Released: 8/30/2005 4:00 PM EDT
Source: Rubenstein
Newswise — Ablatherm® HIFU, a non-invasive technique using high intensity focused ultrasound in prostate cancer patients is now available in North America for the first time " at the Don Mills Surgical Unit in Toronto. This proven prostate cancer treatment was developed in Europe and has been successfully used in over 7,000 patients. To learn more about the Ablatherm® HIFU treatment visit http://www.hifu.ca.
Ablatherm® HIFU is a highly precise procedure using high intensity, focused ultrasound to eliminate prostate cancer. Ninety per cent of patients can be treated by a single procedure usually lasting 1 1â„2 to 3 hours. Patients are generally discharged a few hours after the procedure. There are fewer side effects with the Ablatherm® HIFU treatment than conventional treatments such as: radical prostatectomy, radiation, and cryotherapy.
During the procedure an Ablatherm® HIFU probe is placed into the rectum after administration of spinal anesthesia. A high intensity and focused beam of ultrasound is directed into the prostate, which rapidly raises the temperature of the prostate to 85 degrees Celsius and destroys the prostate tissue. By computer imaging, the prostate beam is focused to incorporate the entire prostate gland. The Ablatherm® HIFU procedure is completed without blood loss or exposure to radiation.
Ablatherm® HIFU can be effectively used on patients with localized prostate cancer (clinical stage T-1 or T-2) who would otherwise be considered curable by radiation or radical surgery. This treatment can also be considered in patients who have received external beam radiation for localized prostate cancer but who have developed a recurrence without evidence of disease outside of the prostate.
Until recently definitive treatment options for localized prostate cancer included either radical surgery or radiation. Unfortunately both treatments were associated with significant side effects including impotence (loss of erections), and incontinence of urine.
The surgical approach, known as a radical prostatectomy, requires the complete removal of the prostate including the seminal vesicles, deferent canals, and part of the bladder neck. This major surgical procedure performed under general anesthesia requires hospitalization for a number of days.
External Beam Radiotherapy (EBRT) treatment is a non-invasive technique requiring high levels of radiation to be directed through the pelvis into the prostate. The daily treatments are completed in a cancer center over a 7-week period (35 treatments in total). Immediate complications include fatigue and malaise while long-term problems include erectile dysfunction and incontinence. Recent information suggests that external beam radiation for prostate cancer is associated with a 70% increase risk of rectal cancer.
Additional treatment options for localized prostate cancer includes brachytherapy, a surgical procedure during which radioactive pellets are inserted into the diseased prostate gland, and cryotherapy, during which probes are surgically placed into the prostate and areas are frozen thus destroying portions of prostate tissue. Each of these procedures carries its own significant side effects including incontinence, impotence and severe pelvic pain and rectal injury in the case of cryotherapy. Five year cure rates of prostate cancer are considerably lower than with the use of Ablatherm® HIFU.
Clinical Studies
A recently published study in the Journal of Urology (February, 2004; 63(2):297-300) showed that 93% of patients had negative biopsies and 87% had stable PSA levels (less than 1.0) five years after treatment. Overall 90% of all patients treated with Ablatherm-HIFU require only one treatment and with complication rates lower than surgery, radiation, or cryotherapy.
Ablatherm HIFU has shown to be an effective treatment for recurrent prostate cancer. Recently published results in the Journal of Urology (April, 2004; 63(4):625-9) indicate that 71 consecutive unsuccessful EBRT patients shows 62% of patients had negative biopsies, stable psa results and zero rectal fistulae. The study reports that complication rates are significantly lower with Ablatherm HIFU than with salvage cryotherapy or salvage surgery. Unlike treatment with salvage cryotherapy or salvage surgery there have been zero incidents of rectal fistulae in patients treated with Ablatherm HIFU since 2002.
About Prostate Cancer
The prostate gland is a chestnut shaped organ surrounding the urethra at the base of the bladder. Its primary function is to produce seminal liquid, which is used as a means of transportation for the sperm. Prostate cancer, the leading cancer in North American males, occurs when a cluster of cells within the prostate grows uncontrollably. When detected early these tumors are confined to the prostate allowing for a cure rate of 90% and above
Prostate cancer is the most common cancer among men in North America and is second only to lung cancer as a cause of cancer deaths in North American males. It is estimated that 39 million men in North America, Europe and Japan have prostate cancer. Each year over 230,000 new cases of prostate cancer are detected in the United States representing one new case of prostate cancer every 2 minutes. Over 40,000 men will die of this disease each year.
About the Don Mills Surgical Unit in Toronto.
The Don Mills Surgical Unit is a private surgical facility that is licensed by the Province of Ontario. It is under the direction of Dr. William Orovan, a board certified urologist and chair of the Department of Surgery, McMaster University. Additionally, Dr. Orovan is the former president of the Ontario Medical Association
Permalink to this article
« Return to article list | Print-friendly Layout
Libraries:Medicine
Keywords:Ablatherm, HIFU, Prostate, Cancer
Contact Information
Available for logged-in reporters only
Description
Ablatherm(r) HIFU, a non-invasive technique using high intensity focused ultrasound in prostate cancer patients is now available in North America for the first time.
Wednesday, December 23, 2009
Tuesday, November 24, 2009
UPCOMING SEMINAR FROM DR. SUAREZ
Hi Jim, I heard that Dr. Suarez is giving another seminar in the near future. How do I get on his list? Please let me know. Thanks Richard
Thursday, November 12, 2009
WEDNESDAY, NOVEMBER 18th AT 6:00 P.M.
