News

December, 2008: Prostate cancer may promote growth of new nerves associated with more aggressive tumors, research suggests.

Clin Cancer Res. 2008 Dec 1;14(23):7593-603: Cancer-related axonogenesis and neurogenesis in prostate cancer. Ayala GE, Dai H, Powell M, Li R, Ding Y, Wheeler TM, Shine D, Kadmon D, Thompson T, Miles BJ, Ittmann MM, Rowley D.
 

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Conclusions by the authors (Drs. Ayala, Miles, et al): “This is the first description of cancer-related neurogenesis and its putative regulatory mechanism. We hereby introduce a novel biological phenomenon, cancer-related neurogenesis and axonogenesis. Our in vitro experimental and human prostate tissue data show the existence of cancer-related axonogenesis/neurogenesis. We also present data substantiating its involvement and significance in aggressive human prostate cancer and a putative regulatory mechanism based on S4F.”
 

In the study by researchers at Baylor College of Medicine, including Drs. Ayala nod Miles "Prostate cancer can promote the growth of new nerves that are associated with more aggressive tumors," according to research "published this week in the journal Clinical Cancer Research." To reach this conclusion, researchers "calculated the density of nerves in human prostate tissues from prostate cancer patients and from people who died of other conditions." The researchers "found that nerve density was much higher in those with prostate cancer and precancerous lesions versus those without." In addition, they "created a 3-D computer model that simulated the growth of nerves and axons (which carry nerve messages) in prostate cancer. They also found that blocking a protein called semaphorin 4F prevented the growth of new nerves and axons." This study was covered by many media sources including US News, Healthday, Forbes, eurekalert.com.

News

Selenium, vitamins E and C may not prevent prostate cancer, study suggests.

Dec 2008:
1. Journal of American Medical Association (JAMA), JAMA. 2009;301. Effect of Selenium and Vitamin E on Risk of Prostate Cancer and Other Cancers. The Selenium and Vitamin E Cancer Prevention Trial (SELECT). Scott Lippman et al.

2. Journal of American Medical Association (JAMA), JAMA. 2009;301. Vitamins E and C in the Prevention of Prostate and Total Cancer in Men. J Michael Gaziano et al.

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1. Conclusion Selenium or vitamin E, alone or in combination at the doses and formulations used, did not prevent prostate cancer in this population of relatively healthy men.
2. Conclusions In this large, long-term trial of male physicians, neither vitamin E nor C supplementation reduced the risk of prostate or total cancer. These data provide no support for the use of these supplements for the prevention of cancer in middle-aged and older men.

Researchers from University of Texas and the Cleveland Clinic Lerner College of Medicine gave “[35,533] healthy men either the trace mineral selenium, vitamin E, both, or a dummy pill." The authors found that "there were no statistically significant differences in the numbers of men who developed prostate cancer in the four groups. In all cases the proportion of men diagnosed with prostate cancer over a five-year period was four percent to five percent." The second study included 14,641 males, and the researchers found that "neither vitamin E nor C reduced the risk of prostate or total cancer by any significant degree. Nor was any significant protective effect seen against specific cancers including bowel, lung, bladder and pancreatic cancers.
This news was extensively covered by BBC News, NBC Nightly News, HealthDay, CNN, Financial Times, Medscape.

News

Jan 2008: Journal of Urology:
Effectiveness of Antibiotics Given to Asymptomatic Men for an Increased Prostate Specific Antigen

Sümer Baltacı, Evren Süer, Ahmet Hakan Haliloğlu, Mehmet İlker Gokce, Atilla Halil Elhan, Yaşar Bedük
Although antibiotic therapy will decrease serum total prostate specific antigen, it will not decrease the risk of prostate cancer even if the prostate specific antigen decreases to less than 4 ng/ml. Therefore, prescribing antibiotics for asymptomatic men with a newly increased prostate specific antigen may not be an appropriate method of management.

News

Carrying a cell phone in a pocket while using a hands-free device may hurt a man's sperm quality, study suggests.

Fertility and Sterility, September 2008. Effects of radiofrequency electromagnetic waves (RF-EMW) from cellular phones on human ejaculated semen: an in vitro pilot study. Ashok Agarwal, Nisarg R. Desai, Kartikeya Makker, Alex Varghese, Rand Mouradi, Edmund Sabanegh, Rakesh Sharma.

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Conclusions by the authors: Radiofrequency electromagnetic waves emitted from cell phones may lead to oxidative stress in human semen. We speculate that keeping the cell phone in a trouser pocket in talk mode may negatively affect spermatozoa and impair male fertility.
 

