Video: Steam Treatment for Enlarged Prostate

Prostate gland enlargement can cause uncomfortable urinary symptoms for men. And, as they age, their risk increases. Approximately 30 percent of men experience symptoms by age 60 and 50 percent of men by age 80. There are several effective treatments for an enlarged prostate, including a relatively new treatment that uses steam to reduce the size of the prostate and alleviate symptoms.

Watch video at You Tube (1:00 minutes) . . . . .

Some Drugs for Enlarged Prostate May Do Harm

Dennis Thompson wrote . . . . . .

Popular hormone-based drugs for treating an enlarged prostate could increase men’s risk of type 2 diabetes, heart disease or stroke, a new study suggests.

A group of German men taking the drug Avodart (dutasteride) for three years wound up with higher blood sugar and cholesterol levels than men taking another class of prostate medication that does not affect male hormones, the researchers reported.

“Our small study suggests there are really adverse effects on metabolic function from these drugs that has not been reported previously,” said lead researcher Abdulmaged Traish. He is a professor of urology with the Boston University School of Medicine.

But Dr. Ashutosh Tewari, chair of urology for the Icahn School of Medicine at Mount Sinai in New York City, said the new findings run counter to prior clinical trials of the drug, and do not warrant any change in use at this time.

Still, Traish believes urologists should talk about these new results with patients before prescribing either Avodart or another hormone-based prostate drug called Proscar (finasteride). Both are in the class of drugs known as 5-alpha-reductase inhibitors.

“They should have a clear, open and honest discussion with their patients,” Traish said. “This drug might cause some of these problems.”

However, according to Tewari, “This is an interesting finding which is a little different than the large ‘controlled’ studies. It needs to be studied in a larger pool of patients in a prospective manner.”

The association seen in the study doesn’t prove a cause-and-effect relationship.

The prostate is a walnut-sized gland surrounding the urethra where it connects to the bladder. The prostate produces fluid that goes into semen, and is essential for male fertility. But as men age, their prostates tend to enlarge, pinching the urethra and making urination more difficult.

Avodart reduces production of dihydrotestosterone (DHT), a hormone linked to enlargement of the prostate gland. Treatment with Avodart can cause a man’s prostate to shrink by roughly 18 percent to 20 percent, Traish noted.

“The men urinate a little bit better,” Traish said. “They don’t have to stand an hour and a half in the bathroom at the airport.”

However, DHT also plays an important role in the function of other organs, particularly the liver, Traish said. He and his colleagues are concerned that reducing DHT could have other unknown health effects.

To examine the issue, Traish’s team reviewed records of 460 men treated at a single urologist’s office in Germany for enlarged prostate.

Half of the men had been prescribed Avodart to treat their problem, and the other half had been prescribed Flomax (tamsulosin). Flomax, in the class of drugs known as alpha-blockers, does not affect hormones, but works by causing the smooth muscle tissue of the prostate to relax, Traish said.

The researchers tracked all of the men for 36 to 42 months, performing blood tests and assessing prostate size and function.

Avodart was linked to an ongoing rise in blood sugar levels among men who received the drug, while men taking Flomax did not experience any such increase, the study authors said.

Further, long-term Avodart treatment was linked to increased “bad” LDL cholesterol levels in men, the investigators found. Men on Flomax experienced a smaller but yet significant increase in their LDL cholesterol levels, but also had an increase in their “good” HDL cholesterol levels, the findings showed.

Based on his findings, Traish said he would lean toward prescribing Flomax first rather than a hormone-based prostate drug.

“I would rather have my patient try something safer, and if it works for him, keep him on that,” Traish said.

Tewari noted that the clinical trials that found Avodart effective in treating enlarged prostate did not show any of these other metabolic problems.

Those clinical trials relied on men being randomly assigned Avodart, Tewari said. The men in this new study were not assigned medication randomly, but were allowed to choose their treatment following discussion with a doctor.

The new study also did not compare men taking Avodart to a control group taking a placebo, and relied on past data rather than an entirely new experiment, Tewari continued.

“This is interesting, yet needs to be verified in a controlled setting with a larger pool of patients,” Tewari explained. “At this time, I’m not too impressed with any clinical significance of this study.”

The study was published online recently in the journal Hormone Molecular Biology and Clinical Investigation.

Source: HealthDay


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New Type of PET Imaging Identifies Primary and Metastatic Prostate Cancer

In the featured article from the February 2017 issue of The Journal of Nuclear Medicine, researchers document the first-in-human application of a new imaging agent to help find prostate cancer in both early and advanced stages and plan treatment. The study indicates that the new agent—a PET radiotracer—is both safe and effective.

The new agent is a gallium-68 (Ga-68)-labeled peptide BBN-RGD agent that targets both gastrin-releasing peptide receptor (GRPR) and integrin αvβ3. Dual-receptor targeting provides advantages over single-receptor targeting by allowing tumor contrast when either or both receptor types are expressed, improving binding affinity and increasing the number of effective receptors.