BILTMORE HOTEL IN MIAMI
1200 ANASTASIA AVENUE
CORAL GABLES, FLORIDA
STONEMAN DOUGLAS AMPHITHEATER
1200 ANASTASIA AVENUE
CORAL GABLES, FLORIDA
STONEMAN DOUGLAS AMPHITHEATER
SEMINAR IN MIAMI FLORIDA
If you have prostate cancer, THINK TWICE BEFORE GOING UNDER THE KNIFE. We invite you to a special FREE seminar to present information to you and answer your questions about a new option for treatment with Dr. George Suarez, MD and Dr. Bert Vorstman, MD formerly of the University of Miami.
SPACE IS LIMITED SO PLEASE RSVP to 305 595-0199
If you would like to schedule a FREE 10 minutes personal consultation with Dr. Suarez or Dr.Vorstman between 5-6 P.M. or 7-8 P.M please call 305 595-0199
www.hifumedicalexpert.com
SPACE IS LIMITED SO PLEASE RSVP to 305 595-0199
If you would like to schedule a FREE 10 minutes personal consultation with Dr. Suarez or Dr.Vorstman between 5-6 P.M. or 7-8 P.M please call 305 595-0199
www.hifumedicalexpert.com
Conditions Causing Penile Shortening
Penile shortening is a phenomenon that is associated with certain medical and surgical conditions. These conditions include prostate cancer patients treated with radical prostatectomy, Peyronie's disease and congenital anomalies. There is also some evidence that erectile dysfunction may be an independent risk factor for shortening.
There have been several studies that have evaluated penile length after radical retropubic prostatectomy (RRP). In 2001, Munding et al.[15] examined penile length in 31 men who underwent RRP by a single surgeon. All men had erections that were sufficient for penetration preoperatively. Penile measurements were recorded in triplicate on all patients in the holding area prior to surgery. These were performed in the stretched flaccid condition only, from the tip of the glans to the pubopenile skin. The same measurements were taken again 3 months postoperatively. No erect measurements were recorded, nor was penile girth recorded. They demonstrated penile shortening in the stretched condition in 71% of patients; 23% of patients were found to have <1.0 cm decrease in length whereas 48% were seen to have a>1.0 cm decrease in stretched penile length.[15]
A second study published in 2003 by Savoie et al.,[16] similarly examined post-RRP flaccid and flaccid stretched penile lengths. Penile lengths and girth of 63 men undergoing RRP were measured pre- and postoperatively. Measurements were recorded from the pubopenile skin to the meatus, in the flaccid and stretched flaccid conditions. Penile circumference was also measured midshaft. Measurements were taken preoperatively in the holding area and then 3 months postoperatively. About 68% of patients demonstrated a statistically significant reduction in penile length in both the flaccid and flaccid stretched conditions, but interestingly, an increase in penile girth was also seen.[16] Etiology of penile shortening is unclear at the present time. Theories include early penile shortening related to urethral shortening due to RRP, or secondary corporal fibrosis from chronic hypoxia and fibrosis.
There is increasing evidence, however, that penile shortening is not limited to surgical treatments of prostate cancer. This was demonstrated by Haliloglu et al.[17] in 2006, when they looked at penile length in men treated with a combination of androgen suppression and radiation therapy. All subjects received hormone deprivation therapy in the form of a luteinizing hormone releasing hormone (LH-RH) agonist, (either leuprolide or goserelin) every 3 months for a total of nine injections. Twenty days of bicalutamide (50 mg per day) was given ten days prior to the LHRH agonist. External beam radiation (70 Gy) was administered in a two-phase four-field approach. Penile measurements were recorded in the stretched flaccid condition from the pubopenile skin to the tip of the glans. They found that there was a statistically significant decrease in penile length in men treated with hormonal suppression plus radiation. More specifically the men who had a pretreatment stretched length of <14 cm had a lower percentage of penile shortening compared to men with pretreatment lengths >14 cm.[17] Although the literature is limited, there is some evidence that external beam radiation can cause penile fibrosis and ultimately penile shortening.[18] The effects of hormone deprivation alone on penile length is not known.
Awwad et al.[14] examined penile size on normal adult Jordanian men and in men with erectile dysfunction. Their data on 'normal' subjects have already been outlined earlier. Awwad found that when comparing normal men to men with erectile dysfunction, there was a statistically significant reduction in both flaccid and stretched penile length. More specifically, the average flaccid penile length was 7.7 cm (potent patients 9.3 cm), whereas the average stretched penile length was 11.6 cm (potent patients 13.5 cm). Penile girth of the impotent men was not assessed. The aut
Penile shortening is a phenomenon that is associated with certain medical and surgical conditions. These conditions include prostate cancer patients treated with radical prostatectomy, Peyronie's disease and congenital anomalies. There is also some evidence that erectile dysfunction may be an independent risk factor for shortening.
