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All Prostate Disorders Alerts
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Understanding the TNM Prostate Cancer Staging System
Determining the extent of prostate cancer is important for predicting the course of the disease and in choosing the best treatment. The TNM (tumor, nodes, metastasis) staging system is used to describe a cancer's clinical stage, or how far it has spread. This Health Alert provides an explanation of this important prostate cancer staging system. More...
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Clinical Trial Terminology Explained
The National Cancer Institute estimates that between 5% and 8% of cancer patients participate in clinical trials. Why is the number so low? Part of the problem is that many patients believe that all clinical trials include a placebo (an inactive treatment with no known therapeutic value) and treat participants like 'guinea pigs' -- neither of which is true. To help clear up the confusion, this Health Alert explains clinical trial terminology, including randomization, placebo, and blinding. More...
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Surgery With the da Vinci Surgical System
Mohamad E. Allaf, M.D., Assistant Professor of Urology and Biomedical Engineering at the Johns Hopkins University School of Medicine, is the Director of Minimally Invasive and Robotic Surgery at the Brady Urological Institute. Dr. Allaf has performed more than 300 robotic-assisted prostatectomy procedures using the da Vinci Surgical System. In this excerpt from an article in our Prostate Bulletin, Dr. Allaf talks about the advantages of having a radical prostatectomy performed robotically. More...
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Urine-Based Prostate Cancer Screening Test Looks Promising
Today the diagnosis of prostate cancer typically begins with an abnormal prostate-specific antigen (PSA) test or perhaps a worrisome finding on a digital rectal exam (DRE). But because an elevated PSA level can be caused by benign prostatic hyperplasia (BPH), prostatitis, as well as prostate cancer, there is a need for a more specific screening test. Now a report in the journal Cancer Research (Volume 68, page 646) suggests that a urine-based prostate cancer test may be the answer. More...
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The Gleason Behind the Gleason Score
If you have had prostate cancer, you probably know that the Gleason score is the most important factor in predicting your current state of prostate cancer and its probable outcome. The score is based on tumor grade -- an indication of the tumor's aggressiveness. Tumor grade reflects how far the cancer cells deviate from normal, healthy cells, which are highly organized, with well-defined structures. More...
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The Case for Active Surveillance
When a prostate biopsy indicates cancer, you might think you have to choose a treatment quickly. But usually there's no need to rush. Prostate cancer typically is a slow-growing malignancy, and most of the time men have months to consider their options. In this Health Alert, Johns Hopkins explains why active surveillance can be the right choice for some men. … More...
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Getting A Second Opinion
Prostate cancer is usually not an emergency. By taking your time, learning about your illness, and exploring your options, you're likely to make an informed decision that's right for you. And since doctors don't always agree on prostate cancer treatment, many men find it helpful to get a second opinion. More...
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Why the PSA Velocity Test Is So Valuable
In a recent article posted on the Johns Hopkins Health Alerts website, Recent PSA Studies: What You Need To Know, H. Ballentine Carter, M.D., Director of Adult Urology at the Brady Urological Institute at Johns Hopkins wrote: 'I think a lot of the over treatment we see has to do with using PSA as an absolute cutoff. I think PSA velocity, how fast the PSA moves over time, may be a better measure of the presence of lethal cancer.' Here's some basic information about the PSA velocity test. More...
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Can TURP Spread Prostate Cancer?
The choice of treatment for prostate cancer -- active surveillance (also known as expectant management), surgery, radiation therapy, or hormone therapy -- depends on the clinical stage of the cancer and the age and general health of the individual. With increased use of PSA testing, some men will be diagnosed with small prostate cancers (which cannot be felt during a digital rectal exam but are confirmed by biopsy) that pose no immediate threat and may never need treatment. Here's a question from a reader who has chosen expectant management for his prostate cancer. More...
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Recent PSA Studies: What You Need To Know
The recent contradictory studies of more than 240,000 men published in the New England Journal of Medicine (NEJM) about the effectiveness of using the prostate specific antigen (PSA) test for reducing death from prostate cancer left many men and physicians confused, upset, disappointed, and wondering what they should now do. One study reported that PSA saves lives, while the other noted no benefit whatsoever. To help our readers with this confusing data, we asked H. Ballentine Carter, M.D., Director of Adult Urology at the Brady Urological Institute at Johns Hopkins, to provides his thoughts. Here are Dr. Carter's remarks … More...
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Can Vitamin D Prevent Prostate Cancer?
If you thought vitamin D's main role was preventing rickets and strengthening bone, think again. Many researchers now believe that the 'sunshine vitamin' may one day play a key role in preventing the growth of prostate cancer, and in killing rogue prostate cancer cells that have escaped into the body. The data are quite suggestive and vitamin D is a most promising area for prostate cancer research. More...
