2015 Blog

Food for Thought; Our Help in Weakness.

bjgabrielsen : October 19, 2015 4:20 am : 2015, Encouragement

God always provides!
Food for thought. God always provides! Photo from BJ Gabrielsen’s yard

When we as individuals put our faith in Jesus Christ’s sacrifice for the payment of our sin debt to God, and asked Him to come into our lives, we received a special gift, namely the presence of the Holy Spirit Himself.  John 14:16-17 (NewAmerican Standard version) expresses it this way.  “And I will ask the Father, and He will give you another Helper, that He may be with you forever; that is, the Spirit of truth, whom the world cannot receive, because it does not behold Him or know Him, but you know Him because He abides with you, and will be in you.”  This Helper will stand alongside us in any trials we may face.

We men often face life’s issues (e.g. prostate cancer or other crises) with a stiff upper lip, trusting our own ingenuity and skills to get us through.  In choosing to follow the Lord, however, we agree to adopt a totally different mindset.  We’re weaker than we could have imagined but through the Holy Spirit, we are stronger than we dare to hope.  Whether our struggle is physical, emotional or spiritual, we can rely on the Holy Spirit to intervene with God and help us.  The apostle Paul gives us a perfect example of what this looks like.  While dealing with pain from a physical condition, Paul prayed that the Lord would take away what Paul referred to as a “thorn in the flesh”.  Instead of removing it, God said His power would be manifested or “perfected in weakness.”  (2 Corinthians 12:9).  Too many Christians operate under the misconception that “God helps those who help themselves” or that God helps us only when we have gone as far as we can go.  In reality, His Spirit doesn’t add to our strength, like some kind of spiritual steroid.  Instead, when we admit we are powerless to help ourselves, the Holy Spirit gives us the strength we need to face any challenge with absolute confidence in God.

If you are not sure of your relationship with God and His Son Jesus Christ, and therefore may not possess the Holy Spirit’s presence and power in your life, please see the website section entitled “How to Enter Into a Personal Relationship with God.”  Portions of the above were taken from the InTouch devotional dated October 8th, 2015 by Dr. Charles Stanley.

 


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Don’t Let Yourself Go! The Benefits of Exercise During Hormone Therapy

bjgabrielsen : October 17, 2015 4:05 am : 2015, General Patient Information, Treatment Information

Old fishing boats, Placida, S.W. Florida; Photo: BJ Gabrielsen
Old fishing boats, Placida, S.W. Florida; Photo: BJ Gabrielsen

A recent article written by researchers from the University of Southern California was published in the August 2015 issue of Prostate Insights from the Prostate Cancer Research Institute.  The article discussed how exercise may help with treatment-related side effects of hormone therapy (ADT) and what types of exercise were most effective.  Two of the primary side effects of ADT are the loss of muscle mass and increase in body fat within 3-12 months of starting treatment.  These effects, termed sarcopenic obesity, also contribute to insulin resistance and greater risk of diabetes.  Prevention of muscle loss was observed with exercise programs that were at least three (3) months in duration and involved resistance exercise rather than aerobic exercise although both were recommended.  Resistance exercise utilizes weights (machines or free weights), while aerobic exercise such as walking, cycling or swimming, elevates heart rate.  Weight exercises should be done two (2) or three (3) times per week targeting the major muscle groups beginning at moderate intensity and progressing to more vigorous intensity with limited rest periods.  For example, a chest press exercise which involves more muscle mass is preferred over a biceps curl exercise.  In addition, the exercises should start at light weight and high repetitions (>12) and slowly progress throughout the weeks to heavier weight and less (around 8) repetitions.  Minimal rest sessions of less than one minute should be taken between sets as a way of keeping the heart rate elevated in a manner similar to aerobic training.  It was also found that performing either aerobic or resistance exercise at least twice a week reduced fatigue, another side effect of ADT.  In summary, regular exercise incorporating resistance and aerobic training should be carried out 2-3 times per week.  Resistance exercise should focus on large muscle groups (e.g. chest press, leg press and leg curl) combined with dynamic movements e.g. squats, lunges. Also, remember to discuss starting any rigorous exercise program with your physician.