There have been several studies that have evaluated penile length after radical retropubic prostatectomy (RRP). In 2001, Munding et al.[15] examined penile length in 31 men who underwent RRP by a single surgeon. All men had erections that were sufficient for penetration preoperatively. Penile measurements were recorded in triplicate on all patients in the holding area prior to surgery. These were performed in the stretched flaccid condition only, from the tip of the glans to the pubopenile skin. The same measurements were taken again 3 months postoperatively. No erect measurements were recorded, nor was penile girth recorded. They demonstrated penile shortening in the stretched condition in 71% of patients; 23% of patients were found to have <1.0 cm decrease in length whereas 48% were seen to have a>1.0 cm decrease in stretched penile length.[15]
A second study published in 2003 by Savoie et al.,[16] similarly examined post-RRP flaccid and flaccid stretched penile lengths. Penile lengths and girth of 63 men undergoing RRP were measured pre- and postoperatively. Measurements were recorded from the pubopenile skin to the meatus, in the flaccid and stretched flaccid conditions. Penile circumference was also measured midshaft. Measurements were taken preoperatively in the holding area and then 3 months postoperatively. About 68% of patients demonstrated a statistically significant reduction in penile length in both the flaccid and flaccid stretched conditions, but interestingly, an increase in penile girth was also seen.[16] Etiology of penile shortening is unclear at the present time. Theories include early penile shortening related to urethral shortening due to RRP, or secondary corporal fibrosis from chronic hypoxia and fibrosis.
There is increasing evidence, however, that penile shortening is not limited to surgical treatments of prostate cancer. This was demonstrated by Haliloglu et al.[17] in 2006, when they looked at penile length in men treated with a combination of androgen suppression and radiation therapy. All subjects received hormone deprivation therapy in the form of a luteinizing hormone releasing hormone (LH-RH) agonist, (either leuprolide or goserelin) every 3 months for a total of nine injections. Twenty days of bicalutamide (50 mg per day) was given ten days prior to the LHRH agonist. External beam radiation (70 Gy) was administered in a two-phase four-field approach. Penile measurements were recorded in the stretched flaccid condition from the pubopenile skin to the tip of the glans. They found that there was a statistically significant decrease in penile length in men treated with hormonal suppression plus radiation. More specifically the men who had a pretreatment stretched length of <14 cm had a lower percentage of penile shortening compared to men with pretreatment lengths >14 cm.[17] Although the literature is limited, there is some evidence that external beam radiation can cause penile fibrosis and ultimately penile shortening.[18] The effects of hormone deprivation alone on penile length is not known.
Awwad et al.[14] examined penile size on normal adult Jordanian men and in men with erectile dysfunction. Their data on 'normal' subjects have already been outlined earlier. Awwad found that when comparing normal men to men with erectile dysfunction, there was a statistically significant reduction in both flaccid and stretched penile length. More specifically, the average flaccid penile length was 7.7 cm (potent patients 9.3 cm), whereas the average stretched penile length was 11.6 cm (potent patients 13.5 cm). Penile girth of the impotent men was not assessed. The aut
Conditions Causing Penile Shortening
Penile shortening is a phenomenon that is associated with certain medical and surgical conditions. These conditions include prostate cancer patients treated with radical prostatectomy, Peyronie's disease and congenital anomalies. There is also some evidence that erectile dysfunction may be an independent risk factor for shortening.
There have been several studies that have evaluated penile length after radical retropubic prostatectomy (RRP). In 2001, Munding et al.[15] examined penile length in 31 men who underwent RRP by a single surgeon. All men had erections that were sufficient for penetration preoperatively. Penile measurements were recorded in triplicate on all patients in the holding area prior to surgery. These were performed in the stretched flaccid condition only, from the tip of the glans to the pubopenile skin. The same measurements were taken again 3 months postoperatively. No erect measurements were recorded, nor was penile girth recorded. They demonstrated penile shortening in the stretched condition in 71% of patients; 23% of patients were found to have <1.0 cm decrease in length whereas 48% were seen to have a>1.0 cm decrease in stretched penile length.[15]
A second study published in 2003 by Savoie et al.,[16] similarly examined post-RRP flaccid and flaccid stretched penile lengths. Penile lengths and girth of 63 men undergoing RRP were measured pre- and postoperatively. Measurements were recorded from the pubopenile skin to the meatus, in the flaccid and stretched flaccid conditions. Penile circumference was also measured midshaft. Measurements were taken preoperatively in the holding area and then 3 months postoperatively. About 68% of patients demonstrated a statistically significant reduction in penile length in both the flaccid and flaccid stretched conditions, but interestingly, an increase in penile girth was also seen.[16] Etiology of penile shortening is unclear at the present time. Theories include early penile shortening related to urethral shortening due to RRP, or secondary corporal fibrosis from chronic hypoxia and fibrosis.
There is increasing evidence, however, that penile shortening is not limited to surgical treatments of prostate cancer. This was demonstrated by Haliloglu et al.[17] in 2006, when they looked at penile length in men treated with a combination of androgen suppression and radiation therapy. All subjects received hormone deprivation therapy in the form of a luteinizing hormone releasing hormone (LH-RH) agonist, (either leuprolide or goserelin) every 3 months for a total of nine injections. Twenty days of bicalutamide (50 mg per day) was given ten days prior to the LHRH agonist. External beam radiation (70 Gy) was administered in a two-phase four-field approach. Penile measurements were recorded in the stretched flaccid condition from the pubopenile skin to the tip of the glans. They found that there was a statistically significant decrease in penile length in men treated with hormonal suppression plus radiation. More specifically the men who had a pretreatment stretched length of <14 cm had a lower percentage of penile shortening compared to men with pretreatment lengths >14 cm.[17] Although the literature is limited, there is some evidence that external beam radiation can cause penile fibrosis and ultimately penile shortening.[18] The effects of hormone deprivation alone on penile length is not known.
