There is a lot to read about the benefits of certain foods in the prevention and treatment of prostate cancer. Prominent among these “super foods” are tomatoes and broccoli. Tomatoes are rich in the antioxidant lycopene and broccoli is stacked with sulforaphane.
Many studies indicate that a diet high in lycopene can reduce the risk of prostate cancer, while others report the benefits of lycopene in slowing the development of prostate cancer cells in newly diagnosed men. Just last month, Oregon State University issued the results of a study focused on African American men that indicates the sulforaphane found in broccoli can destroy prostate cancer tumors while preserving healthy cells. There have even been studies conducted on the benefits of eating tomatoes and broccoli together.
I am very happy to see on-going research in all areas of healthy food consumption. We don’t know everything there is to know about how specific fruits and vegetables positively impact prostate cancer cells and other cancer development. But, we do know that with a wellness lifestyle of both healthy eating and exercise, the body is better equipped to fight infection and disease. These are the easiest first steps for men to take. This is particularly true since obesity can pose a significant increase in men and their risk of developing prostate cancer, and can make prostate cancer surgery more complex.
I am also encouraged to see prostate cancer research focused on African American men, as statistics show them to be at increased risk of developing the disease. Understanding new research and arming ourselves with a well-nourished, healthy immune system are among the best things we as men can do to prevent prostate cancer.
But please do not forget that prostate cancer prevention must include vigilance. I urge men over age 50 to get PSA (Prostate-Specific Antigen) screenings annually. And high-risk men – African American men and those with genetic components increasing their risk of prostate cancer– must do so annually over age 40. These screenings ensure early detection of prostate cancer.
I believe that the combination of early detection and removal of the prostate through robotic prostatectomy once the cancer is detected is the key to eradicating prostate cancer. But let’s start before we even get to a diagnosis. Your focus on a healthy lifestyle now can lead to overall wellness long into your future and may even help you avoid prostate cancer.
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Men facing prostate cancer experience a wide range of emotions and fears about treatment, survival and cure. Robotic prostatectomy procedures, performed to remove the prostate gland and all surrounding cancer, provides very good results but can add to the fears that men have. Primarily, men want to know if they will be able to have and enjoy sex after prostate cancer treatment.
Prior to the advent of laparoscopic and robotic techniques to remove the prostate gland, open, abdominal surgery was the standard. During these procedures, it was very difficult for the surgeon to see the tiny nerves responsible for erectile functioning and they were often severed unintentionally. As a result, men typically experienced changes in their ability to have sex after prostate removal. Today, robotic radical prostatectomy provides the surgeon with a magnified view of the prostate gland, along with increased precision and dexterity, greatly reducing the risk of damage to nerves vital to erectile functioning.
Dr. Samadi maintains that prostate surgery recovery means a return to the patient’s normal quality of life. “I consider robotic surgery successful when the cancer is cured and the patient has full continence and potency. All three criteria must be met for me to consider the surgery a success.” Dr. Samadi employs a start-to-finish approach, including individualized evaluation of sexual function prior to radical prostatectomy and assessment of options to aid in the return of sexual function after prostate surgery.
Robotic radical prostatectomy using the da Vinci Surgical System is the commonly recommended treatment for men with localized prostate cancer. The da Vinci system’s greatly magnified visualization and sensitive electronics permit Dr. Samadi to perform highly precise movements at the surgical site. This allows for cleaner removal of the cancerous tissue and results in overall superior clinical outcomes when compared to open and laparoscopic prostatectomy procedures. Using his own SMART (Samadi Modified Advanced Robotic Technique), Dr. Samadi is able to spare the nerves critical for sexual function. Prostate surgery recovery is then faster, with an improved outlook for regaining the ability to have sex after prostate removal. SMART surgery also mitigates the risks associated with incontinence after prostate surgery.
The resumption of sexual potency can take up to 12 months, or longer depending on the complexity of the prostatectomy surgery. It’s not uncommon for men to experience ED after prostate surgery, particularly during the weeks immediately following the procedure. However, this is not an indication of the long-term sexual potency of a patient. On-going post-operative communication is part of Dr. Samadi’s comprehensive approach to ED after prostate cancer treatment.
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This week Medicare announced that it will continue to pay in full for the use of Provenge in treating prostate cancer when used in accordance with label indications. Provenge is a relatively new, FDA-approved drug used for patients with advanced prostate cancer. Unlike immunotherapy or chemotherapy, it uses a patient’s own cells to fight the cancer. Over a series of three procedures, cells are removed from the prostate cancer patient, “trained” in a lab, and then reintroduced in the patient in hopes that the body will attack the cancer like an infection. Provenge is reporting success in patients who are able to extend their lives with minimal side effects.
