Archive | Prostate Enlargement

HIFU Treatment looks Promising for Localized Prostate Cancer

Data from a large clinical registry showed that over 80 percent of men with localized prostate cancer had negative biopsies for as long as 10 years after treatment with high-intensity focused ultrasound (HIFU).

The negative biopsy rate ranged from 78.3% of patients with high-risk prostate cancer to 89.3% for men with low-risk disease. The 10-year biochemical failure-free survival was 56% by a U.S. definition of biochemical failure and 42% by a German definition.

As reported at the American Urological Association meeting, the most common adverse events were urinary incontinence (mostly grade I) and urethral stenosis (bladder outlet obstruction) occurring in 20.6% and 18.5% of patients, respectively.

HIFU is available throughout Europe but not in the U.S., and it has appealed to many men as a noninvasive therapeutic option for early prostate cancer.  Whole-gland application of high-intensity ultrasound produces thermal and mechanical effects.  HIFU energy rapidly heats tissue to a temperature of greater than 80° C.  The ultrasound also generates gas bubbles that cause cavitation when they collapse, leading to the rupture of cell walls.

Roman Ganzer, MD, of the University of Regensberg in Germany. presented data on 2,552 prostate cancer patients treated with the Ablatherm HIFU system.  The mean age of the study population was 70.1 years.  Eight hundred twenty (32.1%) of patients received short-term hormonal therapy prior to HIFU treatment.  On average, the patients were followed for 3.3 years and as long as 16 years.  Overall, 83% of the patients had negative biopsies at follow-up, including 89.3% of low-risk patients, 81.2% of intermediate-risk patients, and 78.3% of high-risk patients.

In addition to incontinence and urethral stricture, the most common adverse events were infection and urinary retention, both at 11%.

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Alpha Blocker Improves Symptoms of Chronic Prostatitis

Recent findings show that treatment with a specific alpha blocker helps reduce symptoms and improve quality of life for men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).  This alpha-blocker, called silodosin, works by selectively relaxing the muscles in the neck of the urinary bladder and prostate.  It has been approved in Canada, the United States, the EU and Japan to treat symptoms of another prostate gland condition, benign prostatic hyperplasia, which is commonly referred to as an enlarged prostate.

Although CP/CPPS is the most common form of prostatitis, it is the most misunderstood and difficult to treat because the symptoms are very similar to other conditions and requires a significant amount of testing and screening to identify.

Curtis Nickel, a professor in the Department of Urology, practicing urologist at Kingston General Hospital and Canada Research Chair in Urologic Pain and Inflammation, emphasized that antibiotics are commonly used as a treatment, but they are not typically effective.  This could be because CP/CPPS does not seem to be caused by a bacterial infection.

CP/CPPS is a debilitating condition; patients with this condition suffer from discomfort in the lower pelvic area including the bladder area, testicles, and penis.  Symptoms may be severe and can include painful and frequent urination and difficult or painful ejaculation.  The cause of CP/CPPS is not known.

In Dr. Nickel’s study, about 60 percent of men reported feeling better after treatment with silodosin as opposed to 30 percent of participants who were given a placebo.  These results for patients feeling better is higher than a similar study he conducted several years ago that tested the effects of a different alpha blocker.

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Urine Test Can Help Detect and Sort Prostate Cancer

Researchers report that an investigational urine test can detect and stratify prostate cancer in men with elevated prostate specific antigen (PSA).  According to Arul Chinnaiyan, MD, PhD, of the University of Michigan Medical School in Ann Arbor and colleagues, the test is based on the detection of a gene fusion that is specific to prostate cancer combined with another marker.  Stratifying patients by the combined marker identified groups with markedly different risks of cancer, high-grade cancer, and clinically significant cancer on biopsy.

This noninvasive test may allow some men with elevated PSA to avoid a needle biopsy.  Although many more men have elevated PSA than actually have cancer, the test could be an intermediate step before getting a biopsy.

The fusion that doctors look for in the test involves the genes transmembrane protease, serine 2 (TMPRSS2), and v-ets erythroblastosis virus E26 oncogene homolog (avian) (ERG).  This fusion appears in roughly half of all prostate cancers, but when it does appear, it is almost 100% specific for malignancy.  Through a series of experiments, the research team showed that the fusion gene was associated with indicators of clinically significant cancer at biopsy and prostatectomy.  The indicators included tumor size, high Gleason score at prostatectomy, and upgrading of Gleason grade at prostatectomy.

Because this fusion gene is not always present, the team created a model that combined it and the prostate cancer antigen 3 (PCA3) gene.

The researchers use the model to stratify 1,065 men who underwent biopsy into three groups – lowest, intermediate, and highest levels of the combined genes.

These tests, however, remain investigational.  Additionally, the researchers note that most of the men studied thus far have been Caucasian.  More studies are needed to see if the results can be generalized.

