Dutasteride (Avodart according to GalxoSmithKline) is used to treat an enlarged prostate. It works by blocking the production of a natural substance that enlarges the prostate. This shrinks the prostate, relieves symptoms of BPH (benign prostatic hypertrophy), such as frequent and difficult urination, and decreases [...]]]> Source: New England Journal of Medicine; BBC Health

Dutasteride (Avodart according to GalxoSmithKline) is used to treat an enlarged prostate. It works by blocking the production of a natural substance that enlarges the prostate. This shrinks the prostate, relieves symptoms of BPH (benign prostatic hypertrophy), such as frequent and difficult urination, and decreases the chance that surgery will be needed to treat this condition.

Why am I telling you this? Have I suddenly started working for GlaxoSmithKline and wish to pitch their on-patent medications to stave off the competition from the generics?  No.  Not at all.  I’m telling you because the results of a 4 year study of some 6,500 men taking dutasteride showed a 23% lower risk of prostate cancer compared with those taking a placebo (a fake pill, typically made of sugar).

This isn’t the first study to initially show promise. In 2003, a study of men taking finasteride, a BPH drug now marketed as Propecia by Merk.  (Yes for hair loss), was said to also lower the risk of prostate cancer.  However, there were issues with the aggressive nature of the tumors found in that group.  Oh and both medications can cause sexual dysfunction and frequent and painful urination.

The Glaxo funded study (you had to know that) looked at men aged 50 to 75 years in the “high risk” for prostate cancer category given elevated PSA scores but without demonstrable cancer.  Among those with a family history of prostate cancer, those also taking dutasteride are reported to have cur their risk of developing cancer by 31.4%.  Why the disparate numbers?  It’s not clear.  And what about the tumors that did develop?  The researchers felt that those found during the trial were likely present to begin with but too small to be detectable.  According to them, this suggest that the drug shrinks early prostate tumours or keeps their growth at sub-detectable levels.  (The later of which doesn’t appear to be all that helpful).

The proponents of the study believe that the drug might offer thousands of men a simple way to reduce their risk of disease.  This would mean that more men with a high PSA could potentially avoid unnecessary or more involved treatment including surgery on the prostate, chemotherapy and radiation and all of the attendant side effects and symptoms which follow.

Others, like Dr. Helen Rippon of the Prostate Cancer Charity, aren’t so charitable.  (See what I did there?)  According to Dr. Rippon, “[W]e don’t yet know what will happen to these men in the coming years and whether they will still go on to develop the disease [Prostate Cancer] and it will be many years before we know if the drug [dutasteride] can provide any long-term benefit to men.”

~Posted by D.M. Schwadron, Esquire

No, it is not anticipated that home testing for breast cancer, ovarian cancer or prostate  cancer will be available any time in the near future.  However cervical cancer is unique due to it’s associated risk with the human papillomavirus (HPV or genital warts), 13 of it’s 100 variants apparently cause cancer.

The issue [...]]]> Source:  BBC Health News

No, it is not anticipated that home testing for breast cancer, ovarian cancer or prostate  cancer will be available any time in the near future.  However cervical cancer is unique due to it’s associated risk with the human papillomavirus (HPV or genital warts), 13 of it’s 100 variants apparently cause cancer.

The issue is so serious that a vaccine for HPV was introduced in the past few years and made available to school-aged girls.  So then what role does testing play?  First, not all women are receiving vaccinations for HPV.  Second, not all women are undergoing routine screening for HPV at their gynecologist’s or primary care provider’s office.  For these women, the availability of a reliable home test could be an option.

HPV causes cellular damage even after the initial infection clears.  A simple swab may collect damage cells and tell doctors a great deal about a woman’s risk for the development of cervical cancer.  Were it only that all medical solutions were simple solutions.

