Category Archives: Cáncer de próstata

Save The Date For The 2nd USC Annual Conference: Practical Urology

Dear Friends,

On behalf of Dr. Inderbir Gill, and the entire faculty of the USC Institute of Urology, we would like to welcome you to participate in our second annual “Practical Urology” meeting, scheduled for January 26 – 28, 2017.

We’re offering a full day of surgeries covering the entire scope of urology, two full days of scientific lectures from renown leaders in the world of urology, and a magical evening full of fun and laughter at our exciting program dinner scheduled to be held at the Globe Theater inside Universal Studios. There is no better way to start off the year, than by attending USC’s Practical Urology meeting!

Registration at https://keck.usc.edu/cme/

We look forward to having you join us in January 2017!

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Prostate biopsy

What is a prostate biopsy?
It is obtaining a small amount of prostate tissue with a needle. This tissue sample is analyzed under the microscope in order to make a diagnosis.

Who need this procedure?
It is recommended for those patients in whom there is suspicion of prostate cancer, either because they have an elevated prostate-specific antigen or because the digital rectal examn revealed a suspicious area in the prostate.

Who performs the biopsy?
The biopsy is performed by a urologist. The procedure also involves the use of an ultrasound to guide the needle to take the sample. The biopsy is typically performed under local anesthesia.

How many samples are needed for a diagnosis?
In the case of patients with tumors that are not palpable during rectal examination, an those in which there is only a suspicion of cancer because the prostate-specific antigen is high, the method of sextant biopsy is used. This involves taking six fragments from each of the two lobes (right and left), extracting 12 in total. In the cases where the prostatic biopsy is negative but the patient has an increasing level of prostate antigen in successive follow-up tests, a new biopsy is performed in which additional sample are taken from each lobe.

 

MetodoSix

 

Extract from: Prostate Cancer: A Patient’s Guide

#Prostatectomy Preparation Prior to Surgery and Aftercare

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Ten days before surgery:

All treatment with Aspirin ® or other anticoagulants should be suspended (warfarin, Plavix ®, etc.). All of the preoperative examinations should be done: laboratory exams, chest X-ray, and cardiovascular evaluation. If diabetic, estop taking, tablets of the oral hypoglycemic type (Glibenclamide, Metformin, etc.) 48 h before surgery.

The day before surgery: Have a light breakfast at 9 am .Starting at noon; take one-half of a bottle (50 ml) of undiluted oral laxative (Fleet Fosfoda®) followed by several and unpleasant taste of the laxative. Three hours after taking the first dose, take the remaining half of Thais laxative, also followed by the sweetened drinks. This oral laxative, also followed by the sweeting drinks. This Boral laxative will cause increase bowel movements in order to clean the intestine for the day of the operation.

For supper, have clear liquids such as water, juice, or tea; consuming liquid is acceptable, if thirsty, until midnight. Antihypertensive drugs should not be suspended nor should the time they are habitually taken be altered. Even on the morning of the day of the surgery, this medication should be taken with a small quantity of water (just a sip).
Finally, pack luggage for the hospital stay: take comfortable pants with an elastic waist, a shirt with buttons (which can be opened in front), and a bathrobe.

The day of surgery:

A full fast all day is required. If necessary, take only the anty-hypertensive medication with a sip of water.

The first hours after surgery: In the first hours the patient might feel cold, as well as some paint at the incision sites. This is easily controlled with painkillers.

A very common feeling is the discomfort produced by the presence of the catheter inside the urethra of the patient; generally this is perceived as an irritation or an intermittent desire to urinate without being able to, but the sensation is, mild an transitory. This is a normal effect due to the surgery and catheter in the urethra and bladder. The feeling disappears completely after a few hours. Family members and person accompanying the patient play an important role in the first hours after the operation to help control anxiety. If more intense discomfort occurs, the medical personnel should be notified.

Extract from Prostate Cancer: A Patient’s Guide.

Complication of Radical Prostatectomy

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Traditionally, this has been a greatly feared operation because of the complications and consequences associated; however, thanks to research in recent years, it has been posible to describe the anatomical details and exact location of the blood vessels and nerves that are responsable for both urinary continence and for the erection. Now that the anatomy of the region is known perfectly, the technique has evolved and surgery can be performed while respecting each of these important structures and minimizing the associated risks. These risks are inherent in the general condition of the patient and the surgical procedure itself. They can be classified into general and specific risks.

General:
These are the same complications as for any other surgery, and include the following:

  • Allergic reactions
  • Infecion
  • Pumonary problems
  • Hemorrhage
  • Cardiovascular problems

Specific:
These are the complications related to the specific surgery used in the treatment of prostate cancer.

