September 08 Newsletter Articles

New Websites Launched by Physicians

A new website has been developed by Dr. Gerald Chodak, a prostate cancer specialist with 25 years experience. This unique new website will be entirely in a video format as if you are sitting in a doctor's office listening to the information. The information is evidence-based, meaning that it reflects the results of good scientific studies. When good studies are not available, all the options will be discussed. This site will enable patients to understand the controversies and uncertainties that exist.

There are three goals this site hopes to achieve: To educate men and their families about all aspects of prostate cancer, to inform them of all the treatment options, and to empower them to ask good questions that will help them get the most appropriate treatment.

Dr. Chodak has published over 150 scientific articles, has been invited to speak in 14 countries on prostate cancer and helped form Us TOO back in 1990.

The website is reached at <www.lprostatecancer.com
for a direct link or even more directly by going to <www.chsdak.answerstv.com> It was made possible by an educational grant from AstraZeneca Pharmaceuticals

Dr. Arnon Krongrad, Founder of the Krongrad Institute, also announced this week he is bringing back to life the Prostate Cancer InfoLink,<http://prostatecancerinfolink.net>. Dr. Krongrad and his friend Mike Scott are using web 2.0 technology to include a blog and a social network at <http://prostatecancerinfolink.ning.com> where you can invite friends, form groups, and share ideas.

New Report Compares Prostate Cancer Treatment Outcomes

People who undergo complete prostate removal are less likely to experience urinary incontinence or other complications if the operation is done by an experienced surgeon in a hospital that does many of these procedures, according to a report funded by the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services.

However, the new report concludes that scientific evidence has not established surgery or any other single treatment as superior for all men. The analysis compared the effectiveness and risks of eight prostate cancer treatments, ranging from prostate removal to radioactive implants to no treatment.

"This report is a reminder that patient outcomes may vary according to treatment settings," says AHRQ Director Carolyn M. Clancy, MD. "But this analysis also underscores a broader message: when it comes to prostate cancer, we have much to learn about which treatments work best, and patients should be informed about the benefits and harms of treatment options."

In 2007, about 218,000 men were diagnosed with prostate cancer. The primary goals of treatment are to determine whether an intervention is needed to prevent death and disability and to minimize complications. Treatment choices often take into account a person's age, race, ethnicity, health status, family history, personal preferences, and how quickly the cancer is likely to spread.

The lifetime risk of being diagnosed with prostate cancer has nearly doubled to 20 percent since the late 1980s, due mostly to expanded use of the Prostate Specific Antigen (PSA) blood test. But the risk of dying of prostate cancer remains about three percent. Therefore, considerable over-detection and over-treatment may exist.

AHRQ's new report, based on a review of 592 published articles, compares eight prostate cancer strategies: complete surgical removal of the prostate and related tissue; minimally invasive surgery to remove the prostate; external radiation; radioactive implants; destruction of cancer cells through rapid freezing and thawing; removal of testicles or hormone therapy; high intensity ultrasound; and no immediate treatment, also known as "watchful waiting."

The report, compiled by AHRQ's Minnesota Evidence-based Practice Center, is intended to provide unbiased, evidence-based information so that patients, clinicians, and others can make the best treatment decisions possible. The following are some of its conclusions:

• Not enough scientific evidence exists to identify any prostate cancer treatment as most effective for all men, especially those whose cancers were found by PSA

PROSTATE CANCER PATIENT SUPPORT 1 800 80 Us TOO

testing. However, more than 90 percent of people reported they would make the same treatment decision again, regardless of the treatment they received.

• All treatment options cause health problems, primarily urinary incontinence, bowel problems, and erectile dysfunction. The chances of bowel problems or sexual dysfunction are similar for surgery and external radiation. Leaking of urine is at least six times more likely among people who undergo surgery than those treated by external radiation.

• One study showed that men who choose surgery over watchful waiting are less likely to die or have their cancer spread. The benefit appears to be limited to men under 65. However, because few participants in this study had cancer detected through PSA tests, it is unknown if this finding would apply to those whose cancers were detected through PSA screening. Another smaller study showed no difference in survival between surgery and watchful waiting.

• Among people who choose surgery, urinary complications and incontinence are less likely if their surgeons performed more than 40 prostate removals per year.

• Surgery-related deaths, urinary complications, and re-admissions were lower and hospital stays were shorter in hospitals that performed more prostate removals.

• A lack of research makes it impossible to compare several treatments: rapid freezing and thawing (cryotherapy), minimally invasive surgery (laparoscopic or robotic assisted radical prostatectomy), testicle removal or hormone therapy (androgen deprivation therapy), and high-intensity ultrasound or radiation therapy.

• Adding hormone therapy prior to prostate removal does not improve survival or decrease recurrence rates, but it does increase the chance of adverse events.

• Combining radiation with hormone therapy may decrease mortality. But compared with radiation treatment alone, the combination increases the chances of impotence and abnormal breast development.

Action! The report, Comparative Effectiveness of Therapies for Clinically Localized Prostate Cancer, is the newest analysis from AHRQ 's Effective Health Care program. This program represents an important federal effort to compare treatments for significant health conditions and make the findings public. Information on the program, including full reports and summary guides, can be found at www.effectivehealthcare.ahrq .gov.