Archive | April, 2011

Use Caution When Deciding on HIFU

Normally, high-intensity focused ultrasound (HIFU) is used as a salvage treatment for prostate cancer.  Recently, a movement has taken place to push HIFU as a front-line use, but both the US Food and Drug Administration and the European Association of Urology classify the procedure as experimental.

The first case series to report outcomes in men after failed whole-gland HIFU and salvage radical prostatectomy suggests that there is reason for caution.

Researchers report they were alarmed at the pathology results.  Morbidity appeared to be higher after salvage prostatectomy than after primary surgery.

Declan G. Murphy, MD, from the Department of Urological Oncology at the Peter MacCallum Cancer Centre in Melbourne, Australia, notes, “Whether it is that standard prostate biopsy cannot be relied on to predict final pathological outcome, or that HIFU ‘makes cancer angry,’ patients should be fully counseled about what we know and, importantly, what we do not know about HIFU treatment for localized prostate cancer today.”

“Our own initial experience with HIFU treatment for primary and recurrent prostate cancer unfortunately led us to conclude that the technology is not yet suitable for mainstream clinical practice, and led us to suspend our program,“ Dr. Murphy added.

Dr. Lawrentschuk believes that using radical prostatectomy as salvage treatment after the failure of primary HIFU is feasible; however, he is concerned about the rate of extraprostatic extension.

“HIFU is experimental and should only be done in studies where patients are told of the risks of failure and the poor results of salvage.  They need very careful monitoring, follow-up biopsies, etc.  I do not advise patients to have HIFU.  There may be a problem with HIFU selecting out more aggressive cells, but this warrants further study,” explains Dr. Lawrentschuk.

“Experimental treatments are fraught with danger.  I was surprised at the aggressive nature of the disease and the recurrences in this supposedly low-risk group,” he continues.  “I think HIFU is inadequate in its current form, perhaps because of poor patient selection for HIFU and a lack of standardized ways of detecting post-HIFU recurrences in a timely fashion.”

Howard Sandler, MD, chair of radiation oncology at Cedars-Sinai Medical Center’s Samuel Oschin Comprehensive Cancer Institute in Los Angeles, California, also reviewed the study.

“I wouldn’t conclude that the high number with extracapsular extension is a result of HIFU.  It is more likely that patients who fail HIFU had worse cancers in any case from the start.  Additionally, there may have been a bit of a delay after some suspicion of recurrence before salvage surgery was done, given the presurgery PSA [prostate-specific antigen] of 3.8, with the nadir PSA of 1.0.  Thus, patients waited on average for their PSA to rise from 1.0 to 3.8 before something was done.  During this interval, extracapsular extension may have occurred,” Dr. Sandler explained.

Overall, Dr. Sandler believes that HIFU is a poor choice for whole-gland ablation and focal therapy.

Posted in Prostate Treatment0 Comments

Research Underway for FDA Approved Investigational Medication for Prostate Cancer

Men naturally produce the male hormone testosterone which stimulates the prostate cancer cells.  Constantly suppressing the testosterone can treat prostate cancer however this diminishes quality of life by causing loss of sexual interest, impotence, hot flashes, decreased mental ability, fatigue and even depression. In an effort to turn this around, patients are now being enrolled at Florida Urology Physicians to evaluate the role of a new method of suppressing cancer growth.

The study being conducted by Dr. Barry Blitz evaluates the role of an FDA investigational medicine that has been successfully treating prostate cancer to allow men to live years with fewer side effects than current therapies.

To qualify as a study participant, men must have been treated for prostate cancer and have a rising Prostate Specific Antigen (PSA).  Study participants can receive study related exams, lab tests, and study medications at no charge.  They are also compensated for their involvement.

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Dutasteride and Finasteride May Contribute to Irreversible Sexual Dysfunction in Men

Dutasteride (Avodart), a drug frequently prescribed to treat enlarged prostate and Finasteride (Proscar and Propecia); a drug frequently prescribed to treat hair loss may contribute to erectile dysfunction, depression and loss of libido.  Symptoms may even persist after the medication stopped.

This is according to a study led by Abdulmaged M. Traish, a professor of biochemistry and urology at Boston University School of Medicine.  The team searched for available medical literature for reports of sexual side effects associated with Finasteride and Dutasteride. Of the men taking the drugs, 8% reported erectile dysfunction and 4.2% reported reduced libido while those taking the placebo only 4% of men reported erectile dysfunction and 1.8% of men reported reduced libido. The researchers also noted that reduced ejaculation, reduced semen volume and depression were also reported by some men.

The drugs (Dutasteride and Finasteride) work by blocking androgen but androgen is needed for erectile function, libido and ejaculation, and for just feeling good.

Traish said “as a physician you have a responsibility to take the time and explain to your patient that maybe not everyone will have these side effects, but you may, and in some cases they are irreversible””.

Dr. Bruce R. Kava, an associate professor of urology at the University Of Miami Miller School Of Medicine agreed that “these drugs do cause some of these problems but they haven’t convinced me yet, based on the data, because they don’t have any long term data”.  He added that most urologists discuss potential side effects with their patients but usually “don’t discuss long term consequences that are irreversible, because most of us have not been aware of any long term problems from these drugs”.

Posted in Prostate Enlargement, Prostate Treatment0 Comments

Label Switch in Pfizer Drugs

There is a possible label switch in two of Pfizer’s drugs – an antidepressant and a drug used to shrink the prostate.  This prompted Pfizer to do a subsidiary recall on both drugs.

The affected drugs are both in generic formulation -  Citalopram is an antidepressant and Finasteride is used to treat benign prostatic hyperplasia (BPH).

It is said that only one lot was affected.  Bottles labeled as Citalopram Lot # F10510058-A may contain Finasteride.  The lot number involves Citalopram in 100-count  bottles of 10-mg tables and Finasteride In 90-count bottles of 5-mg tablets.

Greenstone LLC, the Pfizer unit selling the products stressed that patients taking the wrong medications may be at risk for serious side effects.  Patients who discontinue Citalopram abruptly may experience withdrawal symptoms and/or worsening depression. Women who are, or may become pregnant, should not take or handle Finasteride due to possible risk of abnormalities to the external genitalia of a developing male fetus.

Patients should check their bottles of either drug with this lot number on the label should return the products to the pharmacy.

The recall stemmed from the possibility that incorrect labels have been placed on the bottles by a third party manufacturer.

Posted in Feature, Prostate Treatment0 Comments


April 2011
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