  • Intestinal injury: this is the most dangerous of all; it consists of fecal material leaking into the abdominal cavity due to the opening of the colon or rectum during surgery. This complication is very rare.
  • Rectovesical fistula: this is a communication between the rectum and the location where the bladder was joined to the urethra.
  • Urinary incontinence: This is the involuntary loss of urine, requiring the use of diapers. Usually it is transient. The patient progressively notes his recovery. Generally, one year after surgery, 96% of the patients have restored urinary continence.
  • Erectile dysfunction: the difficulty to achieve and maintain erections, due to the loss of the blood vessels and nerves responsible for erection. The way the patient is affected depends on age and the condition of the erections before surgery, in addition to general health conditions and risk factors such as smoking, diabetes, and others having to do with the microcirculation in the penis.
  • Urethral stricture: narrowing of the urethra due to scaring. This can occur anywhere along the urethra, from the tip of the penis to the site where the urethra joins the bladder.

Extract from Prostate Cancer: A Patient’s Guide.

Radical prostatectomy

The radical prostatectomy  is the name given to surgery used to remove the prostate in patients with cancer. It involves the removal of the entire prostate gland, together with the seminal vesicles, and the bladder is the reconnected with the urethra, the channel through which the urine flows from the bladder through the penis to the exterior. In special cases, the surgeon might also remove the regional lymph nodes to evaluate them and determine if the cancer has spread beyond the prostate.

An important consideration is that after surgery, the patient will no longer ejaculate due to the removal of the prostate and the seminal vesicles, which store the seminal fluid; although this happens, the patient will conserve exactly the same sensation of pleasure during orgasm. In the case where the patient wishes to have children after the procedure, some assisted reproductive techniques to achieve fatherhood will be needed, such as those that involve the extraction of sperm from the testicles with subsequent injection into the female reproductive cells (as such is the case with in vitro fertilization).

Prostatectomy

Indications

In general, a radical prostatectomy is recommended only for men who have clinical, biochemical, and /0r radiological evidence of the cancerous disease located only in the prostate, as well as being in good health in general, with a life expectancy of 10 years or more. An exception to this are young men with suspicion of a localized advanced disease, who could benefit more from a combined treatment including radical prostatectomy, radiotherapy and hormonal blocking (as opposed to just receiving radiotherapy and hormonal blocking). The urologist cam make, to estimate the risk of extraprostatic disease and evaluate the pros and cons of surgery.

Diagnostic studies currently available do not make it possible to precisely evaluate whether the prostate tumor has extended beyond the prostate. This can only be known after surgery, once the pathological examination has been completed. Furthermore, on rare occasions (less than 3% of patients), it happens that the disease was limited to the prostate, the prostate-specific antigen begins to rise after surgery, revealing that possibly cancerous cells still remain at the prostate bed or has entered the bloodstream and disseminated in the body. For this reason, patients who have undergone this operation, even when according to the biopsy the disease was contained, must continue annual control during at least 10 years after surgery.

Extract from Prostate Cancer: A Patient’s Guide.

 

Why should you have a prostate examination?

The prostate can be the source of diverse illnesses, like with all organs of the human body. Among these, the most representative are those caused by inflammation (prostatitis), benign growth (benign prostatic hyperplasia), and cancer. Fortunately, the prostate is an organ that is easily accessible with a simple and rapid examination by way of the rectum. All of these diseases can be treated in time to prevent the deterioration of other related organs and the advancement of the illness.

What means are available for prostate evaluation?

For the general prostate evaluation, two basic tools are available: a digital rectal examination and a blood test to measure a substance called prostate-specific antigen (PSA), which will be dealt with in a special chapter.

What is the digital rectal examination?

During digital rectal examination, the urologist inserts his index finger into the patient´s rectum in order to palpate (feel) the back part of the prostate. This examination not only can give the physician information about abnormalities in the configuration of the glans, but also information about its size, consistency, and tenderness. It assist in diagnosing the growth of the prostate, specifically with a concern for prostatitis or suspected prostate cancer.

Prostate Cancer Prevention

Prostate cancer

The prostate is a gland in the male reproductive system.  It is about the size of a walnut and surrounds part of the urethra. The prostate gland makes fluid that is part of the semen.

According to National Cancer Institute, prostate cancer is the most common nonskin cancer and the second leading cause of cancer-related death in men in the United States. It is estimated that, in 2014, 233,000 menwewre diagnosed with prostate cancer in the United States, and nearly 29,500 men will die of the disease. African American men have a higher incidence rate than, and at least twice the mortality rate of, men of other racial/ethnic groups.

Can prostate cancer be prevented?

The exact cause of prostate cancer is not known, however, some risk factors for cancer can be avoided. On th other hand, other risk factors such as age, race, and family history can’t be controlled. But based on what we do know, there are some things you can do that might lower your risk of prostate cancer.

Different ways to prevent cancer are being studied, including changing lifestyle or eating habits. For example, there is some evidence that choosing a healthy diet that’s low in fat and full of fruits and vegetables may contribute to a lower risk of prostate cancer. Moreover, to reduce cancer risk you can maintain a healthy weight and avoiding things known to cause cancer as smoking.

