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The Prostate Clinic

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25.01.2022 You cant be fat and fit - Type 2 diabetes 6th Sept 2016 - In important Australian research it has been shown that overweight people who exercise do not control their diabetes. It is possible to reverse or even cure type 2 diabetes with substantial weight loss, but not exercise alone.

24.01.2022 Radiation for prostate cancer raises risk of secondary cancers http://buff.ly/1pVGbLr A large study in the British Medical Journal has shown an increased rate of second cancers in men treated for prostate cancer by external beam radiation therapy. Cancers occurred in the regions near the prostate such age colon and bladder, with each of these areas receiving radiation during the treatment. These side effects need to be considered when deciding on treatment. They generally beg...in to show after 5 yrs, but the risk increases with time. For younger patients with a long life expectancy, the risks are expected to increase over time, making radiation less suitable for men with a life expectancy over 10 yrs. The overall risk is small, but much higher than if the radiation had not been given. Localised radiotherapy with implanted seed brachytherapy did not have an increased risk of second malignancies. Previous studies have shown similar problems with radiation and other recent studies have shown a significantly higher risk of failure after 5 yrs when compared with surgery. The effect is greatest for the more serious tumours. See more

24.01.2022 In this article in the Journal of Clincal Oncology a large cohort of 17000 men with prostate cancer were studied for the development of Alzheimers disease. The 14.5% of men who received testosterone lowering therapy had a statistically significant increase in Alzheimers disease. Cognitive ability is known to decline with testosterone withdrawal and an increase in diabetes and cardiac events also occurs. It is also known that less than 30% of men recover normal testosterone le...vels after treatment. The impact of androgen ablation may be underestimated long term and the routine use of testosterone lowering needs to be weighed against the benefits of treatment, Androgen deprivation has been the mainstay of treatment for advanced disease, but with many men now living with their prostate cancer, or having opportunities for cure despite an advanced age, the role of ADT is diminishing. Early detection of disease is the best defence against needing ADT. See more

24.01.2022 In late 2011 the US Preventative Task Force gave a D rating to PSA testing, which has resulted in a 28% reduction in the diagnosis of the disease. Low, moderate and high risk disease has been equally affected, making this a potentially serious development in the fight against death from prostate cancer. Prostate cancer is the second most common cause of cancer death in men in Australia, with over 70% of cases diagnosed being the more serious high grade type. Whilst some cance...rs are low risk, there is a very low rate of treatments for these diseases in this country. What we need to do is to find the cancers likely to cause death early enough to cure them, whilst avoiding unnecessary treatment. The advent of MRI into the diagnostic pathway has been a huge leap forwards to achieving this goal. Good quality MRI will reduce the diagnosis of insignificant disease by 90%, whilst increasing the rate of diagnosis of serious disease. A recommendation against PSA testing is unwarranted and likely lead to an increase in the rates of metastatic disease and death. A more comprehensive approach to prostate cancer management is needed, beyond PSA testing alone, that better reflects current practice. Risk prediction, serial PSA testing and MRI help us to target those who will benefit whilst minimising unnecessary treatment. See more

23.01.2022 Weight loss improves sexual and urinary function in obese men with diabetes. In this article from the journal of sexual medicine obese diabetic men were placed on a VLCD (shakes based) diet or a high protein (CSIRO type) diet for 8 weeks, with all continuing on after with the high protein diet. Men on the VLCD lost almost twice as much weight, but both groups had improvements in sexual and urinary function. Their inflammatory markers (linked to cancer) also improved. Weight loss needs to be a integral part of the approach to sexual and urinary dysfunction. At the Prostate Clinic we have been routinely helping men lose weight and improve their overall health for many years. This article adds further to the weight of evidence that a holistic view to these problems is needed.

22.01.2022 Exercise can fix erections - http://buff.ly/2eIe9OK In this meta analysis researchers have concluded that exercise, especially aerobic activity with periods of intensity can improve erection function scores in men. The size of the effect was half as effective as using a PDE5 like viagra. Previous studies have also shown that lowering cholesterol can have a similar effect. It is clear that in most cases poor erections are a sign of a much bigger problem with blood vessels. Poo...r blood vessel health i the greatest killer in our community through heart disease, strokes and possibly even cancer. The penile vessels may be the equivalent of the canary in the coal mine, with erectile problems beginning years before clinical signs of heart disease. If youre next exercising, then start. Start slowly and get your weight under control first, then move up to the more intense bursts of activity that keep your vessels healthy. If you are already an exerciser, keep it up! (Pun intended) See more

21.01.2022 Last September, our da Vinci Xi surgical robot featured in a Channel 7 report about medical technology and innovation. In case you missed it, here it is!