There are two main concerns I have with the use of drugs such as Provenge. First and foremost, this is a late game effort. Most prostate cancer patients using Provenge are doing so because earlier treatments failed or because their “watchful waiting” led them too far in their cancer’s progression. I don’t want my patients to reach this stage in prostate cancer treatment. From the moment men are diagnosed with prostate cancer, I want to help them make decisions that will remove prostate cancer from their lives for good. I believe that my experience in robotic prostatectomy procedures and my SMART (Samadi Modified Advanced Robotic Technology) surgery can help do this.
Prostate cancer is often referred to as the silent killer. Nearly symptomless, prostate cancer can develop, and progress significantly, in patients without their knowledge. For that reason, the key to eradicating prostate cancer is to start early – test early, treat early. Early detection of prostate cancer buys valuable time. Watchful waiting may waste that time, especially since studies indicate that in post-surgery biopsies many patients’ prostate cancer was actually far more advanced than initial staging tests indicated. And patients who do decide to treat their prostate cancer, but with less-aggressive options, may face a lifetime of worry and additional treatments. Robotic surgery removes the prostate and all surrounding cancer. Other treatments may not provide such concrete results.
Second, as the United States is on the brink of healthcare reform, I worry that focusing on high-priced drugs like Provenge (estimated to cost $93,000 per patient) distracts from healthcare efficiencies. The most efficient way to manage cancer patients of all types is to provide the method of treatment that leads them most directly to the best possible cure rate. Naturally, this varies by patient and by type of cancer. In my opinion, robotic prostate surgery is an early, aggressive way to remove cancer from the body and eliminate the need for a lifetime of costly treatments, drugs and care.
So, while Provenge may be doing very good things for certain patients, patients should never be faced with taking a drug that will buy them a year or two; not when they can act early to remove prostate cancer from their lives.
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I’ve written before about the positive results my patients are experiencing post-prostatectomy, but in light of a new study released this month I’d like to remind patients of my position. It’s no secret that once men learn of their prostate cancer and its treatment, their immediate thoughts are of how it will affect their quality of life. The Internet is rich with research providing accounts of those recovering from prostate cancer and the negative affects it can have on continence and erectile function. But as my statistics indicate, this does not have to be the case. As new research continues to pour from institutions across the world, the findings must be interpreted carefully.
The study recently published in the August 2011 Journal of Urology reveals that of 152 men surveyed one year post-surgery, only 36 percent indicated that their initial expectation for urinary function matched their true results, and only 40 percent said so of sexual function. At first glance, these numbers are less than stellar, but read on. While about half of those surveyed expected urinary and sexual function to return to normal, a surprising 17 percent expected improved sexual function.
Unfortunately, the survey report lacks details about the type of surgery performed – laparoscopic or robotic. Additionally, pre-surgery counseling was provided, but the researchers do not indicate the type or depth of the counseling. In questioning the findings of this study I am not discounting the fact that continence and sexual function can be negatively impacted by prostatectomy. Therefore, the choices you make regarding your treatment and your surgeon are critical. Saving the lives of those affected by prostate cancer is my charge in life, but that does not make me a miracle worker per se.
My SMART (Samadi Modified Advanced Robotic Technology) surgery provides enhanced vision and more precise angles of dissection during surgery allowing me, in most cases, to remove the prostate while sparing the nerves surrounding it. This reduces the risk of damaged nerve bundles and arteries critical to blood flow. As a result, 96 percent of my patients regain urinary control and 87 percent regain sexual potency within 12 to 24 months.
I realize that, for most of you, success is not measured in cure alone. Prostate cancer treatment will always be determined on an individual basis, but I believe my vast experience coupled with my robotic technology expertise can lead patients to a promising post operative recovery and fulfilling life.
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Recently the FDA unveiled new anti-smoking imagery that will be required to be displayed on cigarette packages by September 2012. These images have caused some controversy due to their graphic nature and have raised questions regarding their effectiveness. As an example, one of these images shows a man holding a cigarette, with smoke coming from a tracheotomy in his neck. This image is accompanied by text warning that smoking is addictive. The implication of this warning is that even after undergoing the removal of the larynx (voice box) due to cancer caused by smoking, the addictiveness of the habit is strong enough to keep you hooked. It’s a warning to both the physical and psychological dangers of smoking.
There’s one warning not included with these new labels that men need to be made aware of. A new study published in the Journal of the American Medical Association has found a link between smoking and prostate cancer recurrence and mortality rates. This 25 year study followed a large cohort of men, of which 5,366 were diagnosed with prostate cancer during the study period. Current smokers, categorized by pack-years (< 40 and ≥ 40), were 61% more likely to die from the disease than their non-smoking counterparts. Smokers were also 61% more likely to have a recurrence of the disease after treatment. As expected, prostate cancer mortality rates increased with heavier cigarette usage: men who smoked two packs per day for 20 years (or 1 pack per day for 40 years) saw an 82% increase in the risk of death from the disease.
