Articles tagged with: Prostate Cancer Awareness

08
September
2015

Prostate biopsy infection - antibiotic resistance

Prostate biopsy infection - antibiotic resistance

Infections associated with prostate biopsy have increased over time, and there is growing evidence of infections that are resistant to the antibiotics used to prevent infection.

Resistant infections after trans-rectal prostate biopsy (TRUS)

About 1-2% of patients who have a TRUS biopsy of the prostate will develop a febrile infection, which can be serious. Antibiotics (usually ciprofloxacin) are used before and after biopsy to keep this infection rate at 1-2%. However, there is increasing evidence that many of us carry bacteria in our gut (and rectum, where the needle is passed through to reach the prostate) that are resistant to ciprofloxacin.

A recent study from the Journal of Urology (Liss et al.) looked at 2673 men from 6 different medical centres undergoing biopsy and discovered cirpofloxacin-resistant bacteria in the rectum in 20.5% of men.

We know that some men are at increased risk of carrying such resistant bacteria (known as ESBL), and these include men who have been treated with ciprofloxacin in the prior six months, and those that have travelled to SE Asia or the Indian subcontinent in the recent past. The bacteria are harmless in the gut, but become dangerous if seeded into the prostate by biopsy.

How can the risk of infection be reduced?

One of the ways to reduce the risk of infection is to consider a transperineal biopsy instead of a transrectal biopsy. In transperineal biopsy, the needles for biopsy are not passed through the rectum, but instead through the skin of the perineum, and the infection risk is greatly reduced. A study from Jeremy Grummet in Melbourne demonstrated a reduction in serious infection, with a greater than 10x reduction in risk compared to transrectal biopsy.

You can read more about this study by following this link to an article by Jeremy Grummet.

Follow this link to read more about transperineal biopsy.



Categories: Updates, Prostate Cancer

28
November
2014

Should I have a PSA test?

Should I have a PSA test?

This short article may help you with the decision about having a PSA test (also known as PSA screening) to look for prostate cancer

Australia has one of the highest rates of prostate cancer in the developed world. The PSA test is the first investigation that can be done to look for prostate cancer. It is not a perfect test, and there are problems associated with the test, which is why you should be as well informad as possible about PSA.

Information for Patients Considering Prostate Cancer Screening

Background

  • Prostate cancer is common. Most men will develop prostate cancer if they live long enough. Despite this, only about 3% of all men will die of prostate cancer.

  • This indicates that most prostate cancers do not cause trouble in a man’s lifetime (‘low-risk’ or ‘indolent’ cancers). However, there are some more aggressive cancers that can cause trouble, and these benefit from detection and treatment.

  • Screening studies do show that the number of prostate cancer deaths can be reduced by screening with PSA. However, quite a large number of men need to be diagnosed by screening and treated to prevent one prostate cancer death.

  • One study (the Goteborg study) showed that 12 men need to be diagnosed to prevent one prostate cancer death. That means that 11 men were unnecessarily diagnosed. Another larger study demonstrated that (ERSPC) that 781 men need to be screened and 27 men need to be diagnosed to prevent one prostate cancer death. Thus 26 men are unnecessarily diagnosed.

  • Screening will detect many of these indolent cancers, and if they are detected, they may go on to be treated, perhaps unnecessarily.

  • Treatment is associated with long term complications in men, such as incontinence, erectile dysfunction (impotence) and bowel problems. Therefore, some men (indolent cancers that are treated) may have unnecessary treatment and suffer side effects.

The aim of screening

  • The aim of screening should be to identify aggressive or high-risk prostate cancers early, before they have spread beyond the prostate.

  • Some men are at higher risk of aggressive prostate cancer than others. These are men with a family history of prostate cancer, or with a strong family history of breast or ovarian cancer in females of the family, men of African-American decent, and men who have been exposed to some environmental agents (fire-fighters possibly, and veterans exposed to Agent Orange).

  • Most prostate cancers found by screening are low risk and do not need to be treated, and can just be closely followed by active surveillance (click for link to AS).

  • If you choose to be screened, there is a reasonable chance you will be diagnosed with low-risk prostate cancer, and may be in a position where you have to consider treatment that may be unnecessary.

Your decision to be screened – what sort of person are you?

  • If you have risk factors for prostate cancer (see above), your risk of prostate cancer may be higher than the general population, and this may impact your decision to be screened.

  • If you are the sort of person who would be uncomfortable not being treated if low risk prostate cancer was discovered, screening may not be the right decision for you.

  • If you are the sort of person who would accept treatment for aggressive prostate cancer, but would be happy to observe (active surveillance) things if you just had low risk prostate cancer, then you may be a good candidate for screening.

Categories: Updates, Prostate Cancer

14
September
2013

Urology Cancer Surgery - Present and Future

Urology Cancer Surgery - Present and Future

Continuing the series of Guest Posts by highly regarded Urologists, Benjamin Davies from UPMC answers questions on Urologic Cancer Surgery

Dr. Benjamin Davies is a Urological Surgeon specialising in cancer management. He is an Assistant Professor in Urology at the University of Pittsburgh Medical Centre and the Director of the Urologic Oncology Fellowship. He is a respected clinician scientist and is considered a pioneer for urologists in social media, particularly Twitter.