Awwad et al.[14] examined penile size on normal adult Jordanian men and in men with erectile dysfunction. Their data on 'normal' subjects have already been outlined earlier. Awwad found that when comparing normal men to men with erectile dysfunction, there was a statistically significant reduction in both flaccid and stretched penile length. More specifically, the average flaccid penile length was 7.7 cm (potent patients 9.3 cm), whereas the average stretched penile length was 11.6 cm (potent patients 13.5 cm). Penile girth of the impotent men was not assessed. The authors c
Penile shortening is a phenomenon that is associated with certain medical and surgical conditions. These conditions include prostate cancer patients treated with radical prostatectomy, Peyronie's disease and congenital anomalies. There is also some evidence that erectile dysfunction may be an independent risk factor for shortening.
There have been several studies that have evaluated penile length after radical retropubic prostatectomy (RRP). In 2001, Munding et al.[15] examined penile length in 31 men who underwent RRP by a single surgeon. All men had erections that were sufficient for penetration preoperatively. Penile measurements were recorded in triplicate on all patients in the holding area prior to surgery. These were performed in the stretched flaccid condition only, from the tip of the glans to the pubopenile skin. The same measurements were taken again 3 months postoperatively. No erect measurements were recorded, nor was penile girth recorded. They demonstrated penile shortening in the stretched condition in 71% of patients; 23% of patients were found to have <1.0 cm decrease in length whereas 48% were seen to have a>1.0 cm decrease in stretched penile length.[15]
A second study published in 2003 by Savoie et al.,[16] similarly examined post-RRP flaccid and flaccid stretched penile lengths. Penile lengths and girth of 63 men undergoing RRP were measured pre- and postoperatively. Measurements were recorded from the pubopenile skin to the meatus, in the flaccid and stretched flaccid conditions. Penile circumference was also measured midshaft. Measurements were taken preoperatively in the holding area and then 3 months postoperatively. About 68% of patients demonstrated a statistically significant reduction in penile length in both the flaccid and flaccid stretched conditions, but interestingly, an increase in penile girth was also seen.[16] Etiology of penile shortening is unclear at the present time. Theories include early penile shortening related to urethral shortening due to RRP, or secondary corporal fibrosis from chronic hypoxia and fibrosis.
There is increasing evidence, however, that penile shortening is not limited to surgical treatments of prostate cancer. This was demonstrated by Haliloglu et al.[17] in 2006, when they looked at penile length in men treated with a combination of androgen suppression and radiation therapy. All subjects received hormone deprivation therapy in the form of a luteinizing hormone releasing hormone (LH-RH) agonist, (either leuprolide or goserelin) every 3 months for a total of nine injections. Twenty days of bicalutamide (50 mg per day) was given ten days prior to the LHRH agonist. External beam radiation (70 Gy) was administered in a two-phase four-field approach. Penile measurements were recorded in the stretched flaccid condition from the pubopenile skin to the tip of the glans. They found that there was a statistically significant decrease in penile length in men treated with hormonal suppression plus radiation. More specifically the men who had a pretreatment stretched length of <14 cm had a lower percentage of penile shortening compared to men with pretreatment lengths >14 cm.[17] Although the literature is limited, there is some evidence that external beam radiation can cause penile fibrosis and ultimately penile shortening.[18] The effects of hormone deprivation alone on penile length is not known.
Awwad et al.[14] examined penile size on normal adult Jordanian men and in men with erectile dysfunction. Their data on 'normal' subjects have already been outlined earlier. Awwad found that when comparing normal men to men with erectile dysfunction, there was a statistically significant reduction in both flaccid and stretched penile length. More specifically, the average flaccid penile length was 7.7 cm (potent patients 9.3 cm), whereas the average stretched penile length was 11.6 cm (potent patients 13.5 cm). Penile girth of the impotent men was not assessed. The authors c
Nineteen percent of men who undergo prostate surgery later regret their decision, data indicates.
The New York Times (8/27, Parker-Pope) reported in its Well blog that a study published in the journal European Urology suggests that "one in five men who undergoes prostate surgery to treat cancer later regrets the decision." Notably, "regret is highest among men who opt for robotic prostatectomy." For the study, researchers "surveyed 400 men with early prostate cancer who had undergone either a traditional 'open' surgical procedure or newer robotic surgery to remove the prostate." While "the vast majority of men were satisfied,"19 percent reported regretting their choice of treatment. "Men who had undergone robotic surgery were four times more likely to regret their choice than men who had undergone the open procedure." The researchers said that "the higher level of regret among robotic patients suggests that they had higher expectations for their recovery, possibly because the robotic procedure is widely touted as a more innovative treatment." They concluded "that the study shows urologists need to communicate more carefully the risks and benefits of the treatment prior to surgery so that men have more realistic expectations of what to expect."
August 27, 2008, 9:26 am
Regrets After Prostate Surgery
One in five men who undergoes prostate surgery to treat cancer later regrets the decision, a new study shows. And surprisingly, regret is highest among men who opt for robotic prostatectomy, a minimally invasive surgery that is growing in popularity as a treatment.
The research, published in the medical journal European Urology, is the latest to suggest that technological advances in prostate surgery haven’t necessarily translated to better results for the men on which it is performed. It also adds to growing concerns that men are being misled about the real risks and benefits of robotic surgical procedures used to treat prostate cancer.
Of the 219,000 men in the United States who learn they have prostate cancer each year, nearly half undergo surgical removal of the gland, according to the National Cancer Institute.
Duke University researchers surveyed 400 men with early prostate cancer who had undergone either a traditional “open” surgical procedure or newer robotic surgery to remove the prostate. Overall, the vast majority of men were satisfied. However, 19 percent regretted their treatment choice. Notably, men who had undergone robotic surgery were four times more likely to regret their choice than men who had undergone the open procedure.
