4 MORE Things on I learned at the AUA on Prostate Cancer
As I’m sure you know by now, there is nothing that occupies my attention more than up-and-coming research that could help men live longer, healthier, happier lives. As I discussed in my last post, I recently went to the annual meeting of the American Urological Association (AUA) to hear about new research, listen to great speakers, and take an absurd amount of notes. (I am still working on putting them all in order.)
I want to share with you some of the fascinating things I learned.
1. The Use of PSA and Prostate Cancer in Men 55 to 60 years-old.
What is PSA?
PSA stands for Prostate-Specific Antigen (not Patient Stimulated Anxiety, as many would like to think) and it is primarily found in the prostate. Scientists have recently been taking a closer look at the PSA test and trying to determine whether it’s a reliable way to show how “at-risk” you are of developing prostate cancer. Many people think PSA as a measurement leads to a lot of unnecessary diagnoses, but recent research says it might be more valuable than we thought.
What They Said at the AUA
Researcher Dr. Kovac and his team gathered data from nearly 11,000 men and found that one group had virtually zero chances of developing prostate cancer: men between the ages of 55 and 60 with a PSA of 0.5 ng/ml or less.
Compare that with similarly-aged men who have a PSA between 2.0 and 3.0; there is an 8% chance they will develop prostate cancer within 5 years of their test and a 24% chance they will develop prostate cancer within 13 years, respectively.
My Take on PSA
PSA is a very good test, and I think it’s too bad that the US Preventive Task Force finds it useless. Of course, this blood test is not perfect. Yes, it has led to unnecessary treatments. But is also has saved many lives by finding life-threatening yet curable prostate cancer early. In my opinion, it’s not PSA test that’s the problem; it’s the way doctors use it. A high PSA does not always require a prostate biopsy. Observing PSA velocity, meaning, the rate of change of the PSA number within three, six and perhaps twelve months is valuable along with PSA density. When you divide your PSA number over the size of your prostate (only measured by MRI or ultrasound in cubic centimeters (cc)) that gives your PSA density. Generally, if that calculation higher than 0.15 that may mean there is cancer cells in the prostate.
What You Should Do
Get a PSA test, starting at age 40, especially if you are an African American man or you have a strong family history of prostate cancer. Then, monitor your PSA every one to two years if low the first time. Look for trends, and make a graph (as some of my clients do). (Don’t be alarmed by just one number, one time.)
2. Salvage Prostatectomy Can Work After Radiation—but it’s not exactly pretty.
What is Salvage Prostatectomy?
After a first-line prostate cancer treatment fails to work—whether it’s radiation, prostate removal, or something else—another treatment may be required. That second treatment is known as “salvage therapy.” If the salvage therapy is removal of the prostate, we call it “salvage prostatectomy.”
What They Said at the AUA
Dr. Antoni Vilaseca, MD and his team at Memorial Sloan-Kettering Cancer Center observed 251 men who were all around 65 years old. All these men had had their prostates removed because their prostate cancer had returned after they went through a first round of therapy. In five years, 92% of these men had survived (or passed away from something other than prostate cancer). After 10 years, 78% had not died from prostate cancer.
My Take on Salvage Prostatectomy after Radiation
Prostate removal after radiation is an ugly procedure. Kudos to Memorial Sloan Kettering for looking at this approach, as I know many surgeons who simply don’t want to do it. (The process of removing the prostate after radiation is as difficult as peeling melted cheese off bread.)
While this presentation showed good survival rates up to 10 years, it neglected to mention that urinary tract infections are likely to follow a Salvage Prostatectomy. Incontinence is almost guaranteed.
What You Should Do If You Have Recurrence After Prostatectomy
Aggressive lifestyle interventions (like the CaPLESS Method) are viable options for cancer survival and improved quality of life. Don’t overlook the power of your daily decisions and behaviors. If surgery after radiation is what’s required for survival, I’d recommend I’d recommend a visit to Memorial Sloan Kettering as they seemed to be the most experienced with removing prostates after radiation therapy.
3. You Can Possibly Save Your Erectile Function If you Delay Radiation Following Prostate Removal.
What is Adjuvant Therapy?
