Health and Prostate

Persistent bone pain in the back or hip region is one of the most common presenting symptoms of metastatic disease. The imaging modality of choice in this situation is the radionuclide bone scan. This will reveal the most common sites of spread to be the spine (74%, most commonly the lumbar and thoracic region), ribs (70%), pelvis (60%), femur (44%), and shoulder (41%). Demonstrable metastases are most commonly osteoblastic or mixed osteoblastic-osteolytic, with pure osteolytic comprising approximately 10% of lesions. Treatment of the prostate cancer patient who has osseous metastases is primarily palliative. The aim of therapy is to relieve pain, prevent pathologic fracture, and to improve mobility and functional status. This usually demands a multidisciplinary approach, involving a urologist, medical oncologist, radiotherapist, nurse, and pain control specialist. The mainstay of systemic treatment of the prostate cancer patient with osseous metastases is androgen deprivation. Approximately 80% of men with osseous metastases will have symptomatic improvement with androgen deprivation alone. Objective Read more [...]

Major iatrogenic injuries of the anorectum during prostate surgery are unusual occurrences. They are, however, challenging and troublesome clinical situations to treat. Minor injuries, including functional alterations, may be more common than have been appreciated in the past. Fortunately, proper, precise, and prompt management of iatrogenic injuries of the anorectum usually leads to successful outcomes. Successful outcomes in managing iatrogenic anorectal injuries incurred during prostate surgery begin with careful preoperative planning. The surgeon must thoroughly understand the technical aspects of the planned procedure and the challenges unique to his or her patient, such as prior surgeries or radiation therapy in the area being operated on. Preoperative planning should include an assessment of the functional status of the anorectum with respect to bowel function and continence to feces. The diagnosis, the patient's history and functional status, and the experience and capabilities of the operating surgeon should all be considered when deciding on the operation best suited for the patient. Read more [...]

When a tiny shadow turned up on Nancy Reagan's mammogram, nearly everyone understood that it raised the specter of breast cancer. A person on the street could tick off the next steps as well as any doctor: biopsy, a choice of surgeries, examination of the lymph nodes, and possibly radiation and follow-up chemotherapy. There was even a public debate over whether, in deciding on a mastectomy, Mrs. Reagan made the right choice. Such a debate, however, would never have occurred if the patient had been not the first lady but the president, and the disease had been not breast cancer but prostate cancer. The general public knows almost nothing about prostate cancer. Yet in many ways "prostate cancer is very similar to breast cancer in women," said Dr. John Lynch, a urologist at Georgetown University School of Medicine. According to the American Cancer Society, 96,000 cases of prostate cancer and 130,000 cases of breast cancer will be diagnosed this year. Both diseases are lethal: Prostate cancer will kill about 26,000 men this year; breast cancer will kill 41,000 women and 300 men. Breast Read more [...]