Researchers say the higher level of regret among robotic patients suggests that they had higher expectations for their recovery, possibly because the robotic procedure is widely touted as a more innovative surgery than traditional prostatectomy. Even among men who had the same scores on erectile function and other measures of post-surgery recovery, the robotic patients still reported a higher level of dissatisfaction and regret than other men.
Part of the problem may be that doctors who perform robotic prostatectomies commonly cite potency rates as high as 95 percent and above among their patients, giving patients an unrealistic view of life after surgery.
But the data are highly misleading. Researchers often define potency as simply being able to achieve an erection that is “adequate” for intercourse — but for many men, that definition doesn’t capture their ongoing struggle to return to a normal sex life. Earlier this year, researchers from George Washington University and New York University used a more realistic definition of potency, showing that after surgery, fewer than half of the men studied felt their sex lives had returned to normal within a year.
Another important finding of the new research showed that men were less likely to regret their choice shortly after surgery. The men who were long past surgery experienced more regret. That finding likely speaks to the fact that as time passes after surgery, men gain a more realistic view of lingering health and quality-of-life issues like erection problems and other changes in their sex lives.
The Duke researchers said that the study shows urologists need to communicate more carefully the risks and benefits of the treatment prior to surgery so that men have more realistic expectations of what to expect.
To learn more, read “Sex After Prostate Cancer,'’ a Well blog post that includes my column about the issue as well as numerous comments from men and women about the aftermath of prostate cancer treatment
The New York Times (8/27, Parker-Pope) reported in its Well blog that a study published in the journal European Urology suggests that "one in five men who undergoes prostate surgery to treat cancer later regrets the decision." Notably, "regret is highest among men who opt for robotic prostatectomy." For the study, researchers "surveyed 400 men with early prostate cancer who had undergone either a traditional 'open' surgical procedure or newer robotic surgery to remove the prostate." While "the vast majority of men were satisfied,"19 percent reported regretting their choice of treatment. "Men who had undergone robotic surgery were four times more likely to regret their choice than men who had undergone the open procedure." The researchers said that "the higher level of regret among robotic patients suggests that they had higher expectations for their recovery, possibly because the robotic procedure is widely touted as a more innovative treatment." They concluded "that the study shows urologists need to communicate more carefully the risks and benefits of the treatment prior to surgery so that men have more realistic expectations of what to expect."
August 27, 2008, 9:26 am
Regrets After Prostate Surgery
One in five men who undergoes prostate surgery to treat cancer later regrets the decision, a new study shows. And surprisingly, regret is highest among men who opt for robotic prostatectomy, a minimally invasive surgery that is growing in popularity as a treatment.
The research, published in the medical journal European Urology, is the latest to suggest that technological advances in prostate surgery haven’t necessarily translated to better results for the men on which it is performed. It also adds to growing concerns that men are being misled about the real risks and benefits of robotic surgical procedures used to treat prostate cancer.
Of the 219,000 men in the United States who learn they have prostate cancer each year, nearly half undergo surgical removal of the gland, according to the National Cancer Institute.
Duke University researchers surveyed 400 men with early prostate cancer who had undergone either a traditional “open” surgical procedure or newer robotic surgery to remove the prostate. Overall, the vast majority of men were satisfied. However, 19 percent regretted their treatment choice. Notably, men who had undergone robotic surgery were four times more likely to regret their choice than men who had undergone the open procedure.
Researchers say the higher level of regret among robotic patients suggests that they had higher expectations for their recovery, possibly because the robotic procedure is widely touted as a more innovative surgery than traditional prostatectomy. Even among men who had the same scores on erectile function and other measures of post-surgery recovery, the robotic patients still reported a higher level of dissatisfaction and regret than other men.
Part of the problem may be that doctors who perform robotic prostatectomies commonly cite potency rates as high as 95 percent and above among their patients, giving patients an unrealistic view of life after surgery.
But the data are highly misleading. Researchers often define potency as simply being able to achieve an erection that is “adequate” for intercourse — but for many men, that definition doesn’t capture their ongoing struggle to return to a normal sex life. Earlier this year, researchers from George Washington University and New York University used a more realistic definition of potency, showing that after surgery, fewer than half of the men studied felt their sex lives had returned to normal within a year.
Another important finding of the new research showed that men were less likely to regret their choice shortly after surgery. The men who were long past surgery experienced more regret. That finding likely speaks to the fact that as time passes after surgery, men gain a more realistic view of lingering health and quality-of-life issues like erection problems and other changes in their sex lives.
The Duke researchers said that the study shows urologists need to communicate more carefully the risks and benefits of the treatment prior to surgery so that men have more realistic expectations of what to expect.
To learn more, read “Sex After Prostate Cancer,'’ a Well blog post that includes my column about the issue as well as numerous comments from men and women about the aftermath of prostate cancer treatment
Comparative Effectiveness of Minimally Invasive vs Open Radical Prostatectomy
Jim C. Hu, MD, MPH; Xiangmei Gu, MS; Stuart R. Lipsitz, ScD; Michael J. Barry, MD; Anthony V. D’Amico, MD, PhD; Aaron C. Weinberg, MD; Nancy L. Keating, MD, MPH
JAMA. 2009;302(14):1557-1564.
Context Minimally invasive radical prostatectomy (MIRP) has diffused rapidly despite limited data on outcomes and greater costs compared with open retropubic radical prostatectomy (RRP).
Objective To determine the comparative effectiveness of MIRP vs RRP.
