Early screenings, tests vital to diagnosing prostate cancer

We are writing about a recent article about prostate-cancer screening with both blood testing and rectal examinations. The article said blood testing and rectal examinations were not helpful for prostate-cancer diagnosis and treatment. One has to be very careful in how he or she interprets this information.

Screening always has been imperfect and will continue to be imperfect as it stands. When used in conjunction with a physical examination, historical examination and other testing, however, the blood-testing tool is quite valuable in many circumstances. Rectal examination is similarly used.

Subsequently, for anyone to state these tests are ineffective and invaluable is shortsighted. On top of that, the brief article really didn’t assess a study done on the treatments, let alone that it was one epidemiologists’ opinion and in itself, quite controversial.

At this juncture, blood testing and rectal exams still are recommended to be appropriate screening tools when the guidelines are followed. Most importantly, what they are doing is making men aware they have potential problems and should be examined on a regular basis.

If you have questions, speak with your doctor. More importantly, do not use this as an excuse not to seek regular examinations and attention. More than 30,000 men per year in the United States die from prostate cancer. The most effective way to prevent this is to be diagnosed at an earlier stage.

THOMAS A. COURY, MD
MARSHALL KAMER, MD
GLENN G. BETRUS, MD

Urology Associates of Port Huron, P.C.

Alternative therapy common in prostate cancer

About one third of prostate cancer patients in the United States use some type of complementary or alternative medicine, a large national study shows.

Continue reading Alternative therapy common in prostate cancer

Study: Gene linked to prostate cancer?

Scientists at the University of Southern California (USC) have linked certain variations in a gene for IGF-1 to a greater risk of prostate cancer.

IGF-1, which stands for “insulin-like growth factor 1,” is a protein hormone produced by the liver. It affects how our cells grow, develop, change and die, and it plays a large part in controlling human growth and development.

Several studies in the past have linked increased levels of IGF-1 to various types of cancer, including prostate cancer.

The hormone seems to increase mutations in prostate cells, while at the same time providing those cells a mechanism that keeps the body from recognizing them as “bad” cells.

But it’s not simply the increase in the hormone that ups the risk for cancer; it’s the genetic variation within the hormone. The USC scientists focused their work on variations called single nucleotide polymorphisms, or SNPs (pronounced “snips”).

Although more than 99 percent of human DNA sequences are identical, a single genetic variation can have a big effect on how our bodies respond to disease, environmental toxins, and even drugs and medical treatments. SNPs are the most common genetic variations.

The presence of SNPs provides a genetic predisposition to a disease. It doesn’t guarantee that the disease will occur, though.

The USC group looked at 2,320 men who had developed prostate cancer and 2,290 who had not. They looked at Latinos, African-Americans, Japanese-Americans, Hawaiians and whites.

The researchers found several SNPs within IGF-1 that increased the risk of prostate cancer. But two SNPs in particular raised the risk of cancer across the five different ethnic groups, said lead researcher Iona Cheng, Ph.D.

A post-doctoral fellow in epidemiology and biostatics, Cheng said many researchers have tried to explain why prostate cancer is more prevalent in African-American men than in white or Asian men.

“We still need to understand other contributing factors, including other genes,” Cheng said. Environmental and lifestyle factors also might play a role, she said.

For now, at least, Cheng and her colleagues have identified a common risk factor among ethnic groups.

Study:Turmeric protects against prostate cancer

Are you a diehard fan of aloo gobhi sabzi made with lots of turmeric? If the answer’s yes, you might have just ensured protection against prostate cancer.

Scientists in New Jersey have found that the curry spice turmeric holds good potential for the treatment and prevention of prostate cancer, when combined with certain vegetables.

Scientists from Rutgers’ University’s Ernest Mario School of Pharmacy, whose discovery has appeared in the January 15 issue of the journal Cancer Research, tested turmeric, also known as curcumin, along with phenethyl isothiocyanate (PEITC), a naturally occurring substance, found in abundance in a group of vegetables like watercress, cabbage, winter cress, broccoli, Brussels sprouts, kale, cauliflower, kohlrabi and turnips.

The scientists said prostate cancer is the second leading cause of cancer death in men in the US with a half-million new cases appearing each year. The incidence and mortality of the disease have not decreased in decades despite tremendous efforts and resources devoted to treatment.

This is because advanced prostate cancer cells are barely responsive even to high concentrations of chemotherapeutic agents or radiotherapy.

They noted that in contrast to the high incidence of prostate cancer in the US, the incidence of the disease is very low in India.

“This is because of the dietary intake of large amounts of plant-based foods rich in phytochemicals non-nutritive plant chemicals that have protective or disease-preventive properties,” said Ah-Ng Tony Kong, professor of pharmaceutics at Rutgers.