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Dietary Changes for Metastatic Prostate Cancer
The effects of diet and lifestyle on the progression of prostate cancer are difficult to study and research results are often conflicting. Nonetheless, many men who face prostate cancer look to a healthy low-fat diet with a high intake of vegetables as a way to keep their cancer from spreading. This question and answer on diet and prostate cancer comes from a recent issue of the Johns Hopkins Prostate Bulletin. … More...
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Understanding the TNM Prostate Cancer Staging System
Determining the extent of prostate cancer is important for predicting the course of the disease and in choosing the best treatment. The TNM (tumor, nodes, metastasis) staging system is used to describe a cancer's clinical stage, or how far it has spread. This Health Alert provides an explanation of this important prostate cancer staging system. … More...
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Propecia and Your PSA
If you're a man who takes the hair-growth drug Propecia, you should let your doctor know before you have your next PSA test, as it could affect the accuracy of the results.
The prostate-specific antigen (PSA) test measures an enzyme produced almost exclusively by the glandular cells of the prostate. It is secreted during ejaculation into the prostatic ducts that empty into the urethra. PSA liquefies semen after ejaculation, promoting the release of sperm. … More...
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HIFU: Testing a Novel Prostate Cancer Procedure
High-intensity focused ultrasound, or HIFU (pronounced HIGH-foo), is a promising technology for noninvasive tumor ablation that heats cancerous prostate tumors to near-boiling temperatures. Its potential clinical impact is indeed significant. But given the lack of long-term clinical data, Johns Hopkins advises caution.
Image-guided HIFU procedures could permit the ablation of tumors (not only in the prostate, but also in the liver and lung) without the need for surgery or even an incision. This form of… More...
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Clinical Trials Q & A
In this 'Ask the Doctor' column from the Prostate Disorders White Paper, Johns Hopkins Professor Dr. H. Ballentine Carter answers a question that's on the minds of many men diagnosed with early-state prostate cancer: 'Are there any meaningful clinical trials for prostate cancer patients who are not at an advanced stage?' … More...
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Multivitamins and Prostate Cancer
The underlying cause of prostate cancer is unknown. As with other cancers, however, multiple events over a period of many years are probably necessary to produce a cancerous change in a prostate cell. A recent study links overuse of multivitamin supplements with the risk of fatal prostate cancer.
The development of cancer is broadly viewed as a two-step process. The first step is initiation, when the cell is exposed to substances (such as a chemical), agents… More...
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Refining What PSA Levels Mean
In this excerpt from a recent issue of Health After 50, H. Ballentine Carter, M.D., Professor of Medicine at the Johns Hopkins Hospital, discusses current trends in PSA testing.
Since the prostate specific antigen (PSA) test became widely used in the 1990s, prostate cancer deaths have dropped dramatically. Today one of the biggest problems with PSA testing is that it detects many cancers that are not life threatening and would never have been diagnosed or… More...
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PSA Questions Answered
Is there a reliable PSA cutoff? H. Ballentine Carter, M.D., Professor of Medicine at the Johns Hopkins Hospital, answers this question and others in this excerpt from the Johns Hopkins Health After 50 newsletter.
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Talking with the Pathologist
In this Q and A from the Prostate Bulletin, Dr. Jonathan Epstein, The Reinhard Professor of Urologic Pathology at Johns Hopkins, talks about the intricacies of prostate biopsy.
Q. Is it possible that a 12-core biopsy can miss a prostate cancer?
Dr. Epstein. Most of the time, good sampling of the prostate means taking 10, 12, or 14 or more cores. Even so, there is potentially a high likelihood of biopsy missing cancer. This depends on where… More...
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Understanding the Risk Factors
In this Health Alert from the Prostate Bulletin, Dr. Jacek Mostwin and colleagues discuss five important risk factors for prostate cancer.
Age, race, and family history are important risk factors for prostate cancer. Diet and lifestyle factors may also influence whether a man develops the disease. No clear association has been found between the development of prostate cancer and smoking, vasectomy, the presence of benign prostatic hyperplasia (BPH), or regular alcohol intake (although binge drinking… More...
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Dr. Mostwin Answers Readers’ Questions
In this Health Alert, Dr. Jacek L. Mostwin, a urological surgeon at Johns Hopkins, answers readers' questions about prostate cancer treatment. The questions come from a recent issue of the Johns Hopkins Prostate Bulletin. Prostate Cancer Question 1: RADIATION OR SURGERY
Q. Well, I am now officially a member of the 'prostate cancer club.' My doctor called me yesterday with my biopsy results: Gleason 7 and PSA of 6.8 ng/ml. I am 63 years old and will… More...
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Is Watchful Waiting for Prostate Cancer Safe?
Is watchful waiting (close monitoring rather than immediate surgery) for low-grade prostate cancer a safe alternative? New research from the Journal of the National Cancer Institute offers guidance.