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AR-V7: A Genetic Test to Determine Effectiveness of Enzalutamide and Abiraterone.

bjgabrielsen : October 13, 2015 10:27 pm : 2015, Diagnostics, Genetics, Imaging, Treatment Information

When prostate cancer becomes “hormone resistant” or refractory, anti-androgen drugs such as enzalutamide (Xtandi®) and abiraterone (Zytiga®) are often prescribed.  But not all patients respond equally. Some 30 percent of men with advanced prostate cancer have an abnormal version of a prostate cancer protein that connects with testosterone.  The protein is missing a key connector that binds to abiraterone and enzalutamide.  The abnormal protein is caused by a genetic variant called AR-V7.  Most patients who test positive for AR-V7 get limited or no benefit from abiraterone or enzalutamide.  Researchers at Johns Hopkins in Baltimore have invented  a test for the genetic variant, AR-V7.  However the test is available for research purposes only at this time.  More information can be found in the linked article and in a blog published on this website on May 7th, 2015.

 


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bjgabrielsen : October 12, 2015 12:57 am : 2015, General Patient Information

Blood moon taken September 28th; Photo by Arnold Dalene
Blood moon taken September 28th; Photo by Arnold Dalene

While not every blog may be applicable to your specific condition and interest, you can get them delivered automatically to your e mail address.  Just go to the lower right hand corner of the Godandprostate home page and enter your e mail address.


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Taking Charge of Your Prostate Cancer Recovery; Old Model Revised.

bjgabrielsen : October 11, 2015 12:08 am : 2015, Encouragement, General Patient Information

The following is from the October 7th Prostatesnatchers, as written by Ralph Blum and urinary oncologist, Dr. Mark Scholz.  I urge the readers to subscribe to their periodic e mail posts.

In the old model of prostate cancer care, you were rushed into radical treatment–usually surgery or radiation–often without fully understanding all your options, or the risks and side effects involved. The entire process was focused on the tumor; minimal attention was given to you as a person, and little effort was made to explore the benefits of healthy lifestyle choices, immune-enhancing treatments, reasonable delays, and emotional support.  

The emerging new model of prostate cancer care recognizes the important role you can, and should, play in your recovery. The emerging model comprehends that simply attacking the cancer is not enough. Greg Anderson, who after surviving “terminal” lung cancer founded the Cancer Recovery Foundation, has said that “Retaining a medical team without doing everything you can to help yourself is like attempting to walk on one stilt.” So what do you need to know in order to take charge of your recovery?

There are three common misconceptions about prostate cancer: a) The assumption that the disease is as dangerous as other cancers; b) The assumption that the urologist who did your biopsy may be a prostate cancer expert; and, c) The assumption that a quick treatment decision is necessary before the cancer spreads.

First of all, prostate cancer is unique among cancers because the mortality rate is so low. Around two hundred thousand men in the U.S. alone are diagnosed with the disease every year, and less than 15% will eventually die from it, usually over a decade down the line, while a majority of men who have the far more common low-risk, slow-growing prostate cancer can anticipate living a normal life span, or dying of something else.

Your local urologist has a busy medical practice that involves treating multiple problems like impotence, infections, incontinence, and kidney stones. He also does biopsies. But the average urologist may perform fewer than five prostate removals (prostatectomies) a year–far too few to be considered proficient. He may be a talented doctor, but he may be an unlikely prostate cancer expert.  So once you have your biopsy results, it is best to consult a prostate cancer specialist, either at a major medical center, or at a high-volume prostate cancer clinic.

As for the third misconception, it is essential, before committing to any form of treatment, that you  do your own research, and are convinced the treatment you choose is the right one for you.  Do not let anyone rush you into making a bad decision. Once your category of prostate cancer is identified (Low, Intermediate, or High Risk), get on the Internet and learn about every treatment option–including no treatment whatsoever–for your type of disease.  If you are over 70, and have low-risk disease, my advice to you is to find a doctor who has experience monitoring an active surveillance protocol.