Design, Setting, and Patients Population-based observational cohort study using US Surveillance, Epidemiology, and End Results Medicare linked data from 2003 through 2007. We identified men with prostate cancer who underwent MIRP (n = 1938) vs RRP (n = 6899).
Main Outcome Measures We compared postoperative 30-day complications, anastomotic stricture 31 to 365 days postoperatively, long-term incontinence and erectile dysfunction more than 18 months postoperatively, and postoperative use of additional cancer therapies, a surrogate for cancer control.
Results Among men undergoing prostatectomy, use of MIRP increased from 9.2% (95% confidence interval [CI], 8.1%-10.5%) in 2003 to 43.2% (95% CI, 39.6%-46.9%) in 2006-2007. Men undergoing MIRP vs RRP were more likely to be recorded as Asian (6.1% vs 3.2%), less likely to be recorded as black (6.2% vs 7.8%) or Hispanic (5.6% vs 7.9%), and more likely to live in areas with at least 90% high school graduation rates (50.2% vs 41.0%) and with median incomes of at least $60 000 (35.8% vs 21.5%) (all P < .001). In propensity score–adjusted analyses, MIRP vs RRP was associated with shorter length of stay (median, 2.0 vs 3.0 days; P<.001) and lower rates of blood transfusions (2.7% vs 20.8%; P < .001), postoperative respiratory complications (4.3% vs 6.6%; P = .004), miscellaneous surgical complications (4.3% vs 5.6%; P = .03), and anastomotic stricture (5.8% vs 14.0%; P < .001). However, MIRP vs RRP was associated with an increased risk of genitourinary complications (4.7% vs 2.1%; P = .001) and diagnoses of incontinence (15.9 vs 12.2 per 100 person-years; P = .02) and erectile dysfunction (26.8 vs 19.2 per 100 person-years; P = .009). Rates of use of additional cancer therapies did not differ by surgical procedure (8.2 vs 6.9 per 100 person-years; P = .35).
Conclusion Men undergoing MIRP vs RRP experienced shorter length of stay, fewer respiratory and miscellaneous surgical complications and strictures, and similar postoperative use of additional cancer therapies but experienced more genitourinary complications, incontinence, and erectile dysfunction.
Author Affiliations: Division of Urologic Surgery (Drs Hu and Weinberg), Center for Surgery and Public Health (Drs Hu, Lipsitz, and Weinberg and Ms Gu), Department of Radiation Oncology (Dr D’Amico), and Division of General Internal Medicine (Dr Keating), Brigham and Women's Hospital, Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute (Dr Hu), The Medical Practices Evaluation Center, Massachusetts General Hospital (Dr Barry), and Department of Health Care Policy, Harvard Medical School (Dr Keating), Boston.
CiteULike Connotea Del.icio.us Digg Reddit Technorati Twitter What's this?
Jim C. Hu, MD, MPH; Xiangmei Gu, MS; Stuart R. Lipsitz, ScD; Michael J. Barry, MD; Anthony V. D’Amico, MD, PhD; Aaron C. Weinberg, MD; Nancy L. Keating, MD, MPH
JAMA. 2009;302(14):1557-1564.
Context Minimally invasive radical prostatectomy (MIRP) has diffused rapidly despite limited data on outcomes and greater costs compared with open retropubic radical prostatectomy (RRP).
Objective To determine the comparative effectiveness of MIRP vs RRP.
Design, Setting, and Patients Population-based observational cohort study using US Surveillance, Epidemiology, and End Results Medicare linked data from 2003 through 2007. We identified men with prostate cancer who underwent MIRP (n = 1938) vs RRP (n = 6899).
Main Outcome Measures We compared postoperative 30-day complications, anastomotic stricture 31 to 365 days postoperatively, long-term incontinence and erectile dysfunction more than 18 months postoperatively, and postoperative use of additional cancer therapies, a surrogate for cancer control.
Results Among men undergoing prostatectomy, use of MIRP increased from 9.2% (95% confidence interval [CI], 8.1%-10.5%) in 2003 to 43.2% (95% CI, 39.6%-46.9%) in 2006-2007. Men undergoing MIRP vs RRP were more likely to be recorded as Asian (6.1% vs 3.2%), less likely to be recorded as black (6.2% vs 7.8%) or Hispanic (5.6% vs 7.9%), and more likely to live in areas with at least 90% high school graduation rates (50.2% vs 41.0%) and with median incomes of at least $60 000 (35.8% vs 21.5%) (all P < .001). In propensity score–adjusted analyses, MIRP vs RRP was associated with shorter length of stay (median, 2.0 vs 3.0 days; P<.001) and lower rates of blood transfusions (2.7% vs 20.8%; P < .001), postoperative respiratory complications (4.3% vs 6.6%; P = .004), miscellaneous surgical complications (4.3% vs 5.6%; P = .03), and anastomotic stricture (5.8% vs 14.0%; P < .001). However, MIRP vs RRP was associated with an increased risk of genitourinary complications (4.7% vs 2.1%; P = .001) and diagnoses of incontinence (15.9 vs 12.2 per 100 person-years; P = .02) and erectile dysfunction (26.8 vs 19.2 per 100 person-years; P = .009). Rates of use of additional cancer therapies did not differ by surgical procedure (8.2 vs 6.9 per 100 person-years; P = .35).
Conclusion Men undergoing MIRP vs RRP experienced shorter length of stay, fewer respiratory and miscellaneous surgical complications and strictures, and similar postoperative use of additional cancer therapies but experienced more genitourinary complications, incontinence, and erectile dysfunction.