Today watchful waiting for prostate cancer is most often recommended for men with low-grade prostate cancer that is believed to be small volume, especially older men whose prostate cancer is unlikely to become life threatening during their remaining years of life. … More...
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Two Studies Link Erectile Dysfunction with Cardiovascular Disease
Two Studies Link Erectile Dysfunction with Cardiovascular Disease Erectile Dysfunction Linked to Cardiovascular Disease and Diabetes
A study of nearly 4,000 men with an average age of 57 found that nearly half had experienced erectile dysfunction in the last month or were taking erectile dysfunction drugs. The development of erectile dysfunction was strongly related to the presence of cardiovascular disease (CVD) and diabetes, probably because of their negative effects on blood vessel function. … More...
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Obesity, Hyperglycemia, and BPH
Benign prostatic hyperplasia (BPH) is the most common benign growth process in men. But the cause of this serious condition is not well understood. A recent Hopkins study sheds light on a possible link between enlarged prostate, hyperglycemia, and obesity.
The term hyperplasia refers to an overgrowth of tissue or any abnormal accumulation of cells that causes an organ or area of the body to enlarge. In benign prostatic hyperplasia (BPH), prostate cells accumulate, and the… More...
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Prostate Cancer in the Family
Is there a history of prostate cancer in your family and if so, what should you do? In this Q & A from an issue of the Johns Hopkins Prostate Bulletin Dr. Jacek Mostwin gives advice to a reader from California with prostate cancer in the family.
Question. My grandfather died of prostate cancer at 58, and a first cousin on my father's side was also diagnosed with prostate cancer at 66; he sought treatment, and… More...
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Grand Rounds Questions and Answers
Urinary incontinence and erectile dysfunction are two major concerns of men facing radical prostatectomy. In this dialogue from a recent issue of our Prostate Bulletin, Johns Hopkins specialists respond to patients’ questions about these important issues.
Q. One of the major reasons I decided to have surgery for my prostate cancer was that I thought I would be able to maintain my erections after my prostate was removed. I am 72 years old and I went… More...
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What to Look For in a Prostate Cancer Surgeon
Dr. Patrick Walsh, former director of Hopkins’ Brady Urological Institute, shares his insights on choosing a doctor for your cancer surgery.
Dr. Patrick Walsh, dean of prostate cancer surgeons, has performed the technically challenging radical prostatectomy procedure thousands of times, and has personally schooled hundreds of surgeons in the finer points of the difficult nerve-sparing cancer operation. He certainly knows what it takes to be an expert in curing a man of cancer, preserving bladder function,… More...
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Using PSA Velocity to Predict Prostate Cancer Risk
Johns Hopkins researchers have found that PSA velocity can predict prostate cancer many years in advance when it is more curable.
PSA velocity is a measurement of how quickly a man's prostate-specific antigen (PSA) level rises from one year to the next. A rapid rise in PSA (a high PSA velocity) suggests the presence of prostate cancer. A study from Johns Hopkins and the National Institute on Aging found that an increase in PSA level… More...
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Calcium: Friend or Foe?
Calcium, a mineral abundant in dairy products, is important for maintaining strong bones and teeth and preventing the bone thinning disease osteoporosis. Studies also suggest that an adequate calcium intake reduces the risks of hypertension and colon cancer.
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Fighting Prostate Disease with Phytotherapy
Phytotherapy -- the use of herbs or other plant-based products to prevent or treat a health condition -- is popular among men with prostate problems. In fact, a study reported in Urology found that one third of prostate cancer patients had used some form of alternative or complementary medicine: vitamin or mineral supplements, herbs, antioxidants, or supplements promoted for "prostate health.”
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Joining a Clinical Trial
Even though all patients want therapies that will keep their cancer in check, it is estimated that only 3% of the possible number of people who would be candidates for clinical trials of novel cancer agents actually enroll in clinical trials. What will help push the science forward at a greater pace is having more men enroll in clinical trials of experimental prostate cancer therapies. More...
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A Better Blood Test For Prostate Cancer
This article on EPCA-2 testing for prostate cancer comes from a recent Johns Hopkins Medicine Press Release.
New studies of a blood protein recently identified at Johns Hopkins, early prostate cancer antigen-2 (EPCA-2), may change the way men are screened for prostate cancer -- a disease that kills over 27,000 men every year. … More...
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Your PSA Questions Answered
I am 56 years old and just had surgery for my prostate cancer (5.5 ng/ml, Gleason 6). Everything went fine. I amazed my doctor by going surfing less than a month after the surgery. My question, however, has to do with my son, who is now 30 years old. When should he have his first PSA test? More...