Approximately one in seven men will be diagnosed with prostate cancer in his lifetime. In 2017, the American Cancer Society estimates that there will be more than 161,000 new prostate cancer cases in the United States and around 27,000 deaths from the disease. “Although treatable at the early stage, prostate cancer is prone to metastasis,” explain the team of authors, led by Xiaoyuan Chen, senior investigator, Laboratory of Molecular Imaging and Nanomedicine at the U.S. National Institute of Biomedical Imaging and Bioengineering. “An effective and specific imaging method of detecting both primary and metastatic lesions is thus of critical importance to manage patients with prostate cancer.”

This study included 13 patients with prostate cancer (four newly diagnosed and nine post-therapy) and five healthy volunteers. Ga-68-BBN-RGD PET/CT detected 20 bone lesions in seven patients either with primary prostate cancer or after radical prostatectomy. The patients with bone metastases did not necessarily have an elevated prostate specific antigen level. “This result is better than bone scanning with MDP,” Chen notes, referring to the most common radiotracer used today. “MDP bone scans are sensitive but lack specificity because localized skeletal accumulation of Tc-99m-MDP can also be observed in the case of trauma and infection.” No adverse side effects were found during the whole procedure and two-week follow-up, demonstrating the safety of Ga-68-BBN-RGD.

“Compounds capable of targeting more than one biomarker have the ability of binding to both early and metastatic stages of prostate cancer, creating the possibility for a more prompt and accurate diagnostic profile for both primary and the metastatic tumors,” explains Chen.

Looking ahead, Chen says, “Ga-68-BBN-RGD could play an additive role in staging and detecting prostate cancer and provide guidance for internal radiation therapy using the same peptide labeled with therapeutic radionuclides.” He points out that larger-scale clinical investigations are warranted.

Source: Society of Nuclear Medicine and Molecular Imaging


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MRI Scans could Spare 25% of Men from Prostate Biopsies

“Every man with suspected prostate cancer should have an MRI scan,” The Guardian reports. That is the conclusion of a study looking at how well MRI scans compare with the current practice of biopsies; removing sections of prostate tissue for analysis.

Disadvantages of prostate biopsies include the fact that they can lead to a small risk of side effects, some of which can be serious, such as sepsis.

Researchers were looking at an advanced type of MRI scan, known as a multi-parametric MRI, which as well as looking at the shape and size of the prostate, can also assess other factors such as blood flow through the gland.

The scan was used on more than 500 British men. The results suggest that scanning would safely reduce the number of men needing a biopsy by about a quarter. Moreover, in men with an aggressive prostate cancer the combination of MRI scan followed by a biopsy is almost twice as likely to pick up clinically significant cancer.

The National Institute for Health and Care Excellence (NICE) is currently considering this new diagnostic method to decide whether introducing it will be cost-effective.

Where did the story come from?

The study was carried out by researchers from University College London, Royal Marsden Hospital, University of York, Hampshire Hospitals NHS Trust and UCLH NHS Foundation Trust, all in the UK.

The study was funded by the UK Government Department of Health, National Institute of Health Research- Health Technology Assessment Programme, UCLH/UCL Biomedical Research Centre, The Royal Marsden and Institute for Cancer Research Biomedical Research Centre.

The study was published in the peer-reviewed medical journal The Lancet, on an open-access basis, meaning it is free to read online.

The story was covered by many UK media outlets and reporting was accurate.

What kind of research was this?

This was a prospective paired cohort trial known as the Prostate MRI Imaging Study (PROMIS), that recruited men with suspected prostate cancer. All the men would previously have been advised to have a prostate biopsy.

Men were each offered two diagnostic tests: the traditional diagnostic test, transrectal ultrasound guided biopsy (TRUS-biopsy) and the new diagnostic test involving multi-parametric magnetic resonance imaging (MP-MRI). The tests were done in addition to a template prostate mapping biopsy (TPM-biopsy). This is a reference standard against which the detection rates of each previous approach could be evaluated.

Because both diagnostic tests were performed on each man participating in the trial, they can be directly compared with the reference standard and the benefits of using both in sequence can be evaluated. Cohort studies provide the best evidence when looking at diagnostic tests.

What did the research involve?

Researchers included 576 men within the UK who had a clinical suspicion of prostate cancer, for example an elevated PSA level (prostate specific antigen – a hormone associated with prostate enlargement) within the previous three months, and had been advised to have a prostate biopsy.

Men first underwent the new diagnostic test – the multi-parametric Magnetic Resonance Imaging (MP-MRI), which provides information on not just tissue anatomy, but also tissue characteristics such as prostate volume.

Men then underwent the traditional transrectal ultrasound-guided prostate biopsy (TRUS-biopsy).