~Posted by D.M. Schwadron, Esquire

192,000 men are diagnosed with prostate cancer annually.  27,000 cases are terminal.  Currently under investigation is a new chemotherapy drug -Cabazitaxel which is being administered in conjunction with Mitoxantrone (a commonly used drug f0r prostate cancer).   Men receiving this chemo cocktail (no pun intended) had a 30% increase in survival.  [...]]]> Source:  Annual Genitourinary Cancers Symposium; Medline

192,000 men are diagnosed with prostate cancer annually.  27,000 cases are terminal.  Currently under investigation is a new chemotherapy drug -Cabazitaxel which is being administered in conjunction with Mitoxantrone (a commonly used drug f0r prostate cancer).   Men receiving this chemo cocktail (no pun intended) had a 30% increase in survival.  To you or I 15.1 months to live vs. 12.7 may not seem like a lot but if you were dying and those were your options, wouldn’t you want more time?  It is thought that giving the combination of drugs early in the diagnostic stage might translate to even greater survival times.

To that end researchers are developing better diagnostic tools for Prostate Cancer.  Showing promise is the PCA3 urine test.  Apparently overly expressed in men with prostate cancer, gene 3 is a fair predictor for advanced prostate disease.   The current complaints against the standard PSA testing is the high rate of false positives resulting in biposy.

Finally, the tried and true cystoscopy procedure (Yes, the one where they insert a catheter with a small camera into the bladder. Over the river and through the woods…Well not quite.  Cystoscopy has been found to be remarkable cost-effective.  Accordingly, look for it to be featured more in insurance schemes and offered more by urologists.  Cynical? Perhaps.  But you’ll see.

~Posted by D.M. Schwadron, Esquire

Men should discuss the benefits and risks of prostate cancer screening with their doctors, according to revised prostate cancer screening guidelines from the American Cancer Society (ACS).  Yes. That’s what they said.  Not much of a guideline is it?

Okay they say a little more.  But really, only a little.  The American Cancer [...]]]> Source: American Cancer Society

Men should discuss the benefits and risks of prostate cancer screening with their doctors, according to revised prostate cancer screening guidelines from the American Cancer Society (ACS).  Yes. That’s what they said.  Not much of a guideline is it?

Okay they say a little more.  But really, only a little.  The American Cancer Society recommends that doctors more heavily involve patients in the decision of whether to get screened for prostate cancer.

ACS recommends that men with no symptoms of prostate cancer who are in relatively good health and can expect to live at least 10 more years have the opportunity to make an informed decision with their doctor about screening after learning about the uncertainties, risks, and potential benefits associated with prostate cancer screening. These talks should start at age 50. Men with no symptoms who are not expected to live more than 10 years (because of age or poor health) should not be offered prostate cancer screening. For them, the risks likely outweigh the benefits, researchers have concluded.

ACS recommends men at high risk – African-American men and men who have a father, brother, or son diagnosed with prostate cancer before age 65 – begin those conversations earlier, at age 45. Men at higher risk – those with multiple family members affected by the disease before age 65 – should start even earlier, at age 40.

For men who choose to be screened after discussing the pros and cons with their doctor, the new guidelines make the digital rectal exam (DRE) optional and offer the option of extending the time between screening for men with low PSA levels.

There it is. No specific PSA recommendations, or even whether PSA testing should be considered mandatory.  So start “talking to your doctor” about screening.  Does this sound an awful lot like the burden of screening for Prostate Cancer is being placed back upon the patient? Yeah. It sounds that way to me too.

~Posted by D.M. Schwadron, Esquire

What do these three things have in common?  Well, men who are non-smokers and who eat more soy MAY have a lower risk of getting lung cancer than other men.  Okay, the non-smoking part may be an obvious one, but the soy?

Soybeans contain natural compounds called isoflavanones.  Isoflavanones mimic estrogen, [...]]]> Source: American Journal of Clinical Nutrition

What do these three things have in common?  Well, men who are non-smokers and who eat more soy MAY have a lower risk of getting lung cancer than other men.  Okay, the non-smoking part may be an obvious one, but the soy?