20.01.2022 In the Feb 1st Issue of the Journal of Epidemiology researchers report their findings showing a prostate cancer risk 56% higher in men with any baldness than in those with no baldness. Whilst this is not a conclusive study it does add weight to other similar studies. It may be that the men with higher testosterones also have a higher risk of baldness and prostate cancer.

19.01.2022 PSA testing guidelines approved by the NHMRC. Prostate cancer remains the second most common cause of cancer death in men in Australia, with new PSA guidelines aiming to give clarity to men and doctors. The PCFA and Cancer council released these evidence based recommendations today after an extensive multidisciplinary review. They do not recommend population based screening, but instead recommend testing after informed consent, advising strongly for testing in men with a pos...itive family history. They have also recommended that the rectal examination is removed from primary care (GP) testing. There is no doubt that if these recommendations are adopted, there will be significant progress made in prostate cancer in Australia. At this point in time, testing is not ideally done, either being overdone to low risk patients or more commonly, under performed in this men who will benefit from an early diagnosis. The recommendations go beyond PSA testing, giving advice to men who have cancer to aid in treatment decision making. It is hoped this will help avoid over treatment, which has been a significant issue in other countries, but is not common in Australia. Previous research in WA has shown that we diagnose cancer at twice the rate of screening studies and that there is a 2.5 times higher rate of significant cancer at biopsy. Men should be able to get a consistent message on early testing and the efforts of this group led by the PCFA provide a solid base for this. We will need to see the response of the RACGP whose current position is to avoid discussion of prostate cancer testing with men. See more

19.01.2022 Clinical prostate test guidelines receive GP college endorsement - PCFA http://buff.ly/1XilhmS The RACGP, the peak body in Australia for GPs, has joined the NHMRC, PCFA, RACP, Urological Society and Australian and New Zealand College of Radiologists in endorsing the new evidence based guidelines. PSA testing is common is Australia, but to date, there has been variation in how the test is applied and interpreted. As the main group responsible for the use of PSA testing, the R...ACGP endorsement will make significant inroads to uniformity in the approach to testing. The guideline recommend that that men in the age of 50 - 69 receive PSA testing after discussing the risks and benefits of the test. Men should have the test at a younger age if they have a family history, or are concerned about the possibility of prostate cancer. The guidelines also give advice on the management of the disease in order to maximise the benefits and minimise the risks of early detection. In recent years there has been a decline in PSA testing, that has led to an increase in late presentations of incurable metastatic disease. prostate cancer survival rates are amongst the highest for all cancers, provided detection is early. Prostate cancer remains the second commonest cause of cancer death in Australia despite this, mainly due to late detection of aggressive disease. See more

18.01.2022 Can exercise cure cancer. Published today in Cell Metabolism is a very interesting article that may explain why exercise is so important in preventing and even treating cancer. We have known for some tim that people who exercise get less cancer and that those who have had cancer get less recurrence if they exercise. In this study, mice with cancer either had access to a running wheel or were sedentary. Those who ran had a 50% reduction in tumour size. It is thought that Inte...rleukin 6 is produced in the muscles during vigorous exercise and this stimulates natural killer cells that destroy cancer. The researchers were able to block the affect by blocking adrenalin. Exercise may soon become a part of every cancer treatment regime if follow up studies prove the benefit. For the rest of us, there is proof enough that we should be exercising to achieve the minimal goals of 30 mins aerobic activity 5 times a week plus two weight lifting sessions. 60 mins is better, so get to it! See more

18.01.2022 Prostate cancer is more likely spread beyond the prostate gland in obese individuals. This study gives an indication why this may be occurring.

18.01.2022 PSA screening reduces cancer specific mortality by 50% http://buff.ly/1pNRQwl In this 2010 article in the Lancet the 14 yrs data from the well known Goteborg study was published. It was a landmark paper, having the longest follow up of any prospective screening study. In this study, 20 000 men were assigned to a PSA test every 2 yrs and a biopsy if the PSA was above 2.5 or usual care, where they could decide on having a PSA test. The results form some of the strongest argume...nts in favour of PSA testing. In a nutshell the study found the following; 1) Improved cancer specific survival of around 50% in younger men 2) Increased detection rate of cancer in those screened 3) Greatest impact in men of lowest socioeconomic status as higher SES linked with more testing in the unscreened group 4) Number needed to screen and number needed to treat to prevent one death was lower than breast and bowel cancer 5) Screening effect increased over time 6) More men in the unscreened group developed metastases 7) More men in the unscreened group had treatment with testosterone reduction 8) More men in the unscreened group had radiotherapy 9) Around 30% of men were on active surveillance after 10yrs At the recent EAU, further information from this study has been published, which I will report on in future blogs.

