More Lessons from the AUA 2011 – Prostate cancer

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PSA cost 

 

A typical PSA test cost about $45 -  but is this the total cost?

Once PSA testing begins, says Dr. Steve Zeliadt, a public health researcher at the University of Washington in Seattle, PSA test may actually lead to $1500 in costs, the study shows. The extra costs generally occur as a result of increased urology office visits, and pelvic imaging procedures and biopsies

 

PSA test before Age 50 predicts long-term risk

A study with more than 20,000 Swedish men, indicates that men with a PSA value above 1.5 ng/mL between the ages of 45 and 49 years account for nearly half of the prostate cancer deaths over the next 30 years or so.

 

Radical Perineal Prostatectomy (RPP)cheaper and as effective as Retropubic prostatectomy (RRP) and minimally invasive radical prostatectomy (MIRP) like robotics

 

In a retrospective study, Dr. Hu , a genitourinary surgeon at Brigham and Women’s Hospitaland Dr. Prasad, a urologic oncology fellow at the University of Chicago and colleagues used the Surveillance, Epidemiology and End Results (SEER) Program database to study 452 prostate cancer patients who underwent PRP, 1,938 who had MIRP, and 6,899 who had RRP between 2003 and 2005.

The study compared postoperative, 30-day, and anastomotic stricture complications, incontinence and erectile dysfunction, and adjuvant cancer therapy use.

Compared to MIRP, men who had PRP had fewer miscellaneous medical complications (and fewer procedures for erectile dysfunction. They did have a higher number of heterologous transfusions, however.

(tranfusions are a result of excess blood loss during the surgical procedure)

The average costs for RPP in the first six months post-operatively were $1,500 less than either RRP or MIRP.

Even though the outcomes are “not demonstrably different” between the older perineal and newer, more minimally invasive approaches, “aggressive, no-holds barred marketing” by the companies that produce surgical robots will likely wipe-out the older approach, said Dr. Mark Litwin, a urologist and health services researcher at UCLA in Los Angeles.

 

Gay men have worse Quality of Life with prostate cancer

Gay men treated for prostate cancer reported lower health-related quality-of-life scores than generalized populations of men. This is the finding  in an Internet-based survey of 92 gay men from the United States and Canada.

In this report, gay men had worse mental health and worse physical symptoms (erectile dysfunction and urinary incontinence) suggested senior author David Latini, PhD, from Baylor College of Medicine in Houston, Texas.

Why do gay men fare worse with prostate cancer? “We really don’t understand why it’s been so difficult,” said Dr. Latini. But there are some possible explanations, he said, including a lack of prostate cancer support groups for gay men.  Another is that men need stronger erections than heterosexual men for anal penetration. To obtain that level of erection may be difficult.

(As an aside – malecare seems to be the leading all-inclusive prostate cancer support group that welcomes gay men)

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by Dr. Geo

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