American Urological Association in Chicago, an updated "best practice statement" with regards to prostate cancer screening was published. These guidelines were somewhat of a surprise in light of recent controversial publications regarding the effect of prostate cancer screening.
First, the age for obtaining a baseline PSA has been lowered to 40 years.
Secondly, the current policy no longer recommends a single threshold value of PSA which should prompt prostate biopsy. Rather, the decision to proceed to prostate biopsy should be based primarily on PSA and DRE results, but should take into account multiple factors including free and total PSA, patient age, PSA velocity, PSA density, family history, ethnicity, prior biopsy history and comorbidities.
For the complete text of the "best practice statement", follow this link:
http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines/main-reports/psa09.pdf
As part of our commitment to stay at the forefront of medicine, Urology Health Solutions is partnering with Discovery Clinical Trials in performing Clinical Research studies. Currently we have several ongoing studies.
I have noticed that in order to attract attention some websites start with this negative statement. In fact, the question should be: why prostate treatment fails. It is well known that small, early stage cancers are the easiest to treat. In fact, with these type of cancers, almost any treatment will have a good result. However, the question now is: how many side effects will one experience from the treatment?
The gold standard, radical prostatectomy (including the DaVinci robotic procedure), will have potency rates anywhere from 50 to 80 percent, and incontinence rates somewhere in the range of 10 percent; radiation therapy will have potency rates from 20 to 50 percent, while having similar or worse incontinence rates; cryoablation will have anywhere from 10 to 50 percent potency rates, and 2 to 5 percent incontinence; HIFU with the Sonablate 500 so far has approximately 90 percent potency rates and less than 1 percent incontince rates in these cases. That's pretty impressive. Some people may say that HIFU is not as effective as radical prostatectomy, but keep in mind that HIFU is a repeatable procedure. I estimate that HIFU effectiveness for the low grade, low stage, low volume prostate cancers is well above 90 percent.
Again radiation therapy for prostate cancer in the spotlight. There seems to be an increased risk for developing bladder cancer and rectal cancer after radiation therapy. Keep in mind though, that it is also feasible that the risk factors for prostate cancer may also be risk factors for the other cancers. However, keep in mind that radiation is ionizing energy, which is known to cause cancer.
Due to the fact that I do cryoablation as salvage therapy for prostate cancer, I started noticing how often patients fail radiation therapy. I did not have any data, but I found it interesting that there are now presentations being given about the exact same subject, which seem to confirm my suspicions that radiation is not what it is said to be. See the link below.