18.01.2022 Proton Beam Therapy for Localized Prostate Cancer 101: Basics, Controversies, and Facts http://buff.ly/1o5CAJn Proton beam radiotherapy is a different type of radiation treatment that has unique properties that allow more accurate dosing. The main benefit of this is to reduce the dose of radiation given to the rectum, as the depth of the radiation can be adjusted. There is evidence that early toxicity to the rectum is reduced over other external beam techniques, but at 12 mon...ths these benefits are likely to have subsided. Proton beam is a very expensive type of treatment as the machines themselves cost around $200 million dollars to set up. They were first made to treat nerve tumours in children, where highly accurate radiation can allow children to grow up without spinal cord injuries that can sometimes occur with standard radiation. Thankfully, there are not too many of these lesions. The use of these machines in prostate cancer has been controversial as there is no evidence of benefit beyond standard radiotherapy. There is a perception that a more accurate radiation treatment will limit the impact of radiation on erections, but there is no evidence to support this, and even in theory, it is not possible to treat the prostate without irradiating erection nerves, as they are contained within the prostatic fascia. Another problem is the fact that radiation has inferior long term success to surgery, especially for high risk disease. Younger men are often the ones targeted by proton beam marketing, as the desire to keep potency is high. These men have the most to lose from an inferior cancer treatment and may find they have limited options if the treatment fails. Studies clearly show that if the life expectancy is over 10 yrs, surgery should be considered the treatment of choice due to its ability to cure, predictable and treatable side effects, ease of follow up and very high success rate. The above article explains proton beam in some detail for those wishing to read more. Tom Shannon See more

17.01.2022 Surgery is changing advanced prostate cancer into a manageable chronic disease. We have seen a significant change over the years, where surgery has become the mainstay for disease once thought to be too advanced. Surgery has advanced to the level where large and significant cancers can be safely removed. This reduces the chance of new lesions in the bones and obstruction of the kidneys. Adding in radioatherapy and chemotherapy is turning a significant problem into a much lesser one, allowing men to continue with a much better quality of life.

16.01.2022 Does erectile dysfunction equal early death? Getting an erection is essentially a vascular event. With vascular disease the main cause of death amongst men the early signs of erectile dysfunction should be taken as a sign of likely problems around the corner. In this short video from nutritionfacts.org, the reasons are well explained. We now have our own prostate care physician to help look into these risk factors and keep you fit and healthy for life. Our keep it up program will keep you at your best.

14.01.2022 Metastatic Prostate Cancer in Men Initially Treated with Active Surveillance - The Journal of Urology http://buff.ly/1WOD1Ww In this single centre study, long term results of active surveillance show an average 3% progression to metastatic disease in men with low or intermediate risk prostate cancer. When looking at subgroup analysis for Gl 7 cancer, the rates of metastases were much higher. These patients predate MRI and the authors suggest that MRI should be done on all pat...ients entering into active surveillance to ensure not cancers of significance are missed. This is an approach we have been using since MRI became reliable and available. The authors stress the need for a quality MRI to be done. It would appear that Gleason 6 cancer has a very low rate of metastases over extended periods. The follow up in the study was only 6.3 yrs on average, suggesting the rate of mets will increase over time and may end being unacceptably high for Gleason 7 cancer. With many men living into their 80s and beyond, active surveillance must be used carefully, cognisant of the risks and traps, as well as the benefits. If good MRI is used before biopsy, especially in older men, it is unlikely that Gleason 6 cancers will be detected, avoiding the difficulties and anxieties that go with an unnecessary diagnosis. Tom Shannon See more

14.01.2022 Thanks to the team at Envision for their sponsorship. You already support the men of WA with such a great service in prostate imaging. I will be plunging off Central Park (abseilling hopefully!), on Sunday morning to raise awareness and funds for prostate cancer and mens health. If you would like to donate or read more https://buff.ly/2iYwcGS