The paper, Combined Inhibitory Effects of Curcumin and Phenethyl Isothiocyanate on the Growth of Human PC-3 Prostate Xenografts in Immunodeficient Mice, revealed, “PEITC and curcumin, alone or in combination, demonstrate significant cancer-preventive qualities in laboratory mice.

Kong said, “We injected the mice with PEITC, alone or in combination, three times a week for four weeks, beginning a day before the introduction of the prostate cancer cells. We found the injections significantly retarded the growth of cancerous tumours. Using PEITC and curcumin in tandem produced even stronger effects.”

The role of bacteria in chronic pelvic pain syndrome

by  Dr. Daniel Shoskes

The role of bacteria in chronic pelvic pain syndrome (CPPS, NIH category III prostatitis) is controversial. Many doctors do not perform cultures on men with CPPS under the rationale that 1) most cultures are negative; 2) positive or negative the only treatment they offer is antibiotics and 3) that conventional cultures may miss many pathogens anyway.

In my practice we always perform extensive cultures as part of our academic interest in this disorder but it important to realize that no-one has proven that treatment based upon these cultures vs empiric treatment offers any improvement in response rate. Furthermore it is ESSENTIAL to understand that the presence of bacteria in urine or prostatic fluid is NOT equivalent to having an infection. By analogy, if somebody had rectal pain and cultured a swab of the the rectum they would find billions of bacteria. That does not prove that these bacteria are causing the pain. Similarly men without symptoms of prostatitis or history of infection will often have low counts of gram positive bacteria found in the prostate fluid and successful treatment of these bacteria in men with CPPS does not always lead to any change in symptoms.

The following specimens should be an absolute minimum for culture:

• * Urethral swab
• * Voided urine
• * Expressed prostatic secretions (preferable) or post prostate massage urine (“VB3”)

In addition, in men with post ejaculatory pain and/or visual changes in the semen we culture the semen.

For bacterial cultures, we ask that all counts of all bacteria be reported. The cutoff that many labs use of 10E5/ml for “significant growth” is based on urine cultures of asymptomatic females and has no bearing on cultures in symptomatic patients, especially in prostatic fluid. We also ask our lab to culture for at least 5 days, although the relevance of positive cultures discovered in this manner has not been confirmed.

More on Bacterial Prostatitis

In a symposium sponsored by Contemporary Urology, three Urology researchers discussed the role of bacteria. Dr. Culley Carson of UNC Chapel Hill said that it is “widely known” that E. coli “is the predominant cause of bacterial prostatitis.” Dr. Carson is referring to acute prostatitis.

Dr. Stacy J Childs of the University of Colorado Medical Center agreed, adding that he also sees ” Klebsiella or Proteus mirabilis.” Hospitalized patients with catheters have prostatitis involving staphylococci or gram negative pathogens, “Pseudomonas in particular. ” Gram-positive bacteria cause prostatitis, particularly Staphylococcus aureus.enterococci, Childs added.

Dr. Carson added Staphylococcus saprophyticus to the list. “A big controversy centers on the issue of whether nonbacterial prostatitis from the old schema is caused by Chlamydia trachomatis, Ureaplasma urealyticum, and Mycoplasma hominis,” Carson contributed.

Dr. Childs disagreed, saying Chlamydia, Ureaplasma and Mycoplasma “do not play a major role in bacterial disease. Yet, if a patient presents with prostatitis symptoms – bothersome urethritis, in particular — and tells me his partner has a documented chlamydial infection, I insist he be treated, even though I’m not sure one disease has anything to do with the other.”

Dr John Krieger of the University of Washington in Seattle suggested that patients “should be treated regardless of whether they are symptomatic or symptom free. Many asymptomatic women have persistent long-term colonization with genital Mycoplasma species.”

“Another formidable issue concerns fastidious or nonculturable organisms,” Dr. Krieger noted. “I prescribe antibiotics to patients with these pathogens, and some of them get better. Their improvement may not last for long, although it’s not uncommon for men to note that when they’re taking x, y, or z drug, they feel better, even if their cultures are negative.”

Dr. Krieger also said that flora in patients’ prostates can be identified using molecular technology or careful culturing. He said evidence of bacteria can be found in 50% or more of chronic prostatitis patients. Dr. Krieger said that identifying these flora requires cloning and sequencing RNA, and then conducting extensive database comparisons.

Dr Childs commented that researchers have “cultured out ” certain gram-positive organisms, for example, streptococci, in addition to coagulase-negative staphylococci. But he asked whether these were “true pathogens?” Many patients get better following 30 days of treatment, Childs said, “which leads some clinicians to believe that if these men have Staphylococcus epididymus in their expressed prostatic secretions [EPS], these organisms must be deep inside the prostate.”

“I bought into that philosophy for a while,” Dr Childs admitted. But he said further research showing the normal flora in the urethra makes him doubt they act as pathogens.

Dr. Krieger countered that UCLA researchers found ” a tenfold increase in Corynebacterium species,” which does not meet some definitions of causing disease, but certainly points in a direction for further research.

