Selenium’s Effect on Cancer Development

Written on 12 May 2011 by

It happens very often that a vitamin, mineral, or a combination of them in a supplement form is said to reduce the risk of cancer. Often times these are things that are found in our daily diet when eating healthy. The benefits of taking large quantities of these vitamins and minerals are often overstated, incorrect, or simply misunderstood. This is sometimes due to an honest lack of data, but other times as part of a marketing campaign in order to increase supplement sales.

In a previous blog post I wrote about how high doses of Omega-3 fatty acids, which do have health benefits on their own, actually increase prostate cancer risks instead of reducing them. This was a shock to the medical community as it was commonly believed that Omega-3s played a role in reducing cancer risks. In a post prior to that I covered a lawsuit put forward by the Federal Trade Commission (FTC) toward POM Wonderful for the bold claims that their pomegranate extract helped to prevent various diseases including cancer. It was found that the data to support POM’s claims was severely lacking. Now, a new study has been released that shows that Selenium, a mineral which has been claimed to have cancer fighting benefits when taken in large doses, not only has no benefit, but can even be toxic.

This study, which looked at the data from 49 observational studies and six randomized, controlled trials, ultimately found that there is no direct link between increased Selenium intake and reduced cancer risk. While the observational studies showed what appeared to be a slight correlation between the two, the more accurate controlled studies showed that to not be the case. It’s believed that one of the reasons that the observational studies had this discrepancy is that the people who took part in them, who had higher Selenium levels, simply had a better nutritional intake overall – and good overall health is a cancer prevention method.

This very much ties into what I said in my post about Omega-3s. The key to staying healthy is to live healthy. There is nothing we can do to entirely remove the risk of developing cancer, as cancer does not discriminate. However, we can reduce our risks by eating well, maintaining a healthy weight, getting plenty of exercise, and preventing ourselves from being around known cancer causing agents such as alcohol and cigarettes.

There is no single vitamin, mineral, or pill that we can take to stay cancer free. Overall good health, with appropriate amounts of our essential nutrients, provides us with the best chance though.

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Prostate Cancer Surgery No Longer Means Dealing with Incontinence or Impotence

Written on 3 May 2011 by

Dr. David Samadi performs a robotic prostatectomy procedure on a patient.Last week, while discussing my collaboration with fashion designer Carmen Marc Valvo, I touched upon some of the reasons why men are hesitant to seek out screening and treatment for prostate cancer. I made the point that one of my goals is to help men understand the truth behind incontinence and impotence after prostate surgery, and that is the purpose of the information I want to share today.

I understand how important both topics are to men. No young man who is undergoing treatment for prostate cancer would ever want to consider the fact they may have to wear adult diapers or see an end to their sex lives. As we diagnose prostate cancer sooner in men through better screening methods however, this has become a reality that many have had to face. This is also one of the reasons why I developed the SMART surgery technique; so I could provide my patients with a greater quality of life after surgery.

SMART surgery (Samadi Modified Advanced Robotic Technique) is what is called a “nerve-sparing technique.” It combines the most effective aspects of open surgery and laparoscopic surgery, and applies those to the robotic platform. Due to the increased range of motion in using the robot, and the easier access that it provides to the prostate, parts of a traditional open surgery can be entirely removed from the equation. There is no need to open the endopelvic fascia and the dorsal vein is not sutured until after the rest of the procedure is complete. What this means is that the risk of damaging the nerves that surround the prostate is greatly reduced; these nerves are what control both sexual and urinary function in men.

The ability to perform the procedure in this way is one of the amazing benefits of robotic prostatectomy surgery compared to other treatments such as radiation. While there are advancements in better targeting radiation treatment towards just the cancer-stricken areas of the prostate, damage does still occur to the surrounding tissue and nerves, causing those continence and sexual function issues that men are so concerned with. Eight to ten percent of men will experience incontinence after radiation therapy, and over 50% of men will see a permanent change in their sexual potency.

Using the SMART surgery technique we have been able to achieve rates much more in favor of the patient, with 97% of them regaining continence and 85% regaining sexual function within one years’ time. For those who are still afflicted with either incontinence or impotence, there are effective treatment methods for both including surgical options if necessary. The truth of the matter is that as treatment methods improve, so do the outcomes; treating prostate cancer no longer means losing your basic bodily functions. As younger and younger men are treated, this becomes an increasingly important issue to those expecting a full, gratifying, and normal life post-surgery.

Please feel free to share your stories on this matter by leaving a comment below. Any information provided by prostate cancer survivors is always a beneficial resource when helping to educate others about this condition.