In October 2008, according to a study published in the journal Fertility and Sterility "carrying a cell phone in a pocket while using a hands-free device may hurt a man's sperm quality". Dr. Agarwal, Ph.D., head of the andrology laboratory and the director of the Center for Reproductive Medicine at the Glickman Urologoical and Kidney Institute at the Cleveland Clinic in Ohio, and colleagues, "collected semen samples from 32 men and divided each man's sample into two parts. They placed half of the semen samples 2.5 centimeters away from a 850 MHz frequency cell phone in talk mode for one hour." According to the researchers, the majority of "cell phones used in the U.S. are 850-900 MHz," and 2.5 centimeters was chosen "because it is the typical distance between the testes and the trouser pockets." Authors reported that there was a “decline in the sperm's function and motility and in the overall health of the sperm in the exposed group." But, "there was no significant difference in damage to the DNA of the exposed cells." Dr. Agarwal said that "more well-designed studies with more convincing results [are needed] before we can say with certainty that cell phones hurt male fertility". This news was covered in CNN, Los Angeles Times, USA Today, and Deadline blog.

News

Experts debate federal task force's PSA screening recommendation: Federal task force advises against PSA screening for men over 75.
 

Annals of Internal Medicine: August 2008. Screening for Prostate Cancer: U.S. Preventive Services Task Force Recommendation Statement
 

U.S. Preventive Services Task Force
Recommendations: Current evidence is insufficient to assess the balance of benefits and harms of screening for prostate cancer in men younger than age 75 years (I statement).
Do not screen for prostate cancer in men age 75 years or older (Grade D recommendation).

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The U.S. Preventive Services Task Force "is now recommending that men over 75 not be screened for prostate cancer." This recommendation was met with wide reaction. Among groups opposing the recommendation were the American Urological Association which believes that a dramatic drop in mortality has been seen due to PSA screening.

The real problem is that we currently don't have any diagnostic tests that can tell us a patient diagnosed with prostate cancer whether the tumor is going to threaten his life or not. Therefore, screening may increase risks by leading to unnecessary treatment (and side effects) for a tumor that would never have been a problem. On the other hand, screening may decrease risks by detecting a tumor that could have turned deadly without treatment.
Men today are not the 75-year-olds of 50 years ago, they are physically younger people, still actively functioning sexually in many cases. And the recommendations are being that some people be screened by the age of 35. Currently, according to American Cancer Society data, "prostate cancer is the second-most common malignancy among men in the U.S., after skin cancer, and the second-leading killer for men, after lung tumors." During 2007, about "27,050 men died of the disease." Meanwhile, "the National Cancer Institute estimates more than 186,000 American men will learn this year they have it, and one in six men will get the diagnosis at some point in his lifetime." The AUA practice statement for PSA screening does not specify a maximum age limit but recommends screening only men who have an estimated lifespan of at least 10 years (which the preventive services task force also recommends). Therefore, we think that PSA testing and results need to be interpreted for each patient individually. And finally we recommend men should follow the recommendations of the American Urological Association, the American Cancer Society, and the National Comprehensive Cancer Network, all of which recommend screening for early detection and treatment of prostate cancer.

This news was also covered by: NBC Nightly News (8/5, lead story, 2:45, Williams), Washington Post (8/5, A1, Stein) reports CBS Evening News , Wall Street Journal's , Times’ Well Blog (8/5), and New York Times (8/5, A1, Parker-Pope).

News

Research indicates robotic surgery may provide faster recovery for patients with bladder cancer.

British Journal of Urology, August 2008: Robotic vs open radical cystectomy: prospective comparison of perioperative outcomes and pathological measures of early oncological efficacy
Gerald J. Wang, Daniel A. Barocas, Jay D. Raman and Douglas S. Scherr

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According to a study published in the BJU International "robotic surgery provides bladder cancer patients with dramatically faster recoveries." Researchers demonstrated that "the robotic approach provides similar benefits to prostate resection, including dramatically faster recoveries with equal, or better, surgical precision." The procedure involved the da Vinci surgical system, which allows "a surgeon makes five to six small abdominal incisions, through which surgical instruments and a tiny stereoscopic camera are inserted. After the bladder is removed, the surgeon creates a new channel for urine to pass from the body. Dr. Miles was one of the first Urologist’s in the Texas Medical center who successfully performed a radical cystectomy with da Vinci Surgical system.

News

Study identifies potential sexual problems of older men and women.

The Journal of Sexual Medicine, August of 2008: Sexual Dysfunction among Older Adults: Prevalence and Risk Factors from a Nationally Representative U.S. Probability Sample of Men and Women 57–85 Years of Age

Edward O. Laumann, PhD, Aniruddha Das, MA, and Linda J. Waite, PhD

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The August of 2008 edition of The Journal of Sexual Medicine suggests that "68 percent of men between 57 and 85 reported having sex last year, as did 42 percent of women." Lead author Edward Laumann, the George Herbert Mead Distinguished Service Professor of Sociology at the University of Chicago, said that "more older women might have wanted to have sex, but there just aren't as many available older men for them to partner with." He said that "Healthy people can have reasonably satisfying sexual health for most of their lives," adding,
The study "found that one of the biggest mental health issues for both women and men was anxiety," while "men reported their biggest sexual problem was not being able to keep and maintain an erection -- something that was also related to urinary tract syndrome. WebMD (8/13, Colihan) , Fox News (8/13) and the U.K.'s Irish Health (8/13, Condon), and HealthDay also covered the story.
At our practice we offer an individualized consultation and treatment options. We offer an evaluation of the sexual health in men and women prior and post surgeries. In conjunctions with our colleague Dr. Mohit Khera we are able to assist you in answering your questions and addressing your concerns.