Soybeans contain natural compounds called isoflavanones.  Isoflavanones mimic estrogen, a hormone which women have in spades.  In contrast, men have high levels of testosterone.  Estrogen is associated with lower levels of breast cancer and prostate cancer, which makes intuitive sense. (Yes, men do get breast cancer. Women, however, do NOT get prostate cancer).

Enter researchers in Japan at the National Cancer Center in Tokyo who studied over 36,000 Japanese men between 45 to 75 years of age who were cancer free at the outset.  The group was compared with some 40,000 Japanese women.  Over the course of 11 years.

The results? 1 in 75 men (and 1 in 225 women) were diagnosed with lung cancer within 11 years.  (Men tend to get lung cancer at higher rates than women).  Of 13,000 men who never smoked, only 22 of them who ate very little soy were diagnosed with lung cancer.  Only 13 of them who ate a lot of soy (up to 162 grams per day) contracted lung cancer.

I was sold up until this point too, however, the authors of the study were very equivocal as to whether the intake of soy itself was the cause of the lower risk or whether non-smoking males adopted other healthier behaviors, such as exercise, which could explain the lower risk.

So what should one take away from such a study?  Well, there is a suggestion that eating more isoflavanones may be good for men.  In fact increased soy intake has already been demonstrated to lower risk of prostate cancer.  It follows that increased soy intake may also be beneficial for non-smoking males who wish to avoid lung cancer as well.  Again, just a suggestion.

~Posted by D.M. Schwadron, Esquire

Rates of new diagnoses and rates of death from all cancers combined declined significantly in the most recent time period for men and women overall and for most racial and ethnic populations in the United States.

The drops are driven largely by declines in rates of new cases and [...]]]> Source: U.S. Centers for Disease Control & Prevention

Rates of new diagnoses and rates of death from all cancers combined declined significantly in the most recent time period for men and women overall and for most racial and ethnic populations in the United States.

The drops are driven largely by declines in rates of new cases and rates of death for the three most common cancers in men (lung, prostate, and colorectal cancers) and for two of the three leading cancers in women (breast and colorectal cancer). New diagnoses for all types of cancer combined in the United States decreased, on average, almost 1 percent per year from 1999 to 2006. Cancer deaths decreased 1.6 percent per year from 2001 to 2006.

These findings are from a report authored by researchers from the National Cancer Institute (NCI), part of the National Institutes of Health, the Centers for Disease Control and Prevention (CDC), the American Cancer Society (ACS), and the North American Association of Central Cancer Registries (NAACCR). The report was published early online Dec. 7, 2009, in the journal Cancer.

Overall cancer rates continue to be higher for men than for women, but men experienced the greatest declines in incidence (new cases) and mortality (death) rates. For colorectal cancer, the third most frequently diagnosed cancer in both men and women, and the second leading cause of cancer deaths in the United States, overall rates are declining, but increasing incidence in men and women under 50 years of age is of concern.

With accelerated cancer control efforts to get more Americans to adopt more favorable health behaviors (such as quitting smoking) and higher use of screening (colonoscopy), as well as optimal treatment outcomes for colorectal cancer (read more effective chemotherapy), there could be an overall colorectal cancer mortality reduction of 50 percent by 2020.

“The continued decline in overall cancer rates documents the success we have had with our aggressive efforts to reduce risk in large populations, to provide for early detection, and to develop new therapies that have been successfully applied in this past decade,” said NCI Director John E. Niederhuber, M.D. “Yet we cannot be content with this steady reduction in incidence and mortality. We must, in fact, accelerate our efforts to get individualized diagnoses and treatments to all Americans and our belief is that our research efforts and our vision are moving us rapidly in that direction.”

“The continued decline in incidence and death rates for all cancers combined is extremely encouraging, but progress has been more limited for certain types of cancer, including many cancers that are currently less amenable to screening, such as cancer of esophagus, liver and pancreas,” said Betsy Kohler, executive director of NAACCR.