Data presented in the study also points to a correlation between smoking and the development of aggressive forms of the disease, which would account for the higher mortality rate. It’s known that the chemicals found in cigarette smoke have a carcinogenic effect. We normally associate this effect with the development of mouth, tongue, throat, lung, and larynx cancers as these areas come in direct contact with cigarette smoke. We must be mindful that the chemicals found in cigarette smoke are not just brought into the lungs, but into the bloodstream where they circulate throughout the body, having a systemic effect. Additionally, cigarette smoke does not only affect smokers; the effects of second-hand smoke can be just as toxic.
There is good news for ex-smokers though. It was found that those men who had kicked the habit for a minimum of 10 years had mortality rates similar to those who never smoked. The area of concern here, however, is that we’re diagnosing men with prostate cancer now at younger ages due to better screening methods. It is common for people to have the misconception that prostate cancer is an “old man’s” disease – it is not. It’s a disease that will affect 1 out of 6 men during their lifetime. While the chance of developing the disease does increase with age, many young men are being diagnosed as well.
It goes without say that quitting smoking, regardless of your age, can greatly improve both your overall health and your chances of surviving prostate cancer.
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Last week the US Food and Drug Administration (FDA) released a warning about the increased risk of developing an aggressive form of prostate cancer while taking 5-alpha reductase inhibitors (5-ARI), such as dutasteride and finasteride. These drugs are frequently used in the treatment of benign prostatic hyperplasia (BPH), a non-cancerous growth of the prostate gland that affects nearly half of men over the age of 55. If the prostate becomes too enlarged due to BPH, it can put substantial pressure on the urethra, leading to various urologic issues including difficulty urinating.
Studies have shown that 5-ARI drugs, commonly known as Avodart, Proscar, and Propecia, have a somewhat paradoxical effect on prostate cancer. While they seem to reduce the overall rate of the disease, at the same time they may increase the risk of aggressive, high-grade cancer among those men who do get diagnosed. These findings raise the question of whether 5-ARI drugs are truly suitable for prostate cancer prevention as was previously thought.
It is important to keep in mind that these drugs are not the only effective treatments for BPH. There are, in fact, safe and minimally invasive surgical treatments available as well, such as GreenLight Laser PVP (Photo Vaporization of the Prostate) and TURP (Transurethral Resection of the Prostate).
GreenLight Laser PVP is a safe and effective outpatient procedure performed by urologists. The procedure involves inserting a thin cystoscope into the urethra to reach the prostate gland. The aspect of the gland surrounding the urethra is heated to the point where the overgrown prostate tissue becomes vaporized, thereby allowing urine to flow more freely from the bladder to outside the body. This procedure takes approximately 60 minutes, and patients are sent home that same day.
TURP (Transurethral Resection of the Prostate) is performed by visualizing the prostate through the urethra and removing overgrown prostate tissue by sharp dissection or electrocautery. TURP has been extremely well-studied in the medical literature, and is considered a common, safe and efficacious way to treat BPH.
With the information now being presented about 5-ARI drugs, men may want to reevaluate their course of treatment. So speak to your urologist and, as always, make sure to know all of your options before you reach a final decision.
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I recently returned from Israel after having attended the second annual Rambam Summit at Rambam Hospital in Haifa. This summit was attended by esteemed physicians, scientists, economists, academics and politicians from Israel and abroad. While the main theme of this years’ two-day summit was pediatric care and Rambam’s plans for the construction of the Ruth Rappaport Children’s Hospital, many other discussions and events were taking place as well.
Followers of my blog will most likely remember my trip to Rambam late last year to perform Israel’s first “SMART (Samadi Modified Advanced Robotic Technique) Surgery” prostatectomy procedure with their newly acquired daVinci surgical robot. This was the first step in my global initiative to spread prostate cancer awareness among the people of Israel and the world. It also gave me the opportunity to demonstrate my surgical technique to many of Israel’s skilled surgeons by performing live, televised, prostatectomy cases. As a featured physician at this years’ summit at Rambam I returned to perform another live robotic prostatectomy, broadcast by video conference, as well as to discuss advancements in prostate cancer detection and treatment.
It was wonderful to once again come back to Israel and see the friends and colleagues who I mentored during my last trip. Rambam’s focus on providing outstanding healthcare gives me so much hope for the future, and leaves me eager to see how robotic surgery will progress as more and more doctors become skilled in the technique.