News

September, 2008: Study suggests RALP may be feasible in patients with enlarged prostates.

Journal of Urology, Sep 2008: The Impact of Prostate Gland Weight in Robot Assisted Laparoscopic Radical Prostatectomy.
Brian A. Link, Rebecca Nelson, David Y. Josephson, Jeffrey S. Yoshida, Laura E. Crocitto, Mark H. Kawachi and Timothy G. Wilson

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"Robot-assisted laparoscopic radical prostatectomy (RALP) is feasible in patients with an enlarged prostate but requires a slightly longer operative time, results in greater urinary leakage rates, and requires a longer hospital stay than in patients with smaller prostates," research published in the Journal of Urology suggests. In the journal, researchers conclude, "Pathologically larger prostates are associated with lower Gleason score and lower risk group stratification. Therefore, RALP may be the preferred treatment in men with clinically localized prostate cancer who are also found to have an enlarged prostate."

In our practice we have seen similar observations as well. We have had good results with large prostates of well over 200gram with good outcomes using the Robotic Assisted Laparoscopic Prostatectomy.
 

News

September, 2008: NSAIDs may lower PSA levels, research suggests.

Cancer. 2008 Sep 8. Prostate-specific antigen levels in relation to consumption of nonsteroidal anti-inflammatory drugs and acetaminophen: results from the 2001-2002 National Health and Nutrition Examination Survey.
Singer EA, Palapattu GS, van Wijngaarden E.
 

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"Regular use of non-steroidal anti-inflammatory drugs may significantly reduce prostate specific antigen (PSA) levels, potentially reflecting a decreased risk of prostate cancer or confounding prostate cancer screening results," according to a study published in the September issue of Cancer. "Regular use of acetaminophen was also associated with a reduction in PSA levels, but not significantly." Researchers wrote, "Whether this [effect of NSAIDs] is indicative of a protective effect on prostate cancer risk or masks possible prostate injury resulting in reduced detection of prostate cancer is unclear." They speculated that, because "inflammation has been postulated as a potential contributor to prostate cancer...NSAIDs and acetaminophen might affect PSA levels and prostate cancer risk via anti-inflammatory activity. Medical News Today (9/8), Daily Scope, MedPage Today, HealthDay (9/8, Edelson), WebMD (9/8, Boyles) also covered the story.


Recent data from Dr. Miles

• 2008: The Impact of the Female Partner in an Erectile Preservation Program.

 Mohit Khera, Osama Mohamed, John Colen, Richard Bennett, Jon Rumohr, Brian Miles, Larry Lipshultz. Female partners from our prostatectomy patients were surveyed. Female partner sexual function scores are correlated with male patient sexual function scores before and after radical prostatectomy. Higher female sexual function scores can predict which men are more likely to be compliant with erectile preservation programs and which men will be more likely to achieve spontaneous erections after surgery.

 • Dec 2008: Robotic-assisted laparoscopic prostatectomy performed in a patient with severe thrombocytopenia due to primary myelofibrosis.

Rose Khavari, Lambros Stamatakis, Brian Miles. RALP can be performed safely in patients with severe thrombocytopenia in the setting of intrinsic hematologic disorders in skilled and expert hands.

• Dec 2008: Who’s Too Old To Test: Prostate Cancer in Elderly Men.

Sandeep Mistry, Rose Khavari, Gustavo Ayala, Wesley Mayer, and Brian Miles. Our findings suggest that the prevalence of clinically significant prostate cancer in the elderly population may be higher than previously thought. As the population continues to live healthier longer, confronting prostate cancer morbidity in the elderly population will become more common. Using higher PSA thresholds to eliminate unnecessary biopsies in older men does not appear to help identify patients at greater risk of having clinically significant prostate cancer. Patients with prostate cancer having aggressive clinical features may benefit from treatment of their prostate cancer well into their eighth and ninth decades of life. Testing and diagnostic recommendations should reflect the potential benefit of identifying patients with aggressive prostate cancer even after age 75.

• The use of combination muse and sildenafil in erectile preservation following radical prostatectomy.

Mohit Khera, Osama Mohammad, John Colen, Brian Miles, larry Lipshultz. Our data on prostate cancer patients suggests that the use of combination MUSE and sildenafil following radical prostatectomy can significantly increase spontaneous erection rates at 3 months.