Another test was undertaken just before the traditional TRUS-biopsy in the same procedure under anaesthesia to minimise infection risk: the transperineal template prostate mapping biopsy (TPM-biopsy). This test was undertaken as the standard for comparison as it is highly accurate, although not commonly used as it is thought too invasive for routine use.

Patients and the clinicians undertaking the traditional TRUS-biopsy were unaware of the results of the previous MP-MRI.

What were the basic results?

From the standard comparison test, using the TPM-biospy, 408 of 576 men had cancer with 230 of 576 men having clinically significant cancer.

For clinically significant cancer, the MP-MRI test was more sensitive (93%, 95% confidence interval [CI] = 88% to 96%) than the traditional TRUS-biopsy alone (48%, 95% CI = 42% to 55%).

The negative predictive value was 89% (95% CI = 83% to 94%). This ability for a negative result to rule out disease led to 158 (27%) of 576 men having a negative MP-MRI. Meaning that using MP-MRI might allow 27% of patients to avoid a biopsy at all.

However, the MP-MRI had a specificity of 41% (95% CI = 36% to 46%) compared with the TRUS-biopsy (96%, 95% CI = 94% to 98%). This means that the TRUS biopsy is better at diagnosing whether the people tested have disease or not and therefore is still needed.

This meant that in combination the MRI test followed by the biopsy was almost twice as likely to pick up clinically significant cancer than biopsy alone.

How did the researchers interpret the results?

The researchers conclude that the “TRUS-biopsy performs poorly as a diagnostic test for clinically significant prostate cancer.”

They suggest that “MP-MRI, used as a triage test before first prostate biopsy, could identify a quarter of men who might safely avoid an unnecessary biopsy and might improve the detection of clinically significant cancer.”

Conclusion

Overall, this study provides good evidence that using an MP-MRI test before a biopsy can result in a much lower proportion of men undergoing unnecessary biopsy. The combination helps detect cancer and avoid unnecessary treatment.

However, the lower accuracy of predicting patients without the disease means that patients with a suspicious MP-MRI scan will still need a biopsy. That is because the current results suggest that in cases where the scan gives an “all-clear” there is around a 40% chance that this is actually an incorrect result.

There are, however, a few study limitations:

  • The time lag between tests (with the new diagnostic test occurring first) may have meant the nature of the tumour was slightly different by the time the traditional diagnostic test and the reference tests were undertaken.
  • Men with a prostate over 100ml were excluded which may have affected the proportion of accurate diagnoses.
  • The traditional TRUS-biopsy was performed directly after the TPM-biopsy.
  • The accuracy of the traditional test might have been affected by swelling and tissue disruption caused by the prior biopsy.

Overall, the findings provide a strong argument for recommending MP-MRI scans for all men with a raised PSA level before having a biopsy.

It is reported that NICE are currently considered whether MP-MRI scans should be added to the standard diagnosis of prostate cancer.

Source: NHS Choice


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Anxiety May Lead to Unneeded Prostate Cancer Treatments

Anxiety may prompt prostate cancer patients to opt for potentially unnecessary treatments, a new study suggests.

The research included more than 1,500 men newly diagnosed with localized prostate cancer. They were more likely to choose surgery and radiation therapy than active surveillance. Active surveillance — also known as “watchful waiting” — is when the patient is monitored closely, but not treated.

“Men’s level of emotional distress shortly after diagnosis predicted greater likelihood of choosing surgery over active surveillance,” said the researchers from the University at Buffalo and Roswell Park Cancer Institute in Buffalo, N.Y.

“Importantly, this was true among men with low-risk disease, for whom active surveillance may be a clinically viable option and side effects of surgery might be avoided,” they noted.

Though the study found an association between anxiety and more aggressive treatment, it didn’t prove cause and effect.

“Emotional distress may motivate men with low-risk prostate cancer to choose more aggressive treatment,” said study author Heather Orom, an associate professor of community health and health behavior at the University at Buffalo.

“If distress early on is influencing treatment choice, then maybe we help men by providing clearer information about prognosis and strategies for dealing with anxiety. We hope this will help improve the treatment decision-making process and ultimately, the patient’s quality of life,” Orom said in a university news release.

Overtreatment is a concern because surgery and radiation therapy can cause side effects such as erectile dysfunction and incontinence. These problems can be avoided in men with low-risk prostate cancer by choosing active surveillance, the researchers said.

Study co-author Dr. Willie Underwood III is an associate professor in Roswell Park’s department of urology. “The goal of most physicians treating men with prostate cancer is to help their patients and family members through a difficult process and help their patients receive appropriate treatment,” he said.

“To do so, it is helpful for physicians to better understand what is motivating men’s decisions and to address negative motivators such as emotional distress to prevent men from receiving a treatment that they don’t need or will later regret,” Underwood added.

The findings were published in the Journal of Urology.

Source: University at Buffalo


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