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PSA Terminology Explained
All men, aged 40 or so, undergo PSA (prostate-specific antigen) testing to screen them for prostate cancer. PSA is an enzyme produced almost exclusively by the glandular cells of the prostate and normally only very small amounts of PSA are present in the blood. High levels of PSA can indicate prostate problems, including BPH and prostate cancer. But high PSA levels can also be caused by a variety of daily activities. Recently, researchers have developed several ways to improve the PSA test’s accuracy. More...
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News on BPH from Johns Hopkins
Researchers at Johns Hopkins reported finding substantially higher levels of a protein made by a gene known as JM-27 in men whose BPH is more severe and more likely to lead to bladder-related complications if left untreated. The study was published in the February 2007 issue of the Journal of Urology.
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Saw Palmetto Losing Ground
Hopkins professor, Dr. H. Ballentine Carter, reviews the data on saw palmetto for BPH symptoms.
Saw palmetto, otherwise known as serenoa repens and sabal serrulata, is an over-the-counter herbal supplement made from the fruit of the American dwarf palm tree. Its manufacturers claim that saw palmetto can ease the urinary symptoms of an enlarged prostate, or benign prostatic hyperplasia (BPH), faster and with fewer side effects than prescription treatment. … More...
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Getting an Accurate Diagnosis for Prostatitis
Effective treatment for prostatitis depends on nailing down the diagnosis.
Prostatitis is a broad term for an infection or inflammation of the prostate. Over the past decade, urologists have identified four types of prostatitis: Acute bacterial prostatitis is a sudden-onset infection that lasts for several days. Chronic bacterial prostatitis is a recurrent infection that can last for weeks, subside, and then flare-up again. Chronic non-bacterial prostatitis/chronic pelvic pain syndrome (CPPS) is diagnosed when no infectious organism can… More...
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The Inflammation - Prostate Cancer Link
Chronic inflammation may promote the development of prostate cancer.
Inflammation is a sign that the immune system is doing its job in protecting us from infectious agents and injuries. But chronic inflammation has been associated with a wide range of diseases. Today scientists know that inflammatory cells produce free radicals—toxic molecules that can damage cells, especially cellular DNA. This type of DNA damage (also called oxidative damage) can cause genetic alterations (mutations) that lead to the… More...
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Recent Research Spells Good News for Prostate Cancer Patients
Men with early prostate cancer who follow a strict vegetarian diet, exercise regularly, and practice stress reduction techniques may be able to lower their PSA levels and their risk of cancer progression, according to a study from the Journal of Urology. Researchers wanted to test the ability of a very low-fat diet (10% or less of daily calories) to slow or prevent worsening of early prostate cancer. More...
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Get Your FREE Special Report: 7 Keys to Treating Prostate Cancer
Dear Health Alert Subscriber,
This Johns Hopkins Special Report: 7 Keys to Treating Prostate Cancer, is our gift to you as a registered Health Alert reader, in recognition of Prostate Cancer Awareness Month. We hope you’ll read it and share it with your loved ones.
The American Cancer Society estimates that 232,000 new cases of prostate cancer will be diagnosed in 2006. 27,000 men will die of the disease. The good news is that prostate cancer is… More...
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When Watchful Waiting Is the Right Choice for Prostate Cancer
Prostate cancer is considered one of the most treatable cancers — detected at an early stage in up to 80% of cases, often slow growing, and typically curable if it is diagnosed before it has spread outside the prostate gland. In fact, some tumors may never become life threatening, even without treatment. Yet because physicians can’t tell which prostate cancers will be aggressive and prone to spread, a certain number of men are treated unnecessarily for prostate cancers that might not have posed significant health risks. More...
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What's Your Prostate Symptom Score?
Here’s an easy way to calculate whether you need treatment for benign prostatic hyperplasia (BPH).
The International Prostate Symptom Score questionnaire (see below) was developed by the American Urological Association to help men evaluate the severity of their symptoms from benign prostatic hyperplasia (BPH). This self-administered test can help determine which type of prostate treatment is needed, if any. … More...
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What to Expect from a Prostate Biopsy
If you're facing a prostate biopsy, it's natural to be apprehensive. Here's a realistic guide to this commonly-performed procedure.
An abnormal prostate-specific antigen (PSA) test provides an important clue to your prostate health. But it cannot determine with certainty whether you have prostate cancer. Until more sophisticated tests are developed, a biopsy of the prostate -- though not perfect -- is the best way to find out whether a high PSA level indicates cancer. … More...
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The DRE -- Don't Skip It
Because the prostate gland cannot be seen or felt externally, your doctor will regularly perform a digital rectal examination (DRE) to assess its size, shape, and consistency. A DRE is among the steps necessary to diagnose benign prostatic hyperplasia, or BPH. In tandem with prostate specific antigen (PSA) testing, the DRE exam is also an essential screening tool for prostate cancer.
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