Author Affiliations: Division of Urologic Surgery (Drs Hu and Weinberg), Center for Surgery and Public Health (Drs Hu, Lipsitz, and Weinberg and Ms Gu), Department of Radiation Oncology (Dr D’Amico), and Division of General Internal Medicine (Dr Keating), Brigham and Women's Hospital, Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute (Dr Hu), The Medical Practices Evaluation Center, Massachusetts General Hospital (Dr Barry), and Department of Health Care Policy, Harvard Medical School (Dr Keating), Boston.
CiteULike Connotea Del.icio.us Digg Reddit Technorati Twitter What's this?
Radiation therapy for prostate cancer raises bladder, rectal cancer risk, study indicates
Tuesday, October 28 2008 | Comments
________________________________________
The risk of developing bladder cancer is higher for men receiving radiotherapy for prostate cancer than those who undergo radical prostatectomy, and the risk of rectal cancer is higher for those receiving external beam radiotherapy than those who undergo radical prostatectomy, according to a recent study.
Prostatectomy and radiation therapy are the 2 most common forms of treatment for prostate cancer, and their success rates for achieving long-term disease-free survival are relatively similar. Radiotherapy, however, does not carry the risks of incontinence and erectile dysfunction associated with radical prostatectomy.
In this retrospective study, 243,082 men 40 years or older who underwent radical prostatectomy or radiotherapy for prostate cancer between 1988 and 2003 were grouped according to type of treatment received: radical prostatectomy (RP; 109,178; 45%); external beam radiotherapy (EBRT; 93,059; 38%); interstitial brachytherapy (BT; 22,889; 9%); or a combination of EBRT and BT (EBRT-BT; 17,956; 7%).
The groups were followed from the time of prostate cancer diagnosis until the development of bladder or rectal cancer, death, or date of last follow-up. Median follow-up time was 49 months (range, 6-191 months).
Compared to radical prostatectomy, the relative risk of developing bladder cancer was 1.88 after EBRT, 1.52 after BT, and 1.85 after EBRT-BT. The relative risk of developing rectal cancer was 1.26 after EBRT, 1.08 after BT, and 1.21 after EBRT-BT.
Patients who had a radical prostatectomy had a standardized incidence ratio (SIR) of bladder cancer nearly identical to the U.S. population (SIR, 0.99; 95% CI, 0.91-1.05). However, subjects in the EBRT (SIR, 1.42; 95% CI, 1.34-1.50) and EBRT-BT cohorts (SIR, 1.39; 95% CI, 1.19-1.64) had higher than expected incidence rates of bladder cancer compared to the U.S. population.
"When we calculated the age adjusted incidence risk ratio, we found that all radiation treatment cohorts had a statistically significant higher risk of bladder cancer developing compared to the radical prostatectomy cohort," the investigators noted. Those at highest risk were those who received EBRT. Only the EBRT cohort had an increased risk of rectal cancer. Patients undergoing EBRT-BT were 3 times more likely to have rectal cancer after 10 years than those treated with radical prostatectomy (HR, 3.25; 95% CI, 1.25, 8.44).
According to the investigators, the results of this study support including the risk of secondary malignancy of the bladder and rectum into the decision-making process for the patient. (Nieder A, et al. J Urol 2008;180:2005-2010.)
Tuesday, October 28 2008 | Comments
________________________________________
The risk of developing bladder cancer is higher for men receiving radiotherapy for prostate cancer than those who undergo radical prostatectomy, and the risk of rectal cancer is higher for those receiving external beam radiotherapy than those who undergo radical prostatectomy, according to a recent study.
Prostatectomy and radiation therapy are the 2 most common forms of treatment for prostate cancer, and their success rates for achieving long-term disease-free survival are relatively similar. Radiotherapy, however, does not carry the risks of incontinence and erectile dysfunction associated with radical prostatectomy.
In this retrospective study, 243,082 men 40 years or older who underwent radical prostatectomy or radiotherapy for prostate cancer between 1988 and 2003 were grouped according to type of treatment received: radical prostatectomy (RP; 109,178; 45%); external beam radiotherapy (EBRT; 93,059; 38%); interstitial brachytherapy (BT; 22,889; 9%); or a combination of EBRT and BT (EBRT-BT; 17,956; 7%).
The groups were followed from the time of prostate cancer diagnosis until the development of bladder or rectal cancer, death, or date of last follow-up. Median follow-up time was 49 months (range, 6-191 months).
Compared to radical prostatectomy, the relative risk of developing bladder cancer was 1.88 after EBRT, 1.52 after BT, and 1.85 after EBRT-BT. The relative risk of developing rectal cancer was 1.26 after EBRT, 1.08 after BT, and 1.21 after EBRT-BT.
Patients who had a radical prostatectomy had a standardized incidence ratio (SIR) of bladder cancer nearly identical to the U.S. population (SIR, 0.99; 95% CI, 0.91-1.05). However, subjects in the EBRT (SIR, 1.42; 95% CI, 1.34-1.50) and EBRT-BT cohorts (SIR, 1.39; 95% CI, 1.19-1.64) had higher than expected incidence rates of bladder cancer compared to the U.S. population.
"When we calculated the age adjusted incidence risk ratio, we found that all radiation treatment cohorts had a statistically significant higher risk of bladder cancer developing compared to the radical prostatectomy cohort," the investigators noted. Those at highest risk were those who received EBRT. Only the EBRT cohort had an increased risk of rectal cancer. Patients undergoing EBRT-BT were 3 times more likely to have rectal cancer after 10 years than those treated with radical prostatectomy (HR, 3.25; 95% CI, 1.25, 8.44).