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My Collaboration with Famed Fashion Designer Carmen Marc Valvo

Written on 13 April 2011 by

Dr. David Samadi and fashion designer Carmen Marc Valvo pose together.  Dr. Samadi and Valvo have teamed up to raise awareness of prostate and colon cancer screening and treatment methods.Lately I’ve been talking a lot about the importance of early detection and screening and the positive effect both have when it comes to successfully treating prostate cancer.   The first step in encouraging men to see their doctors and to have their PSA (prostate-specific antigen) and DRE (digital rectal exam) tests done is through educating both men and their loved ones about this disease.  For many men, the screening process as well as the possible side-effects of prostate cancer treatment can be frightening and embarrassing.  This is a roadblock we must navigate to further increase early detection and prostate cancer survival rates.

When faced with the thought of prostate cancer it’s important for men to be able to count on their families, especially their significant others, to understand their fears about how the cancer can affect their lives – such as the possible loss of continence and sexual function after treatment.  This is why I feel it’s so important for us to educate women about prostate cancer: because the men in their lives may need their support, understanding, and encouragement in order to get tested and treated.  This need for support is a key reason for my collaboration with famed fashion designer Carmen Marc Valvo.

Carmen, who designs clothing for Neiman Marcus and Saks Fifth Avenue, and has been dressing Hollywood’s most famous actresses for 30 years, is himself a colon cancer survivor.  He was diagnosed with the disease in 2003 after a malignant growth was found during a voluntary colonoscopy.  Because the cancer was caught early he was able to have it successfully removed and now enjoys life cancer free.

Much like prostate cancer, colon cancer has a very high survival rate when caught early – and this is the message that both Carmen and I want people to understand.  I feel that with his reach and notoriety, Carmen is in a unique position to further educate fashion conscious men and women about both diseases and help prevent unnecessary deaths.  Through his story I hope he will be able to alleviate some of the anxiety men have about cancer screening and treatment, either directly, or indirectly through educating their loved ones who can then play a supportive role.

For more information about our collaboration please read the following story:
International Robotic Prostatectomy Expert Dr. David B. Samadi and American Fashion Mogul Carmen Marc Valvo Campaign to Raise Awareness of Prostate and Colon Cancers

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The Search for Better Prostate Cancer Diagnosis and Treatment

Written on 11 April 2011 by

I’ve mentioned several advancements and new findings in prostate cancer screening methods over the past few months: liquid biopsy screening; the benefits of PSA screening (as well as the controversy); and even the link between balding and prostate cancer.  I also covered prostate cancer treatment options in my last post, and work hard to clear up misconceptions people may have about surgical treatment; such as being too overweight to be a candidate for it or not being able to have surgery due to previous radiation therapy.

A major purpose of this blog is to share this information with as many people as possible; to make them aware of the options currently available for themselves or their loved ones, in addition to making people aware of what the future holds not only for prostate cancer treatment, but treatment of cancer in general.  This week I wanted to discuss a couple new screening and treatment discoveries that may have an effect on how we treat cancer a couple years down the line.

For those of you who follow my blog I’m sure you’ve seen mention of a study that calls the efficacy of PSA (prostate-specific antigen) testing into question.  I, personally, do not agree with the conclusion that the study presents and remain an advocate for regular PSA testing.  With that said, I welcome additional screening methods that can better prevent doctors from performing unneeded biopsies and treatments.  A new, more advanced and more accurate PSA test has recently been announced that hopefully will allow just that.  This new method looks at a more specific portion of PSA called (-2) Pro-PSA, and then compares it versus free-PSA and total PSA through a mathematical formula.  The end result is that a high Pro-PSA and total PSA, and a low free-PSA, is a good indicator of the presence of aggressive forms of prostate cancer which would require treatment.  This new test has been approved for use in Europe, and will hopefully see use in the US soon.

In addition to this new screening method, there have been two recent discoveries in possible prostate cancer treatment methods.  The first comes in the form of a medication that has already been widely used for treatment of heart disease called “digoxin.” A recent study has shown there to be a potential link between the use of this drug and a lower incidence of the development of prostate cancer.  This was found by a process called “drug repositioning” in which research is done on existing drugs to see any additional effects that they had during their intended usage over the years.  It was found that regular users of the drug had a 24% reduction in the incidence of prostate cancer, and those who used it for 10 years saw a 46% reduction in risk.  While more testing would need to be done on the specific effects that digoxin plays on the development of prostate cancer, this gives researches a starting point and a long history of information about the drug that they can leverage.