In this post, Ben Davies answers questions on the current practice and future development of urological cancer surgery


Ben, what was your motivation to concentrate on urology cancers?

I think I was frankly attracted to tumour biology first and then I was introduced to the actual surgery. Once I started being a surgeon I quickly forgot about the basic science biology and become engrossed in large cancer surgeries and robotically enhanced ones as well. I like the direct impactful role that surgery offers to the patient right then and there. No waiting for medication to work or waiting for lab work….it’s operate and hopefully cure. Concrete work.


What is the hardest part of your job?

Sick patients are the absolutely most challenging. It’s simply not a 9-5 job. When I have a patient that is struggling I tend to really take it personally (which of course you shouldn’t) and you can easily become very stressed. Learning to manage the stress is part of becoming a successful physician but is definitely the most challenging.


Female urological system

What have been the biggest developments in urologic cancer in the past few years?

I think two things are the biggest developments:

1. Robotic surgery has significantly aided our surgical approach to prostate cancer care. It has without a doubt decreased the side effect profile of a rather morbid procedure.

2. Genomic testing is finally coming online. We have all been waiting for real genomic testing to help us with our care and the new prostate cancer tests (while still at the beginning of their testing) are promising.



What is the most important preventative measure in urological cancer?

Do not smoke. It is an absolute tragedy to smoke. Just stop it.


Ten years ago, an old boss of mine said to me …”Brook, in years to come you will look back on a holocaust of radical prostatectomies.” Is there is any truth in this?

Of course he was right!! We have done a major disservice in over-treating prostate cancer patients. And as a result our large US screening studies are flawed and we now have to deal with the consequences of bad data. The PSA screening debate has turned against us because we over-treated low volume, low risk prostate cancer without any pause and many times just for money. Hopefully the new generation of urologists has been sufficiently educated to stop the nonsense.


In ten years time, what will prostate cancer treatment look like?

Easy. After your MRI-guided biopsy you will get a genomic profile and risk stratification of your disease. If you are healthy man, then you will be offered a robotic prostatectomy at a centre of excellence.


Male urological system

Prostate cancer receives a huge amount of publicity and funding. Which urology cancer gets a rough deal, and what can be done to improve this?

The absolute worst is bladder cancer! The patient population that is affected is older, sicker, and has lower socioeconomic means. What to do?? The Bladder Cancer Advocacy Network is beginning to generate better lobbying efforts and academics certainly need to bring this issue to the fore more often.


You can read more about Ben Davies on the UPMC site, and follow him at @daviesbj on Twitter


Categories: Updates

06
September
2013

Blue September in Australia

Blue September in Australia

Continuing the series of Guest Posts by highly regarded Urologists, Brian Stork discusses Blue September

Australia has the highest rate of prostate cancer in the developed world. Fortunately, there are a number of ways individuals can raise awareness and funds for prostate cancer research. This month marks the beginning of “Blue September” in Australia and around the world.

Blue September in Australia

Blue September is a campaign to raise awareness and funding for all types of cancer in men and boys. Beginning in infancy, blue is a color associated with boys. The color blue, however, also symbolizes the loss of fathers, brothers, sons, and friends from the many types of cancer that affect men, including prostate cancer. The Blue September campaign not only raises money for cancer research, but also encourages men to take better care of their health in partnership with their healthcare providers. Prostate cancer research, however, has traditionally been one of the main beneficiaries of the Blue September campaign.

Going Blue

Blue September Wristband

There are many ways you can get involved and show your support for the Blue September movement:

2013 Beneficiaries

In Australia, this year’s beneficiaries from the Blue September Campaign include the Australian Cancer Research Foundation and Australian Prostate Cancer Research. Australian Prostate Cancer Research has created some outstanding educational resources for prostate cancer patients, and, thanks in part to support from Blue September Australia, is about to launch Prostmate – the world’s first online support program for men with prostate cancer.

Beyond Australia

Blue September appears to be thriving in New Zealand, the United Kingdom and Ireland. Proceeds from Blue September in New Zealand go to the Prostate Cancer Foundation. In the United Kingdom, procedes will go to the Urology Foundation. In Ireland, the benefits will go to the Mater Foundation, Cancer Care West, and the Mercy Hospital Cancer Appeal Fund.

Last year, the Blue September Community was very active in the United States, particularly in California. Unfortunately, this year, the community appears to be significantly less active. Participants in the United States are encouraged to support the Prostate Cancer Foundation, The Conquer Cancer Foundation of the American Society of Clinical Oncology, Think Cure or the cancer organiztion of their choice.

Leisel Jones

Support a Serious Cause and Have Fun

Having cancer is tough. Raising awareness and fundraising should be fun. Blue September offers a fun opportunity to raise awareness and support men with prostate cancer.

Australian Swimming Champion – Leisel Jones



Dr. Brian Stork, Urologist, MichiganGuest post by Dr. Brian Stork. Dr. Stork is a urologist from the U.S. in private practice at West Shore Urology, in Muskegon, Michigan. Dr. Stork has a passion for patient education, healthcare technology and healthcare social media. You can read more from Dr. Stork on his blog, and follow him at @storkbrian on Twitter and Google .

Categories: Prostate Cancer

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