14.01.2022 New prostate cancer grading system helps decipher risk. The Gleason grading system has been a mainstay of prostate cancer for many years. It classifies the disease based on gland architecture into 5 groups, with a Gleason score derived from two areas in the same core to give a total out of 10. The problem with this system is that the lowest reported score is a 5 or 6. Whilst this is a very low grade cancer, the score would suggest otherwise, perhaps influencing treatment deci...sions. The new system of using Gleason score to give a 1-5 range, better reflects the risk of the disease. 1 = Gl 6 or below 2 = Gl 7, less than 50% grade 4, 3 = Gl 7 greater than 50% grade 4, 4 = Gleason 8 and 5 = Gleasons 9 and 10. As you can see from the attached graph of grade vs survival, grades 1 and 2 have significantly lower risk than grades 3,4 and 5. This gives patients with lower grade disease a better opportunity to balance their risks vs benefits in decision making, whilst also stressing the significance of high grade disease, debunking the myth that you die with and not from your prostate cancer. See more

14.01.2022 Ejaculation Frequency and Risk of Prostate Cancer: Updated Results with an Additional Decade of Follow-up - European Urology http://buff.ly/1rNmR3Q In this large study it was shown that men who maintain more frequent ejaculations into middle life have a lower risk of prostate cancer. Men who has more than 21 ejaculations per month had a 20% reduction in the incidence of prostate cancer compared to men who reported less than 7 ejaculations per month. Frequent ejaculations may reduce inflammation in the prostate, which could be a risk for cellular damage and cancer change.

13.01.2022 Check out this new publication on mens health

13.01.2022 Another benefit of losing weight is the reduction in knee arthritis that is so common today. Weight loss needs to be substantial at around 10% to achieve an effect. On average our patients lose 10-15% of body weight over a 6 week period with our diet and exercise programs, helping more than just their surgical outcomes for prostate cancer.

12.01.2022 Fall in PSA Screening Resulting in More Advanced Disease http://buff.ly/1ocKZe6 In 2008, the US preventative health services taskforce recommended against screening men for prostate cancer if they were over the age of 70. In 2011, they extended this recommendation to all men. Since that time there has been a reduction in PSA testing in primary (GP) care by around 50% and a reduction in the diagnosis of disease. At the European Urology Association meeting this week results wer...e presented showing the impact of the 2008 changes on the disease in older men. The average PSA at diagnosis has increased, showing more advanced cancer, and more men are being diagnosed with high grade disease, in fact 20% more. There has been a 34% increase in the rate of metastatic disease also. It is expected that this effect will translate to younger men soon, as the recommendations applying to younger men were made 3 yrs later. To see such an effect after such a short time is concerning. The patients who did worst, were the fittest, and this is no surprise. The longer you are alive, the longer the prostate cancer is present if you have no treatment. Prostate cancer progresses in grade (aggression) and stage (size) over time, so the longer you live, the more likely it will be significant. This is true for the 70% of disease that is significant and probably untrue for low grade, indolent cancers. By detecting bad cancers early, they are cured and metastases do not occur. If PSA testing is not done, this cannot happen. The risks of over detection and over treatment appear to be very low in Australia, especially in older men since MRI has been introduced. Well informed men are unlikely undergo treatment they do not need. Patients with low risk disease should seek second opinions or independent advice before submitting to treatment. See more

12.01.2022 Most cancers are cause by lifestyle, not genes. In this article published in the December 17th issue of Nature, the authors show that up to 90% of cancers are causes by lifestyle related factors and not inherited genetic risk. The rise in global cancer diagnoses over the last 20 yrs supports this, as does the association of diabetes and cardiovascular disease to cancer development. The good news is that cancer prevention is under our control. The future should be soon that we can predict and prevent cancer by knowing which diseases need prevention and how to achieve this. Today marks one year since the launch of Ionic Health, the first clinic in WA dedicated to determining individual disease risk and developing personalised prevention plans. www.ionichealth.com.au

12.01.2022 In this large study it was found that men who had testosterone reducing therapy for advanced prostate cancer had double the rate of diagnosis of alzheimers disease. The effect was dose related, suggesting that the longer a man has a low testosterone, the higher the risk. Many men do not recover their testosterone levels after androgen blockade, which means that the benefits from even potentially short courses of this medication need to be considered against the long term risks. It is known that bone mass, muscle mass and fat mass can be adversely affected also. These are independent risk factors for other serious diseases, such as heart disease and diabetes. Early detection and cure of serious disease and the avoidance of treatment for less serious disease should remain the key focus in prostate cancer.

