"Many men have some degree of incontinence after prostate surgery, but few are significantly bothered by it, according to a poll at one U.S. hospital.
Of 315 patients who'd had their prostate removed due to cancer, only a quarter said a year or more after surgery that they never experienced any leakage.
Still, more than three-quarters of the men said they didn't use pads in their underwear and only about one in 20 said they were significantly bothered by incontinence.
"The bottom line is that many men, after having their prostate removed, will have some impact on the way they urinate," said Dr. Erik Castle, an associate professor of urology at the Mayo Clinic in Phoenix, who led the new work. "But the degree of the impact is minimal.
According to the American Cancer Society, one in six men gets prostate cancer at some point in his life and one in 36 men in the U.S. will die from it.
While there is controversy over how to treat low-risk tumors, some of which may never cause any harm if left untreated, surgery and radiation are common options when the disease is more advanced. But men considering these treatments also face possible side effects like becoming incontinent or impotent. And getting useful information about how common these problems are is difficult, Castle said, because there are so many different ways of defining them. "There is a lot of miscommunication," he told Reuters Health. "The goal of the study was to come up with a more detailed analysis of what men should expect after their prostate is removed."
The researchers sent out questionnaires to 600 men, from 42 to 82 years old, who'd had robot-assisted prostate surgery at their hospital. The surveys focused on incontinence, asking a wealth of questions, including how the patient's sex life, physical activity and social life were affected.
Just over two-thirds of the men responded. At least one year after their surgery, 78 percent said they didn't use pads in their underwear, while only 26 percent said they never leaked. "The outcomes are actually pretty darn good," said Castle, adding that some of the older men might already have been leaking before they underwent surgery.
Men who used more than one pad a day -- 17 percent -- most often leaked during exercise or when coughing and sneezing, and said their incontinence was most bothersome in relation to their sex life. Overall, five percent of men said they were significantly bothered by their incontinence, and less than one percent reported leaking all the time.
"We just wanted to get the message across that, 'Look, the vast majority of patients had some kinds of changes in their lifestyle but are still very happy,'" Castle said, adding that less than one percent of patients have any major complications at Mayo Clinic.
Prostate removal is usually only recommended for men who are expected to live at least 10 to 15 more years. And even then, the decision should be based on individual preferences, Castle said.
For instance, if a man already has some incontinence and impotence, Castle would encourage surgery. But if he is very worried about impotence, radiation treatment might be a better way to go, because its effect on continence and potency are delayed a few years, he added.
"This study armed us with the information to be able to explain to patients what to expect when we are counseling them," Castle told Reuters Health. "We end up getting patients who say, 'Doctor, I'm very happy.'"
"After following patients for approximately 15 years after treatment, the New England Journal study found that patients under 65 years, and particularly those with low risk prostate cancer, who underwent prostatectomy had a 38% lower risk of death from prostate cancer compared to their watchful waiting counterparts. The surgery patients also had a lower rate of metastasis, or spreading of the cancer to distant sites. These results were even seen among patients with low risk cancer, a groundbreaking finding that had never before been demonstrated this conclusively.
"This has been the subject of much debate and it's encouraging to see there is validity in aggressive prostate cancer treatment in men below 65, and even those with low risk cancer, rather than waiting for the disease to get worse," said robotic prostate surgery expert Dr. David Samadi, Vice Chairman, Department of Urology, and Chief of Robotics and Minimally Invasive Surgery at The Mount Sinai Medical Center in New York City. "Nerve-sparing robotic prostatectomy is wonderful option for patients because it not only cures them of cancer, but also preserves their sexual and urinary function so they can be cancer-free and maintain a high quality of life."
In the past, some have argued that robotic prostatectomy may be an unnecessary treatment option for men with low risk prostate cancer. This study presents a cogent and convincing argument against such claims, since it was particularly younger men with low risk cancer who demonstrated the mortality benefit after undergoing surgery. Furthermore, younger men also hold up very well against surgical complications because of their age, and if operated on robotically, can likely return home after a single night's hospital stay."View Thread
"A high percentage of omega-3 fatty acids in the blood is linked to an increased risk of aggressive prostate cancer Conversely, a high percentage of trans-fatty acids is linked with a lower riskSEATTLE — Apr 25, 2011 — The largest study ever to examine the association of dietary fats and prostate cancer risk has found what's good for the heart may not be good for the prostate.