Long-term incidence trends for colorectal cancer have been fairly consistent for men and women, with major declines from 1985 to1995, minor increases from 1995 to1998, and significant declines from 1998 to 2006.

“This report shows that we have begun to make progress reducing colorectal cancer. Yet, colorectal cancer still kills more people than any other cancer except lung cancer,” said CDC Director Thomas Frieden, M.D.

Let’s hope this trend continues downward on incidence and upward on survival.

~Posted by D.M. Schwadron, Esquire

So it’s a new year and for most people that means resolutions…which if history teaches anything will be pursued in earnest and abandoned by Spring.  So instead of joining an overpriced gym with lots of mirrors and shiny chrome or taking up running in the dark and cold months or buying [...]]]> Source: Me Myself and I

So it’s a new year and for most people that means resolutions…which if history teaches anything will be pursued in earnest and abandoned by Spring.  So instead of joining an overpriced gym with lots of mirrors and shiny chrome or taking up running in the dark and cold months or buying that treadmill/exercise bike/coat hanger, why not change the path you are on?

As a woman I love dearly would say, “Blah, blah, blah” or “whatever.”  But I’m serious.  On the eve of my 40th birthday I returned to the Martial Arts.  Not because I am not more than capable of protecting myself and children on the street or because I intend to hang out in bars and fight, but because like many people I am drawn to the more spiritual side of the martial arts.

So what is Aikido and why do I practice it? And why should you care? Aikido is generally accepted as the martial art the Samurai (think Japan’s feudal period cowboys but really so much more) would have practiced and may have practiced.  Modern Aikido is a blending of ancient Jiu Jutsu, Judo and sword and bo staff (is that a bo staff or are you happy to see me?) practice.

Kinokawa ryu is a form of Aikido that emphasizes the unconditional acceptance and blending of energy (Ki). Its focus is to achieve the unification of mind, body and spirit into one movement with total concentration and purpose.  Kinokawa means “River of ki” or ” River of spirit”. Kinokawa ryu, unlike other forms of Aikido, believes in the realistic application of Aikido as a martial art and as a path for spiritual growth. In addition, Kinokawa ryu practitioners believe and follow the “Five Principles of Aikido” as taught by O’Sensei and the “Four Principles to Unify Mind and Body” as taught by Koichi Tohei.

The Five Principles of Aikido (as taught by O’Sensei)  1. Aikido is the path that joins all paths of the universe throughout eternity; it is the Universal Mind that contains all things and unifies all things.  2. Aikido is the truth taught by the universe and must be applied to our lives on this earth. 3. Aikido is the principle and the path that join humanity with the Universal Consciousness.  4. Aikido will come to completion when each individual, following his or her true path, becomes one with the universe.  5. Aikido is the path of strength and compassion that leads to the infinite perfection and ever-increasing glory of God.  Lofty goals for certain, but if you are setting the bar, why not set it as high as possible?

Four Principles to Unify Mind and Body (as taught by Koichi Tohei) Mind and body were originally one. Do not think that the physical power you have is the only power you ordinarily use to live and grow. The power you ordinarily use is like the small, visible segment of an iceberg. When we unify our mind and body and become one with the universe, we can use the great power that is naturally ours.  1. Keep one-point  2. Relax completely 3. Keep weight underside 4. Extend Ki.

Sounds different? It is.  Powerful and graceful and serene, which if you think about it really is the best way to approach what life throws your way.  For more information check out the dojo (school) to which I belong http://www.kinokawa.org/. Browse the intertubes.  Look for yourself.  Don’t just find your way for 2-3 months, find it for life.

Okay, no charge for the PSA and back to your regularly scheduled programming.