You remember what salvage radiation is, right? Adjuvant treatment is when a second, additional treatment for prostate cancer is given immediately after the first. In other words, it’s like two treatments given back-to-back.
What they said at the AUA 2016
Two Italian researchers, Giorgio Gandaglia, MD and Alberto Briganti, MD looked at 364 men after prostate removal for prostate cancer over 10 years. One group received adjuvant radiation the other received salvage radiation. Men who received radiation therapy 16 months after surgery had a quicker sexual recovery than men who got treated with radiation sooner.
My Take on Radiation after surgery
I am not a big fan of external beam radiation therapy or brachytherapy. One, they may promote secondary cancers, and two, they may increase urinary frequency and incontinence over time.
However, in some cases, radiation therapy—whether as adjuvant or salvage therapy—is required.
Here’s another thing: I like to recommend patients who need radiation therapy after prostatectomy to wait as long as possible before starting radiation. It only makes sense. Let the damaged tissue heal for as long as possible so that there is a better chance not only for sexual function but to avoid urinary problems in the long run.
What should you do
There are cases where radiation therapy is required right after a prostatectomy. Have a conversation with your physician to try to prolong it for as long as possible. In addition to that, immediately adopt an aggressive lifestyle intervention that can help prolong the start date for radiation therapy.
4. Testosterone Therapy Actually Doesn’t Put You at a Higher Risk for Prostate Cancer.
What is Testosterone?
Testosterone is a hormone released in large amounts by the male testicles and in lower amounts by the adrenal glands (which sit right on top of your kidneys). Women, too, release small amounts of testosterone from their ovaries and adrenal glands.
What is Testosterone Therapy?
Men with low testosterone levels typically experience low energy, low sexual desire, forgetfulness, and just simply out of it. In some cases, testosterone therapy is recommended either topically or by injections.
Why does it matter?
Since the 1940s, it has been thought that testosterone fuels prostate cancer. As a result, high doses were discouraged, and doctors treated even low-grade prostate cancer by depriving the body of testosterone. This is also known as Androgen Deprivation Therapy (ADT). Now, ADT, also known as hormone therapy, is still used, but it’s usually combined with radiation therapy , given in cases with psa recurrence or very advanced cases of prostate cancer.
What they said at the AUA 2016
Thomas J. Walsh, MD of the University of Washington and colleagues looked at over 147,000 men with low testosterone in Seattle. They found that prostate cancer was slightly lower in men who had had testosterone treatment, compared to men who had never received treatment. Men treated with testosterone who did get prostate cancer showed no connection overall between testosterone and prostate risk (or risk of aggressive disease) compared with no testosterone treatment.
In other words, testosterone treatment doesn’t automatically lead to prostate cancer.
My take on Testosterone therapy and prostate cancer
At this point, it is clear that undiagnosed men on testosterone (T) therapy should not worry about their “male juice boost” causing prostate cancer.
But what about men with low T after prostate cancer diagnosis? That’s a good question, and there’s not a clear answer I can give you.
Here’s what I can tell you.
Men with a history of prostate cancer who have been diagnosed with encapsulated prostate cancer and successfully treated—meaning no cancer extension anywhere—and have low T may be candidates for testosterone therapy as long as they are properly monitored.
Men who have had ADT—where their T levels have been chemically dropped to near zero should not ever be treated with testosterone, as that can actually make the cancer worse. There’s more info on that in this research article about testosterone and prostate cancer.
What should you do?
Always consult with a physician when taking testosterone—with or without prostate cancer. Don’t fuss around with hormones by yourself as they can cause heart disease, shrink your testicles and be potentially deadly. If you have been through testosterone therapy and suffered a heart attack or stroke as a result of it then you might want to visit a site like https://www.joyelawfirm.com/ to see if you can get compensation for these side effects.
However, if you have low T symptoms, first figure out why and address the cause. Don’t’ run for the injections before figuring out the root of the problem. Only after all other lifestyle and natural treatments are exhausted should you think of external testosterone therapy.
Questions? Drop a comment below.
I am always looking to help people who want to know more about how to live a great life.
There’s a few days left for the Natural Cancer Summit. If you have not tuned in yet, this is the time as it ends this weekend. And it’s at no charge to you.
HERE is the link.
There is more coming on prostate health , bladder health and sexual function. Stay tuned.