Source: The National Cancer Institute and American Cancer Society.

Movember is here

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November is here and men take part in ‘Movember’.

Established in 2003 in Australia, Movember has become a global phenomenon raising awareness of prostate Cancer.

Let grow up your moustache and  contribute  to the positive change for men’s health by raising awareness and educating men year-round about prostate and testicular cancer.

If youre thinking of taking part, how about some of our favourite tache styles above?

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Close Surgical Margins Raise Risk of Prostate Cancer Return, said study

According a study patients who underwent radical prostatectomy for prostate cancer, patients who had close and positive surgical margins on final pathology had 3-year BCR-free survival rates of 70.4% and 74.5%, respectively. Details released on renalandurologynews.com:

surgery

Close surgical margins in radical prostatectomy specimens are associated with biochemical recurrence (BCR) rates similar to those of positive surgical margins, according to a new study.

In study of 609 patients who underwent radical prostatectomy for prostate cancer, patients who had close and positive surgical margins on final pathology had 3-year BCR-free survival rates of 70.4% and 74.5%, respectively, a non-significant difference between the groups, Michael J. Whalen, MD, of the Icahn School of Medicine at Mount Sinai Hospital in New York, and colleagues reported. By comparison, patients with negative margins had a 3-year BCR-free survival rate of 90%, which was significantly higher than the rates for patients with close and positive margins. On multivariable analysis, patients with close margins had a 2.7-fold increased risk of BCR compared with those who had negative margins.

“These results suggest that the finding of a close margin on final pathology cannot simply be interpreted as negative,” the authors wrote in a paper published online ahead of print in Urologic Oncology. “Rather, this finding may have similar outcomes to patients with positive margins and should alert the treating physician of the higher risk for recurrence.”

The investigators concluded that a close margin should be noted routinely in pathologic reports and men with close margins should have more frequent post-operative follow-up to monitor for disease recurrence.

Of the 609 patients, 126 (20.7%) had positive margins, 453 (74.4%) had negative margins, and 30 (4.9%) had close margins. Dr. Whalen’s group defined a close margin as the presence of prostate tumor cells less than 1 mm from the inked surface of the surgical specimen.

During a median follow-up of 20.5 months, the proportion of patients in the close, positive, and negative margin groups was 16.7%, 24.6%, and 8.2%, respectively.

The authors observed that although positive margins “are universally defined as the presence of tumor cells at the inked margin, controversy exists with respect to how to characterize tumor cells that approach, but do not touch, the inked surface.” They noted that early studies have concluded that close margins at the time of radical prostatectomy are similar to negative margins, prompting many institutions to categorize all of these cases of negative margins. More recent studies, however, suggest that close margins more closely resemble positive margins and are an independent predictor of BCR.

Dr. Whalen and his colleagues acknowledged that the retrospective nature of their study and the relatively small number of patients with close surgical margins relative to the overall cohort were study limitations. In addition, they noted that the length of follow-up may not have been sufficient to detect a true difference in BCR rates between close and positive margins.

Editor: Jody A. Charnow.

Dietary Advice for Prostate Cancer

I found this interesting post on Renalandurologynews:

A new BMC Medicine review details a variety of foods, nutrients, and diets that may hold promise for reducing the incidence or progression of prostate cancer (PCa).

Current evidence is still largely inconclusive, according to investigators Pao-Hwa Lin, MD, William Aronson, MD, and Stephen J. Freedland, MD. The literature indicates that excess saturated fat and beta-carotene increase PCa risk. The following eating patterns, nutrients, and foods, however, show potential: low carbohydrate intake, soy protein, omega-3 fatty acids, green teas, tomatoes and tomato products, and zyflamend (an anti-inflammatory herb mixture). Studies on folate, vitamin C, vitamin D, and calcium suggest a U-shape relationship in which optimal ranges and upper limits exist for each vitamin or mineral.

While the ideal diet prescription has yet to be determined, the investigators suggest counseling men with these tips, in line with emerging research and a heart healthy diet:

  • Increase fruits and vegetables.
  • Replace refined carbohydrates with whole grains.
  • Reduce total and saturated fat intake.
  • Avoid overcooked meats (such as charred barbecue).
  • Consume fewer calories (by reducing carbohydrates, for example) to achieve a healthy body weight.

The investigators also recommend future studies should be designed to address these key questions in PCa care:

Can a dietary invention…

  • delay the need for prostate cancer treatment for men on active surveillance?
  • prevent recurrence?
  • delay progression among men with recurrence?
  • reduce the side effects of prostate cancer treatment (especially hormonal therapy)?
  • improve outcomes for men on hormonal therapy to prevent or treat castrate-resistant disease?

 

 

Source
Lin, PH, et al. BMC Medicine (2015)13:3; doi: 10.1186/s12916-014-0234-y.