A new, potential treatment for prostate cancer has also been developed that uses a patient’s white blood cells to carry a cancer-destroying virus.  While this technology is still very new it shows a lot of promise.  It works by carrying the infected cells to the location of the tumor, and upon being exposed to the low-oxygen environment of the tumor the cells are triggered to create more of the virus – which in turn dissolves the cancer from within.  Using this type of virus itself is not a new advancement, but the replication process is.  This new method allows for better accuracy and treatment while requiring a smaller initial amount of the virus to be injected, and also protects it from the body’s natural immune response.  What’s exciting about this is that by changing the trigger parameters, this method can be modified to treat other cancer types as well.

It’s always interesting for me to see the ideas that researchers come up with that allow doctors to better diagnose and treat their patients.  As long as this research is being conducted I’ll remain dedicated to sharing this information with my readers.  With prostate cancer affecting 1 out of 6 men in their lifetime this is an important topic of discussion, and education goes a long way in saving the lives of those affected by this disease.

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Back to Basics: Prostate Cancer and Treatment Options

Written on 8 April 2011 by

A portrait of robotic prostatectomy expert, Dr. David SamadiProstate cancer is the second leading cause of cancer death in American men, with lung cancer being number one. About 1 in every 6 men will be diagnosed with prostate cancer during his lifetime, and over 27,000 men die from it yearly. However, thanks to patient education and awareness, advancements in treatment options, and regular screenings and early detection, more men are surviving this disease than ever before.

The best advice in cancer prevention is to lead a healthy lifestyle; starting with a proper diet, getting enough exercise and staying away from risky activities such as smoking and drinking. These factors can go a long way in cancer prevention. However, the best preventative measure for prostate cancer is diligence – especially with prostate cancer screenings. I routinely counsel my patients to partner with their doctors to receive regular PSA tests every three to six months, annual digital rectal exams and repeat biopsies if there is a rise or fluctuation in PSA levels.  Despite the news floating around about the efficacy of PSA screening, it has been shown through various studies that it does truly work in diagnosing prostate cancer while it’s still early.

The question that many men have on their mind when they receive a prostate cancer diagnosis is, “Is this an automatic death sentence?”  It certainly is not. More than 2 million American men who have been diagnosed with prostate cancer at some point in their lifetime are still living today and are able to talk about their experiences with the disease. If caught early, the cancer is over 95% curable.

There are many options nowadays to treat prostate cancer – the best of which comes down to your own specific case. Factors like Gleason, PSA and DRE scores, age, health and family history need to be taken into account; with treatment being individualized according to these factors. Available prostate cancer treatment options include:

Understandably, many men are fearful of the side effects of these treatments, making the decision to pick one option over another very difficult.  That’s why it’s important that men speak to their doctors in detail about the positives and negatives of each option and the needs for their specific case.

Two major concerns men face with surgical options are the risks of incontinence and impotence.  However, with advancements in robotic treatment options we have been able to drastically reduce these as risk factors.  With robotic surgery being a minimally invasive procedure there is less pain associated with the surgery, minimal blood loss, and recovery tends to be very quick.

Robotic surgical methods provide the best chance at long-term survival as the cancer is removed entirely from the body.  Should there be a recurrence of cancer in the surrounding tissue then the surgery can be followed up with radiation therapy.  Starting with radiation therapy before surgery makes any future surgical options much more difficult, with only a handful of surgeons able to perform what is called a “salvage robotic prostatectomy”.

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New Study Calls into Question the Benefits of Prostate Cancer Screening

Written on 4 April 2011 by

A new study, performed in Sweden and published in the British Medical Journal, has called into question whether doctors should be regularly screening men for prostate cancer.  According to the study there is no long-term survivability benefit gained when comparing a group of men who received screening to a control group that did not.  This is a subject that comes up fairly often, with studies showing a case to be made both for and against screening.  I personally believe there is a great benefit in attempting to detect and treat prostate cancer early, and disagree with the methods used in this study.

As with all studies, we need to be careful to look at the data and testing methods in order to come to an educated conclusion about what is being said.  This particular study followed a group of 9,026 men over a period of 20 years, with a group of 1,494 of them being chosen at random to receive prostate cancer screening every 3 years.

A major problem with how this study was conducted is that PSA (prostate-specific antigen) levels, currently our best indicator of the presence of prostate cancer, were not monitored for the first 6 years of it.  Early screening was based entirely on digital rectal exams, which we know are not an accurate method for detecting prostate cancer when used alone.  A major part of proper screening is looking at the person as a whole to determine whether they’re at high risk for the disease; making an assessment based on those factors and what the tests tell us.  This includes performing digital rectal exams, checking PSA levels and the rate at which they rise over time, and paying attention to a patient’s family history, lifestyle, and other risk factors.