12.01.2022 The consequences of the reduction in PSA testing in the USA are already being felt. In this article in the Journal of Urology trends in diagnosis and biopsy at one institution before and after the USPTF recommended against screening are compared. Their conclusion - In the 2 and a half years after the USPSTF recommendation against prostate specific antigen based screening, patients undergoing prostate needle biopsies were significantly more likely to be diagnosed with high ris...k disease. However, a reduction in the number of prostate needle biopsies performed occurred concomitantly with a decrease in the detection of intermediate risk, potentially curable prostate cancer. Future focus on informed application of screening techniques may prevent the reversal of decades of improvement in the prostate cancer mortality rate. Journal of Urology, The, 2016-01-01, Volume 195, Issue 1, Pages 66-73 We are at risk of going backwards in prostate cancer diagnosis, which will limit the choices for men and decrease the ability to cure.

11.01.2022 Epigenetic drives weight differences in identical twins. Whilst some parts of weight gain are genetic, it appears that it is more important how our genes are expressed, rather than the genes we have. Epigenetics explains the expression of genes to achieve very different outcomes in the same individual. It is like looking at a shopping trolley of food. A poor cook will make a bad dish, but a chef may make an exquisite dish from the same ingredients. In this twin study it was found that overweight twins had different gene expression than the thinner twin, despite having the same genetic code. This suggests that we are able to change our genetic destiny to be healthier. Lifestyle factors under our control are the key to making the most out of what we have. ionichealth.com.au

11.01.2022 Updated Prostate Cancer Stats. in Australia 2016. Prostate cancer is still the most common cancer in men and the second commonest cause of cancer death, despite a falling incidence with decreased PSA testing. Mortality rates are continuing to val with improvements in treatment. (AIHW)

09.01.2022 This video explains the new evidence based PSA testing guidelines now endorsed by the RACGP and NH&MRC. They were developed by a multidisciplinary expert panel headed by the Cancer Council and Urological Society.

07.01.2022 More evidence has emerged showing that prolonged periods of sitting may contribute to diabetes risk. Given the mounting toll of diabetes and our increasingly sedentary lives it would seem a good idea to avoid uninterrupted periods of sitting. This article suggests 5minutes standing every 30 mins.

06.01.2022 The Prostate Cancer Test That Saved My Life - Ben Stiller Ben Stiller gives an articulate and personal account of his recent prostate cancer diagnosis, treatment and journey. As a young man, his cancer diagnosis occurred despite advice suggesting he should have waited until the age of 50 to start looking. He had no family history or symptoms. Prostate cancer is highly curable when detected early, but increasingly, we are seeing the disease present late due to decreased testi...ng rates and ambivalence towards the disease. In Australia, most of the cancer diagnosed is high risk, making early diagnosis more important than guidelines may suggest. As the article states, PSA testing is not perfect, but without it, what do we have? Many of the issues with PSA can be overcome with specialist input and accurate imaging. PSA, along with good medical input and decision making, can achieve early detection of serious disease, whilst minimising the risk of over treatment. At this moment we are able to do this better in prostate cancer than breast cancer, a cancer where the debate about over detection rarely achieves attention. See more

05.01.2022 Earlier alcohol benefit studies flawed http://buff.ly/1XLRUqM The benefits of alcohol may have been overstated.

04.01.2022 Check out this new publication on men's health

03.01.2022 Prostate testing breakthrough. AFR reporting of the PSA consensus statement from PCFA and Cancer Council.

02.01.2022 Surgery vs radiotherapy for localised prostate cancer. ClinicalKey http://buff.ly/1mbvjH7 In this large meta analysis high quality studies with low / mod bias risk were analysed to determine the relative success of surgery vs radiotherapy for localised prostate cancer. The authors report a significantly higher rate of success for surgery over radiation, both for all cause mortality and prostate cancer specific mortality. The effect is greater for worse cancers and became more...Continue reading

01.01.2022 Being overweight and having a large waistline increases risk of prostate cancer http://buff.ly/1RSM8i7 For every 10cm increase in waist size there was an 18% increase in prostate cancer diagnoses and a 13% increase in high grade disease. You must maintain a waist circumference less than 95cm to reduce your risk!

01.01.2022 In the December issue of Neurology there was some good news for those who exercise. It was seen that lower cardiovascular fitness and exaggerated exercise BP and HR responses in middle-aged adults was associated with smaller brain volume nearly 2 decades later. Authors suggested that " promotion of midlife CV fitness may be an important step towards ensuring healthy brain raging. This is not a big surprise, as the most common cause of brain damage with raging is caused by unhealthy blood vessels. Exercise needs to begin as young as possible and sustained through life. The same effect on blood vessels leads to heart disease and erection problems.