Analyzing data from a nationwide study involving more than 3,400 men, researchers at Fred Hutchinson Cancer Research Center found that men with the highest blood percentages of docosahexaenoic acid, or DHA, an inflammation-lowering omega-3 fatty acid commonly found in fatty fish, have two-and-a-half-times the risk of developing aggressive, high-grade prostate cancer compared to men with the lowest DHA levels.
Conversely, the study also found that men with the highest blood ratios of trans-fatty acids — which are linked to inflammation and heart disease and abundant in processed foods that contain partially hydrogenated vegetable oils — had a 50 percent reduction in the risk of high-grade prostate cancer. In addition, neither of these fats was associated with the risk of low-grade prostate cancer risk. The researchers also found that omega-6 fatty acids, which are found in most vegetable oils and are linked to inflammation and heart disease, were not associated with prostate cancer risk. They also found that none of the fats were associated with the risk of low-grade prostate cancer.
These findings by Theodore M. Brasky, Ph.D., and colleagues in the Hutchinson Center's Public Health Sciences Division were published online April 25 in the American Journal of Epidemiology. "We were stunned to see these results and we spent a lot of time making sure the analyses were correct," said Brasky, a postdoctoral research fellow in the Hutchinson Center's Cancer Prevention.
. . .
Among the study participants, very few took fish oil supplements — the most common non-food source of omega-3 fatty acids, which are known to prevent heart disease and other inflammatory conditions. The majority got omega 3s from eating fish.
So based on these findings, should men concerned about heart disease eschew fish oil supplements or grilled salmon in the interest of reducing their risk of aggressive prostate cancer? Brasky and colleagues don't think so.
"Overall, the beneficial effects of eating fish to prevent heart disease outweigh any harm related to prostate cancer risk," Brasky said. "What this study shows is the complexity of nutrition and its impact on disease risk, and that we should study such associations rigorously rather than make assumptions," Brasky said.
The National Cancer Institute funded this study, which also involved researchers from the University of Texas Health Science Center at San Antonio and the NCI."
" Men with high-risk prostate cancer who take statin drugs commonly used to lower cholesterol while receiving radiation therapy are less likely to have their cancer return than patients who do not take these medications, according to a study published in the March issue of the International Journal of Radiation Oncology-Biology-Physics, an official journal of the American Society for Radiation Oncology (ASTRO).
In the study, 1,681 men with high-risk, localized prostate cancer were treated with radiation therapy between 1995 and 2007. Of them, 382 (23 percent) were taking statin medication at diagnosis and throughout the treatment. Statins are a class of drugs used to lower the cholesterol level in people with or at risk of cardiovascular disease. The median follow-up time was approximately six years.
Researchers found that the men taking statins were less like to relapse than other patients. At five years, 11 percent of men taking statins saw their cancer return compared to 17 percent of patients not taking the medication. At eight years, 17 percent of men on statins had a relapse compared to 26 percent not taking the drug.
"In our retrospective study, we have demonstrated that statin use during radiotherapy is associated with improved biochemical tumor control among high-risk patients," Michael J. Zelefsky, M.D., the senior author of the study and a radiation oncologist at Memorial Sloan-Kettering Cancer Center in New York, said. "This study, along with other emerging studies, strongly suggests that statin use improves outcomes in patients treated with definitive radiation therapy.""View Thread
"n the first study of its kind, urologists and biostatisticians at Henry Ford Hospital have found that robot-assisted surgery to remove cancerous prostate glands is safe over the long term, with a major complication rate of less than one percent.
The findings, published online this month by the journal European Urology, follow an earlier Henry Ford study that found nearly 87 percent of patients whose cancerous prostates were removed by robot-assisted surgery had no recurrence of the disease after five years."
"Confronted, in a sense, by "apples and oranges" comparisons of several RP surgical techniques, the Henry Ford researchers set out to produce a five-year safety study that both concentrated on RARP and incorporated an exhaustive collection of data, covering everything from length of hospital stay, to an in-depth examination of other diseases afflicting the patients, but unrelated to their cancers.
Among the study group of 3,317 RARP patients, researchers found a median hospitalization time of only one day. There were 368 complications in 326 of the patients or 9.8 percent of the total most of which were minor and occurred within 30 days of the surgery.
A patient's prostate-specific antigen (PSA) scores before surgery, as well as cardiac disease, were found to predict medical complications after the robot-assisted surgery; age, gastroesophageal reflux disease (GERD ), and biopsy score predicted possible surgical complications.
The researchers' main conclusion was that "RARP is a safe operation.""
""While these results provide strong endorsement for robotic surgery, we want to emphasize that the results are dependent more on the surgical team that controls the da Vinci robot rather than just the robot," Dr. Menon states."View Thread