Another area not addressed is the treatment methods that men who were diagnosed with prostate cancer received.  We need to keep in mind that a lot has changed in cancer treatment over the course of 20 years, especially with the introduction of robotic surgery.  The study does state that those men who received regular screening were discovered to have smaller tumors which were less likely to have spread.  Anyone who follows my blogs and videos knows that detecting prostate cancer early plays a major role in terms of treatment options and cure rate these days.

When done properly I feel that screening is of a great benefit.  While there are studies that call PSA testing into question, it’s my opinion that it’s still one of the best tools that we have when combined with all of the information we can gather about a patient.  The fact that PSA testing was not performed in the beginning of the study instantly makes me question its validity.

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The Technology Behind Cancer Treatment is Always Advancing

Written on 30 March 2011 by

Back in November of last year I discussed a new technology on one of my Fox News segments called “Liquid Biopsy”.  Through the use of microscopic silicon fibers coated in antibodies this technology allows us to filter a person’s blood to discover cancer cells circulating within their body.  As many readers may know, after cancer metastasizes, or spreads to organs outside of its originating area, it is much more difficult to treat.  That’s why the information that we can gather from a liquid biopsy is so important.

Early versions in 2007 were about 60% accurate, and over the past couple of years that accuracy rate has been brought up to 90%.  The test is now capable of detecting a single cancer cell in an 8cc sample of blood.  Last week an article was published describing how Mehmet Toner, a bioengineer from Harvard, and Brian Wardle, an aeronautical engineer from MIT, worked together to further improve on the process by switching the filtering method from silicon fibers to porous carbon nanotubes.

In the original version the silicon fibers were coated with antibodies, and as blood passed around the fibers cancerous cells would stick to them.  It was possible, however, that some cells may never pass by the fibers due to the gaps between them, preventing the cancer from being detected.  To increase the accuracy of the test the switch to carbon nanotubes was made.  These nanotubes not only allow blood to flow around them, but through them, greatly increasing the odds that cancer cells will come in contact with their antibody coated walls.

Another effect of using porous filtering structures is that they can detect more than just cancer cells, they can also detect much smaller viruses such as HIV.  This means that in a couple years HIV screening will no longer require labs and expensive equipment.  This technology can offer doctors a simple, portable, cheap, and accurate method for diagnosing patients, which would be especially useful in developing countries.

While the technology is still 3-5 years away from clinical use, seeing these advancements in the process is extremely exciting.  Any methods that we can use to further provide a better level of care and quality of life to patients is welcome.

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Prostate Cancer Survivor’s Story of a Robotic Prostatectomy Redo

Written on 28 March 2011 by

In the past month I’ve made two blog posts about how experience is such a key factor when dealing with robotic prostate cancer treatment.  Men who are overweight and men who have had radiation therapy before surgery are often told they’re not candidates for a robotic prostatectomy, but the truth of the matter is that many surgeons just don’t have the necessary training to help these men.

For some men this is something that they have to find out first-hand.  Last month I operated on a man named Steven M. who went through an experience that no man should.  In late 2009 he was diagnosed with prostate cancer.  Like every man in his position should he researched not only his treatment options but also his doctors.  He ultimately decided on a robotic prostatectomy as he is young and wasn’t satisfied with the long-term outcomes of radiation therapy.  He also chose a doctor who had performed 600 successful prostatectomy operations with the da Vinci robot – a number he thought was more than enough for proficiency.  He saw the doctor for a consultation and was told he was a great candidate for the procedure.  Steve was doing everything by the book and everything I would suggest of a man in his circumstances.

The day of the operation he entered the operating room expecting to be cured.  He was put under general anesthesia, ready to have his life given back to him.  Upon waking up 2 hours later he was instead given some bad news: the doctor told Steve that he had to abort the procedure because he felt there was too much risk in damaging his lungs due to the pressure being put on them by his weight.  Steve was devastated, and felt defeated.

A patient of mine, who met Steve through a friend, called me one day to tell me about his situation and gave me Steve’s phone number.    I gave Steve a call and convinced him to come to New York for a consultation.  When I looked at the areas where his previous doctor had made the incisions to place the robotic arms I could tell things were not right.  I told Steve I was confident that I could help him and he had faith in me.

On February 14th of this year Steve came in for his operation.  His weight was not an issue.  In fact, the surgery went incredibly well and was completed in just under an hour.  In just over a month he has fully regained his urinary control and his sexual function is making a return.