According to the investigators, the results of this study support including the risk of secondary malignancy of the bladder and rectum into the decision-making process for the patient. (Nieder A, et al. J Urol 2008;180:2005-2010.)
Increased risk of rectal cancer after prostate radiation: A population-based study
Nancy N. Baxter ‡ , Joel E. Tepper§, Sara B. Durham¶, David A. Rothenberger ‡, Beth A. Virnig¶
Received 27 August 2004; accepted 15 December 2004.
Background & Aims: Radiation therapy for prostate cancer has been associated with an increased rate of pelvic malignancies, particularly bladder cancer. The association between radiation therapy and colorectal cancer has not been established. Methods: We conducted a retrospective cohort study using Surveillance, Epidemiology, and End Results (SEER) registry data from 1973 through 1994. We focused on men with prostate cancer, but with no previous history of colorectal cancer, treated with either surgery or radiation who survived at least 5 years. We evaluated the effect of radiation on development of cancer for 3 sites: definitely irradiated sites (rectum), potentially irradiated sites (rectosigmoid, sigmoid, and cecum), and nonirradiated sites (the rest of the colon). Using a proportional hazards model, we evaluated the effect of radiation on development of colorectal cancer over time. Results: A total of 30,552 men received radiation, and 55,263 underwent surgery only. Colorectal cancers developed in 1437 patients: 267 in irradiated sites, 686 in potentially irradiated sites, and 484 in nonirradiated sites. Radiation was independently associated with development of cancer over time in irradiated sites but not in the remainder of the colon. The adjusted hazards ratio for development of rectal cancer was 1.7 for the radiation group, compared with the surgery-only group (95% CI: 1.4–2.2). Conclusions: We noted a significant increase in development of rectal cancer after radiation for prostate cancer. Radiation had no effect on development of cancer in the remainder of the colon, indicating that the effect is specific to directly irradiated tissue.
Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA
‡ University of Minnesota Comprehensive Cancer Center, Minneapolis, Minnesota
§ Department of Radiation Oncology and the UNC/Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina
¶ Division of Health Services Research and Policy, University of Minnesota School of Public Health, Minneapolis, Minnesota
Address requests for reprints to: Nancy Baxter, MD, PhD, Division of Colon and Rectal Surgery, University of Minnesota, MMC 450, 420 Delaware Street SE, Minneapolis, Minnesota 55455; fax: (612) 626-4915.
Supported by a University of Minnesota Academic Health Center Seed grant.
PII: S0016-5085(04)02333-9
doi:10.1053/j.ga
Nancy N. Baxter ‡ , Joel E. Tepper§, Sara B. Durham¶, David A. Rothenberger ‡, Beth A. Virnig¶
Received 27 August 2004; accepted 15 December 2004.
Background & Aims: Radiation therapy for prostate cancer has been associated with an increased rate of pelvic malignancies, particularly bladder cancer. The association between radiation therapy and colorectal cancer has not been established. Methods: We conducted a retrospective cohort study using Surveillance, Epidemiology, and End Results (SEER) registry data from 1973 through 1994. We focused on men with prostate cancer, but with no previous history of colorectal cancer, treated with either surgery or radiation who survived at least 5 years. We evaluated the effect of radiation on development of cancer for 3 sites: definitely irradiated sites (rectum), potentially irradiated sites (rectosigmoid, sigmoid, and cecum), and nonirradiated sites (the rest of the colon). Using a proportional hazards model, we evaluated the effect of radiation on development of colorectal cancer over time. Results: A total of 30,552 men received radiation, and 55,263 underwent surgery only. Colorectal cancers developed in 1437 patients: 267 in irradiated sites, 686 in potentially irradiated sites, and 484 in nonirradiated sites. Radiation was independently associated with development of cancer over time in irradiated sites but not in the remainder of the colon. The adjusted hazards ratio for development of rectal cancer was 1.7 for the radiation group, compared with the surgery-only group (95% CI: 1.4–2.2). Conclusions: We noted a significant increase in development of rectal cancer after radiation for prostate cancer. Radiation had no effect on development of cancer in the remainder of the colon, indicating that the effect is specific to directly irradiated tissue.
Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA
‡ University of Minnesota Comprehensive Cancer Center, Minneapolis, Minnesota
§ Department of Radiation Oncology and the UNC/Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina
¶ Division of Health Services Research and Policy, University of Minnesota School of Public Health, Minneapolis, Minnesota
Address requests for reprints to: Nancy Baxter, MD, PhD, Division of Colon and Rectal Surgery, University of Minnesota, MMC 450, 420 Delaware Street SE, Minneapolis, Minnesota 55455; fax: (612) 626-4915.
Supported by a University of Minnesota Academic Health Center Seed grant.
PII: S0016-5085(04)02333-9
doi:10.1053/j.ga
Wednesday, November 11, 2009
SEMINAR ON PROSTATE CANCER
Hello everybody, I would like to invite you all to the next seminar by Dr. George M. Suarez and Dr. Bert Vorstman, M.D.'s. It will take place at the Biltmore Hotel in Coral Gables 1200 Anastasia Avenue. Coral Gables, florida at the Stoneman Douglas Amphitheater. It starts at 5:00 P.M. and ends at 6:00 P.M. If you would like to schedule a free 10 minute personal consultation with Dr. Suarez or Dr. Vorstman, Please call 305 595-0199. www.hifumedicalexpert.com
Hope to see you there
Hope to see you there
Subscribe to:
Posts (Atom)