In the symposium, Dr. Krieger spoke out about the difficulty most doctors have in getting good lab results. “Even in our well-known microbiology department, it took me a year to get our clinical lab to do what I wanted,” Dr. Krieger recounted. ” That all changed the day I asked if I could run the tests myself in our research lab. Such testing requires careful microbiology, which will uncover organisms in many normal patients. If your lab tests only patients with symptoms, and if your facility runs these tests only occasionally, your laboratorians’ work won’t be the same as that of those who do it on a regular basis.”

Bacterial infection

Your prostatitis could be caused by bacteria. If you ever had acute prostatitis with fever, it was probably bacterial (and most likely quickly brought under control with antibiotics).

In the beginning….there was bacterial infection.

That is to say, the original theory about the cause of prostatitis was that it is caused by bacterial infection. Now, of course, we know that some prostatitis has nothing, or little, to do with bacteria. Exactly how important bacterial infection is in causing prostatitis is a subject of great debate on every level, from patient discussion to scientific research.

The reason there can be any controversy is because of the logic of how one tests for bacteria. Generally speaking, a negative test for bacteria just means the test did not find any. They may be there, hiding from the testing method, the wrong test may have been used, the testing method may not have been sensitive enough, or the test may not have been read properly. Also, until the advent of multiple-drug-resistant bacteria, antibiotics have been so effective that after a long course of antibiotics, many doctors presume that there cannot be any bacteria left.

Then there’s the next question: if bacteria are shown to be present, does that mean that they are causing your symptoms? Will eliminating your bacteria mean the end of your problems, and your pain and other symptoms?

Which leads to another big question. How does one get rid of bacteria? Are there antibiotics that work on your bacteria? Do the antibiotics cause serious side effects? Are your bacteria resistant to antibiotics? Or as a recent study suggests, do some bacteria have mechanisms to survive antibiotics?

In the last 30 years, with the wide availability of powerful antibiotics, doctors in many clinical settings have not honed their ability to diagnosis specific bacterial infections. Why bother? Just prescribe a powerful broad-spectrum antibiotic and watch the patient get better. This reliance on antibiotics goes to such an extent that doctors will prescribe antibiotics, which themselves have risks, even though the doctor doesn’t think your problem is caused by bacteria.

Causes of Prostatitis

On the scientific level, the causes of prostatitis are not completely understood. There is controversy among the most highly regarded experts. Keep in mind that any one patient may have more than one cause operating at the same time. Or, looked at from another point of view, prostatitis could be several different diseases which present with the same or similar sets of symptoms in different individuals.

There are three main schools of thought about the causes of prostatitis. Each of the following linked pages will soon have additional information related to the potential cause.

• Bacterial infection,
• Auto-immune response or disordered immune response,
• Neuromuscular, tension or physical injury problem
• Additional possible causes:
1. a uric acid disorder,
2. prostate stones,
3. a urethral stricture,
4. a rare tumor,
5. prostate cancer,
6. benign prostatic hyperplasia (BPH, non-cancerous growth of the prostate),
7. a food allergy,
8. a yeast infestation,
9. a specific yeast problem from the Genus Candida,
10. or a virus.

If you’ve had prostatitis for very long and had very many appointments to try to deal with it, you’ve heard some of these theories.

Does it matter what is causing it? Will knowing the cause help you get over it? The answer would be “yes,” if only determining the cause were simple. (See the “Methods ” page for a discussion of methods of treating prostatitis.) Also, unfortunately, even doctors who are sure of the cause of prostatitis in their patients cannot cure all their patients.

If your prostatitis is caused by bacterial infection, knowing that should help your doctor treat the infection and make you better. Unfortunately, many doctors and clinics do only cursory checking for bacteria. But even doctors who do very careful checking for bacteria, and indeed find bacteria, cannot always make their patients’ symptoms go away.

Similarly, ruling out bacteria and going on one of the other hypotheses does not necessarily help either. If you thought or even knew that your prostatitis is caused by an immune disorder, does that mean there is a clear route to fixing the problem? Not likely.

There are therapies around for fixing physical problems. There are people who can teach you relaxation techniques, or muscle-strengthening techniques, to repair or ameliorate problems with your pelvic floor musculature. But there is no clear path that works for everyone.

Why can’t doctors fix you up? Well, for one thing, they aren’t trained very well in diagnosing and treating prostatitis. Urologists spend most of their time studying surgery. If prostatitis were something that could be fixed by surgery, they’d give it a try. And other doctors tell patients to “learn to live with it.”

The upshot of all this confusion is that YOU, and only you, brother, are going to have to take charge of finding out what’s causing your prostatitis . Sure, you’ll need doctors to help you, and to run tests and interpret them for you, and prescribe drugs if necessary. But YOU are going to have to be the one who is well-armed with questions and demanding enough to get your doctor to get to the bottom of things.