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In the past year, I have had the opportunity to travel to various parts of the world as part of my global initiative to increase awareness of prostate cancer and robotic prostate surgery. I visited Israel in December, where I performed six live operations to demonstrate my SMART surgery technique to the country’s most skilled surgeons. I then took part in a highly publicized conference on the future of robotic surgery at the Hospital Metropolitano de Santiago (HOMS) in the Dominican Republic. Several articles regarding that trip have since been published in Spanish and the positive feedback that I continue to receive from patients and doctors around the world is truly heartwarming.
English-speaking men are fortunate in that they have access to an abundance of information regarding all aspects of prostate cancer, from screening and prevention to treatment and management. In other parts of the world, however, non English-speakers have a much harder time finding the information they need and deserve. This is why I’ve made my educational website, www.roboticoncology.com, available in as many languages as possible. The site has recently been available in six languages; English, Spanish, Italian, French, German, and Russian. Just last week we added Hebrew as our seventh supported language to assist our friends in Israel who now have the robotic prostatectomy procedure available to them as a local option. I hope this site serves as a centralized information portal, accessible to anyone and everyone who wants to know the most up-to-date news about prostate cancer and how to beat it.
In addition, we also recently launched the Hebrew version of my professional website, www.smart-surgery.com. This site carries useful information specifically related to my SMART surgery technique that was demonstrated during my trip to Israel.
Please visit the links below to read more information about prostate cancer and robotic surgery:
Robotic Oncology Website
SMART Surgery Website
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An interesting study has just been released showing a possible connection between regular use of acetaminophen (Tylenol) and a reduction in prostate cancer. The study, conducted by the American Cancer Society and published in the Cancer Epidemiology Biomarkers and Prevention journal, followed the daily medication habits of 78,485 men who were enrolled in a cancer prevention trial. These patients were followed over a course of 15 years.
Among those men who took a minimum of one acetaminophen tablet per day for five or more years, the rate of developing prostate cancer was 38% lower. In addition, the rate of aggressive prostate cancer in these men was reduced by 51%. No benefit was seen in men who took the drug less regularly or for a period of less than five years.
Often, studies such as this one are based on the patients’ subjective report rather than looking at a controlled experiment, which leads to the possibility of flawed data. That’s not to say that there isn’t truth to this claim however. It just means that more controlled experimentation should be done to confirm the results, and we should always view early research trials with a bit of caution.
That being said, NSAID-based anti-inflammatory medications have been shown in several studies to have an effect on reducing prostate cancer development. Acetaminophen, while not an NSAID, has a similar anti-inflammatory effect on the body. If you remember, last week I also posted information about a study that linked heavy coffee consumption to reduced risk of prostate cancer. That study also stated that the anti-inflammatory properties within coffee may have been the cause for the observed reduction in prostate cancer development. So there seems to be some connection between anti-inflammatory medications and prostate cancer risk, which lends additional credibility to the results of this studies.
Acetaminophen, when taken in recommended amounts, is considered to be a very safe drug. For patients who have risk factors for prostate cancer, such as a family history of the disease, this could be used in an effort to try to prevent its development. Whether you’re a patient or a physician, you can never have too much information, and we’ll keep our eyes open for more news about this drug and its beneficial effects in patients with prostate cancer risk.
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A new study published in The New England Journal of Medicine (NEJM) has come to a very big conclusion; one which will benefit many of the over 200,000 men diagnosed with prostate cancer each year in the United States. The study, performed over the course of 15 years, has confirmed there to be a significant long-term survival benefit for men who choose to undergo a prostatectomy procedure to treat their prostate cancer, rather than watchful waiting.
Watchful waiting is a technique that’s used in which indicators of prostate cancer are monitored for changes that may indicate when it has become aggressive and needs to be treated. The reason this is done is due to how prostate cancer develops. For many men, especially those who are older, the development of prostate cancer is not life-threatening. The disease often grows very slowly with little risk of spreading. However, it can become incredibly serious if the cancer becomes aggressive and spreads. Watchful waiting helps us to try to determine if treatment is necessary by identifying those high risk cases.
It is not an exact science though, and that’s one of the reasons I advocate removing the prostate entirely through robotic surgery. It’s only through removal of the prostate that we can accurately determine the severity of the condition. What the NEJM study has shown is that there is a significant benefit to treating prostate cancer sufferers this way.
The study followed 695 men who were divided between those who received a prostatectomy and those who had their cancer monitored during a period of watchful waiting. What was found was that the men who had their prostates removed were 38% less likely to die from prostate cancer related causes and 48% less likely to have cancer that metastasized.
An interesting thing to note is that, when the results were broken down by age, it was seen that men under the age of 65 gained the most benefits in terms of increased survivability. There was not a drastic increase in survivability in men over the age of 65. Another thing to note is that there have been several advancements in prostate cancer treatment methods since the start of this study 15 years ago. I have no doubt that the survivability rate would have increased even more if the same study were conducted with today’s robotic technology in conjunction with other treatment methods.
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