~Posted by D.M. Schwadron, Esquire

After years of being viewed as a potential health problem, coffee is fighting back and this time it’s kicking your prostate in the…well…

So this must be why my urologist asked me how much coffee I drink this morning. (Yes I saw a urologist, more on that in [...]]]> Source: Wall Street Journal; National Institutes of Health (NIH)

After years of being viewed as a potential health problem, coffee is fighting back and this time it’s kicking your prostate in the…well…

So this must be why my urologist asked me how much coffee I drink this morning. (Yes I saw a urologist, more on that in the future).  There is new research funded by the NIH which suggests that men who drink 6 or more cups of coffee per day had a 60% lower chance of developing aggressive prostate cancer then their tea drinking girly counterparts. (Okay, I added that last bit).  Those drinking 4-5 cups of coffee per day had a 25% lower risk and those (Like me) with the 3 cup daily max had a 20% lower risk of developing aggressive prostate cancer.

Like the whole wine and cholesterol deal, expect the usual backlash and qualifiers but, if true then this might finally be the justification we all needed for those $3.00 Sbucks forays. You all know what I’m talking about.

~Posted by David Marc Schwadron, Esquire

Research published in the Journal of Urology appears to demonstrate that adjuvant radiotherapy (radiation treatment) within 18 weeks of surgery significantly reduced the risk of recurrence and metastasis of prostate cancer. Additional associations were reduced need for hormonal therapy and increased survival. This compared with the typical “watch and [...]]]> Source:  Journal of Urology; Medscape Medical News

Research published in the Journal of Urology appears to demonstrate that adjuvant radiotherapy (radiation treatment) within 18 weeks of surgery significantly reduced the risk of recurrence and metastasis of prostate cancer. Additional associations were reduced need for hormonal therapy and increased survival. This compared with the typical “watch and wait” approach, so-called “salvage therapy.”

How significantly?  Of the 425 men studied, 214 received adjuvant radiation.  (It is important to note that the patients were staged T1-2 with at least one critera of T3).  Only 93 of the 214 in the radiation group became metastatic as opposed to 114 of the 211 who didn’t.

88 of the 214 in the radiation group did not survive their disease however 110 of the 211 who didn’t receive radiation did not survive prostate cancer.  A median survival rate of 1.7 years.  This is fairly medically significant.

This a “practice-changing” study, according to Dr. J. Brantley Thrasher of the University of Kansas School of Medicine and spokesperson for the American Urological Association.  Let’s see how quickly it becomes implemented into practice.

~Posted by David Marc Schwadron, Esquire

A recent Swedish study (Yes, where the candy fish come from) comparing PSA (Prostate Specific Antigent) Test results of 540 men before they were eventually diagnosed with prostate cancer and 1,000 healthy men failed to determine the point where a PSA Test was a diagnostic predictor of prostate cancer.

What [...]]]> Source: BBC Health; British Medical Journal

A recent Swedish study (Yes, where the candy fish come from) comparing PSA (Prostate Specific Antigent) Test results of 540 men before they were eventually diagnosed with prostate cancer and 1,000 healthy men failed to determine the point where a PSA Test was a diagnostic predictor of prostate cancer.

What does that mean?  Okay.  Very low concentrations of PSA (less than 1 ng.ml) basically ruled out a future diagnosis of prostate cancer.  The problem lies in setting the upper ranges. Currently those men with a PSA of 3 ng/ml who are aged 50-59 are candidates for urological follow up.  Men 60 and over with a PSA of 5 ng/ml are also.  But beyond that there is still not enough information.  A viable concern is that over-diagnosis might lead to over-treatment with the attendant side effects of impotence and incontinence.  (Aren’t you glad you don’t have a prostate ladies?)

Prostate cancer has risen to the 2nd most common cause of cancer related deaths in the UK. Rates are somewhat lower in the US with an average mortality age of 80.  Prostate cancer is typically “survivable” if diagnosed and treated early.  Oddly the UK approach of less PSA Testing seems to be the opposite of that in the States.  Time will truly tell on this one.

Posted by David Marc Schwadron, Esquire