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No Relationship Found Between Weight Changes and LUTS

Even though obesity has been related to lower urinary tract symptoms (LUTS) in aging men, new findings from researchers at the Mayo Clinic College of Medicine in Rochester, Minnesota suggest that modest weight loss may not prevent the onset or progression of LUTS among these men.  Also, no relationship was found between weight gain and the development or progression of LUTS.

The research team analyzed data from 1,674 white men participating in the Olmstead County Study (OCS) of Urinary Symptoms and Health Status among Men, funded by Merck Research Laboratories, and 168 black men participating in the Flint Men’s Health Study.  Researchers separated the participants into three categories based on differences between their baseline weight and weight during four year of follow-up: no weight loss, less than 5% of baseline weight loss, and more than 5% of baseline weight loss.

Jennifer L. St. Sauver, Ph.D., the lead author of the study, reported at the American Urological Association annual meeting that participants in both studies and in all weight categories experienced no statistically significant change in LUTS.  Her research team found that in the OCS cohort, weight loss was not related to receipt of treatment for benign prostatic hyperplasia.  Dr. St. Sauver concludes that although weight loss can help prevent a number of diseases such as diabetes, modest weight loss may not prevent development of LUTS.  A report of the study will be published in Urology. Data collection for this study was additionally funded by grants from the National Institutes of Health.

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MRI Highly Effective in Identifying Prostate Cancer Recurrence Even at Low PSA Levels

According to a study conducted by researchers at MD Anderson Cancer Center in Houston, a pelvic MRI scan with IV contrast and rectal balloon is highly effective in identifying local recurrence even at low PSA values in prostate cancer patients with a rising or persistently elevated PSA after prostatectomy.

For prostate cancer patients with rising PSA, a scan is typically performed after a prostatectomy and before salvage radiation therapy treatment.  This is to determine the potential recurrence and the location of the recurrence.  Researchers were not surprised that high rates of cancer recurrence were picked up by the MRI than the traditional CT scan as an MRI is able to differentiate between soft tissues better.  The surprise was the low PSA levels at which the MRI could determine recurrent disease.

Lead author of the study and assistant professor of radiation oncology at MD Anderson Cancer Center in Houston said “Being able to identify such patients is beneficial, as it would be predictive of response to salvage radiation therapy.  It also may allow a radiation oncologist to treat the area of recurrent cancer to a higher radiation dose with or without hormone ablation therapy to increase the chance of cure.”

The study evaluated 389 post prostatectomy patients treated between January 2004 and October 2010, with 143 receiving a pelvic MRI to determine if cancer cells were still present in the area of the surgical bed.  Of those patients, 35 had suspicious MRI findings suggesting a local recurrence where 26 patients were then biopsied, with 23 showing cancer.

The study showed that about one-third of patients with a biopsy proven recurrence after suspicious MRI finding had a PSA of less than 1, with several having a PSA as low as 0.3.

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Research Study for Treatment of Lower Urinary Tract Symptoms (LUTS) Due To Benign Prostatic Hyperplasia (BPH)

Are you a man age 50 or older?

Do you have to urinate frequently during the day and at night?

Do you have trouble urinating?

Are these and other urinary problems interfering with your life and your relationships?

If you answered “yes” to the above questions, you may be a candidate for the L.I.F.T. Study.

The L.I.F.T. Study is an FDA approved research study to evaluate the UroLift system to support a premarketing application to FDA.  Its purpose is to determine the safety and effectiveness of the UroLift system for the treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH).  The study is being conducted at urology practices throughout the U.S., in Canada and in Australia.

BPH is a non cancerous condition that causes the prostate to enlarge as men age.  When the enlarged prostate presses on the urethra, it can cause bothersome urinary symptoms. The UroLift System is a minimally invasive approach to treating BPH that lifts/holds the enlarged prostate tissue out of the way so it no longer blocks the urethra.  There is no cutting, heating or removal of prostate tissue. The goal of UroLift system treatment is to relieve symptoms so you can get back to your life and resume your daily activities.

The UroLift system is an investigational device as such is limited by Federal Law to investigational use only.

To find out more about L.I.F.T. Study and UroLift system treatment and study locations, go to www.neotract.com.

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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”.

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Are You Receiving The Correct Dosage of Saw Palmetto to Alleviate BPH?

According to a recent study conducted by Valensa International, one of the leading producers of saw palmetto, some consumers may not be receiving the correct dosage, or form, to maximize its benefits.  Saw palmetto has been proven through a series of clinical trials to reduce the symptoms of benign prostatic hyperplasia; however, these trials show that a daily dose of 320 milligrams of the oil extract mitigate the effects, not the powdered form.

Currently, two forms of saw palmetto are being advertised in capsules of natural supplements, which has subsequently led to some confusion surrounding the efficacy of the ingredient.  Dr. Rudi E. Moerk, President and CEO of Valensa, states, “There is a solid body of evidence based on a number of clinical trials that show the 320 mg per day dosage of pure saw palmetto oil extract offers support to men experiencing the common effects of BPH.  There have been no studies done on similar levels of the powder-form products.  Just because both product forms start with saw palmetto berries, it doesn’t mean they are equivalent when it comes to achieving the result we expect from saw palmetto oil extracts.”