Steve’s story is really a touching one, especially when reading it in his own words.  If you would like to read the full story complete with quotes directly from Steve I urge you to click here.  What people need to take away from this is that you should never let cancer make you feel defeated.  Explore all of your options, and if one doctor tells you they can’t help you, get a second opinion.

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Robotic Surgery after Radiation Therapy – It is Possible

Written on 21 March 2011 by

Two weeks ago I wrote a post about a common misconception that many men have regarding obesity and the ability to have prostate cancer surgery.  Hopefully the information contained in that post was able to put some minds at ease.  I know there’s another segment of the population though who are also concerned about whether surgery is an option – men who have had ineffective radiation treatment for prostate cancer in the past.

Men are commonly told that it’s possible to be treated with radiation after surgery if needed, but that surgery after radiation is not an option.  The reason why this is said is because radiation treatment does damage to the tissue around the pelvic area, making post-radiation surgery a more complicated procedure with increased risk of damaging the bladder and rectum.

However, more complicated does not mean that it’s not an option.  Earlier this month I successfully performed a post-radiation robotic prostate removal procedure on Jan des Bouvrie, a renowned Dutch interior designer.  It’s known as a “Salvage Robotic Prostatectomy”.  It’s not a very common procedure, and few surgeons can successfully perform it due to the experience needed with the da Vinci robot, but the option does exist.

In Jan’s case he received radiation therapy after being diagnosed with prostate cancer.  Five years later, his cancer returned.  Like anyone would do he continued to research the treatment options available to him to cure his cancer.  Ultimately he decided he wanted to have his prostate, along with the cancer, removed entirely through surgery despite the risks he had read about.  Jan’s research led him to me based on my experience with the da Vinci robot, the salvage robotic prostatectomy procedure, and over 3,300 successful robotic prostatectomy procedures in total.  I’m happy to say that Jan is doing well back home in Netherlands with no signs of prostate cancer.

I hope that the information here has put some more minds at ease.  It’s important for men to know all of the options that are available to them when making decisions on their health.  While a salvage robotic prostatectomy does carry more risks with it than a normal robotic prostatectomy, the option is there.  With an experienced surgeon, those additional risks can be minimized.  I often suggest that men who have prostate cancer spend just as much time researching their doctors as they do their treatment options.  Especially in cases like these, it’s important to find a surgeon who is knowledgeable and experienced in performing the task at hand.

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Advancements in Prostate Cancer Treatment Technology are Worth the Cost

Written on 18 March 2011 by

A new study released this week in the Journal of Clinical Oncology calls into question the rapid adoption of new technologies being used to treat prostate cancer.  The study states that these newer technologies, of which robotic prostatectomy is included, have not been proven to add a level of benefit equal to the increase in cost on a per procedure basis.

I have read similar studies in the past, and have even publicly commented on a couple of them.  The issue that arises with these studies is that they don’t tell you the whole story.  Much like with the study performed by Dr. Jim Hu and the one performed by The Cancer Institute of New Jersey this study has some glaring flaws.  One important factor is that it does not differentiate between open laparoscopic surgery and robotic surgery when talking about surgical treatment options.  It also does not take into account complications that arise from traditional treatment options that require further medical attention such as impotence, urinary incontinence, and a recurrence of cancer.  These risks are greatly reduced through robotic surgery performed by a skilled surgeon, something that this study fails to take into consideration.  Robotic surgery may be more costly when simply looking at the price of the procedure, but when you consider the lack of follow-up treatment necessary and increased quality of life for the patient, it ends up being a more cost-effective option.

The study states that, “Even if there is some underlying clinical benefit to these newer more expensive therapies, it is still important to ask whether the marginal benefit of these therapies is large enough to justify their higher cost…”  As stated above, I personally do not believe the benefit of a robotic prostatectomy to be “marginal” when compared to the alternatives.  I feel that the results that I and other surgeons have been able to achieve prove that robotic surgery provides the best results that can currently be achieved.  In my practice we have a 97% cure rate, 96% of my patients regain urinary continence, and 85% of my patients regain sexual function.

When treating prostate cancer we can’t just look at the cost of the surgery and studies using dated materials when determining whether a new method has benefit.  We need to look at the outcome; the people who have been given their lives back.  Surgeons who actually perform these procedures and see the outcomes for themselves can give you a much better idea of the benefits you’ll see by picking a more advanced treatment option.

If prostate cancer is something you’re facing I strongly urge you to research all of the treatments available to you.  I also urge you to research your doctors.  Talk to them about the procedures they perform, their methods, their success rates and post-operative continence and potency rates.

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