And the differences between the two forms are clear.  In order to extract the powder from the saw palmetto berries, the berry must be dried, crushed, and ground.  Often, younger berries are used in this process and the majority of oil in the crushed berry is left as discard.  On the other hand, high-efficiency extraction methods, like supercritical CO2, are used to extract the oil from more mature berries.  Because mature berries are used for the oil extraction, a higher concentration of the saw palmetto is obtained, thus leading to a more potent form for the capsules.  While powdered forms only see 10 to 12 percent of the effective oil, the oil extract forms are near 100 percent.

Although Dr. Moerck’s objections to the powdered forms are not based on the safety of the product, he does criticize the recommendations made by marketers and retailers.  Manufacturers normally suggest taking 1 pill of the 320 milligram powdered extract form, which is the same dosage recommendation for the oil extract form.  But in order for consumers to retrieve the amount of saw palmetto needed to alleviate BPH, as conducted in the clinical trials, 7 to 10 pills a day are required.  “Saw palmetto has been used safely and effectively for decades.  The powder-form product is probably fine if you take eight to ten capsules or tablets a day,” he said.  “However, if men only use one 320 mg dose of powdered-form product, there is no proof that it will have any impact on the effects of BPH at all.  As people who work in the nutritional supplement market, we are doing a disservice to our customers when we make these casual recommendations that are not based on science—and perhaps more importantly, we aren’t helping give men the relief that they so desperately need.”

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Diagnosed with BPH? Recent Study Shows BPH Does Not Necessarily Mean Cancer

As men age there is an increased chance of developing benign prostatic hyperplasia, or BPH.  Normally, BPH symptoms include an enlarged prostate, increased urinary frequency, urgency, hesitancy, reduced force of stream, dribbling, and frequent waking in the night to urinate.  Prostate cancer, on the other hand, often does not show symptoms in its early stages.  By the time the cancer has progressed, symptoms include, in addition to those seen in BPH patients, blood in the urine and semen, swelling in the legs, discomfort in the pelvic area, and bone pain.  If you are experiencing these symptoms, or have any concerns, make an appointment with your doctor.

But a recent study conducted by the Department of Urology of Chung-Ang University College of Medicine in Seoul, Korea, investigated the expression of specific proteins associated both with BPH and with prostate cancer.  These findings reveal that the protein S100A2 is observed in the tissue of patients with BPH but not in prostate cancer cells; however, a second protein, S100A4, is found in high levels in cancer cells while remains absent in BPH tissues.  Further, the investigators indicate that a decrease in expression of S100A2 and an increase in expression of S100A4 may be used in identifying aggressive prostate cancer in patients.

What this means for urologists and patients is that there is, in fact, a clear distinction between the two conditions.  A test to determine the presence and levels of the two proteins may lead to early diagnosis of cancer before the more severe symptoms, such as blood in urine, indicate a problem.  Further, it may alleviate the worries of patients living with BPH and, thus, increase their overall quality of life.  Rest assured, researchers are constantly discovering differential characteristics between BPH and prostate cancer.

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Trend Toward Minimally Invasive Technology for BPH

As medical treatment advances and more patients have access to health care, each generation in the United States is living longer, fuller lives.  However, awareness has been raised that as many men age an increase in problems such as benign prostatic hyperplasia, or enlarged prostate, is significant.  As a result, medical technological companies such as Urologix are constantly conducting new studies in order to better treat BPH.  One such study has produced Urologix’s Cooled ThermoCath Microwave Catheter, which is now being used in urology centers across the country.

The Cooled ThermoCath (CTC) Microwave Catheter is a minimally invasive catheter used with Urologix CoolWave or Targis units and is delivered in under 30 minutes by a physician.  The success rate of the therapy is 90% as many patients experience an alleviation of the symptoms associated with urinary flow rate and frequent trips to the bathroom.  Further, one of the most advantageous aspects of the minimally invasive procedure is that patients avoid the adverse effects associated with prior treatments and harsh medications.

According to Alan Partin, MD, PhD, Chairman of the James Buchanan Brady Urological Institute at The Johns Hopkins Medication Institution and investigator of the study, “Our support of this long term clinical trial is representative of our Company’s commitment to science to better understand the benefits of the CTC Microwave Catheter for those affected by enlarged prostate disease.  We believe these long term clinical results will aid physicians and patients in their decision making when weighing treatment options.  This study demonstrates the effectiveness of the CTC Microwave Catheter in offering durable relief from symptoms of BPH for the majority of patients in a 30-minute treatment in a physician’s office.” Overall, the CTC has established itself today as a durable and effective treatment that provides lasting relief from the symptoms of BPH.

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