Your role in your recovery, however, doesn’t end with choosing your treatment. The emphasis on lifestyle changes has been one of the most significant shifts in cancer care in the last decade.  A study at UCSF showed that improving your nutrition, reducing stress and getting more exercise, can lower PSA levels.  According to a relatively new field of health psychology called “illness representation,” your beliefs and expectations also impact the outcome of your disease. So take charge of your recovery, and have faith in your choice of treatment. (Added note from this website: Make sure you have a personal relationship with God and then place your faith in His hands.)

 


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Earlier chemotherapy may extend patient survival in multiple prostate cancer settings

bjgabrielsen : September 29, 2015 10:44 pm : 2015, Treatment Information

Whether a prostate cancer patient is just presenting with localized high risk prostate cancer, presenting with metastatic prostate cancer, or experiencing a metastatic recurrence, earlier treatment with taxane chemotherapy may prolong survival.

June 19, 2015 — Chemotherapy with docetaxel® (taxotere) has traditionally been used to treat prostate cancer patients only after they have developed resistance to hormone therapy. However, two new studies presented at the 2015 American Society for Clinical Oncology (ASCO) Annual Meeting found that the addition of taxane chemotherapy extended survival in several groups of patients initiating hormone therapy: in patients with primary metastatic disease or relapse with metastases after definitive local treatment, and as a first-line therapy in previously untreated patients with localized high-risk prostate cancer.

Upfront Therapy with Docetaxel® Prolongs Overall Survival in Men with Hormone-Naïve Metastatic Prostate Cancer Commencing Hormone Therapy

Prostate cancer patients who present with primary metastatic disease or relapse with metastases after definitive local treatment with prostatectomy or radiotherapy (RT) typically receive androgen deprivation therapy (ADT) with or without RT as the standard of care. Taxane chemotherapy or 2nd generation anti-androgen medications are only prescribed following the onset of ADT resistance. However, it is hypothesized that earlier administration of these therapies may extend patient lives.

Dr. Nicholas James of the University of Warwick and Queen Elizabeth Hospital Birmingham presented the first survival results released from the STAMPEDE CLINICAL TRIAL, the largest randomized clinical trial ever conducted in prostate cancer patients. This study tested the outcome of adding various therapies to the standard of care—ADT with or without RT—in hormone-naïve patients either presenting with metastatic disease or relapsing after prostatectomy or RT. The addition of docetaxel + prednisolone to standard of care treatment extended the median failure-free survival time from 21 months to 37 months, and extended the median overall survival time from 67 months to 77 months.

These results support previous results from the CHAARTED trial, presented at the 2014 ASCO annual meeting, where the addition of docetaxel® to ADT improved median overall survival from 44 to 57.6 months in a cohort of hormone-sensitive metastatic prostate cancer patients.  Collectively, these results support a paradigm change in clinical practice. Docetaxel® in combination with ADT should now be considered much earlier in the treatment regimen for men with hormone-naïve metastatic prostate cancer. 

The 2015 ASCO Annual Meeting was held from May 29 – June 2, in Chicago, IL. The preceding article was adapted from the July 2, 2015 issue of the Prostate Cancer Foundation Publication, NewsPulse.


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Men With Low-Risk Prostate Cancer In Active Surveillance Program Not Likely To Succomb To The Disease, Study Shows.

bjgabrielsen : September 27, 2015 3:12 am : 2015, Diagnostics, Genetics, Imaging, General Patient Information

The post below comes from a multi-year study at Johns Hopkins in Baltimore. It should be noted below that repeat biopsies performed on men undergoing active surveillance were performed using MRI-guided technology and pathologists checked biopsy tissue levels of proteins made by the PTEN gene, a biomarker for prostate cancer aggressiveness.

Men with relatively unaggressive prostate tumors and whose disease is carefully monitored by urologists are unlikely to develop metastatic prostate cancer or die of their cancers, according to results of a study by researchers at the Brady Urological Institute at Johns Hopkins, who analyzed survival statistics up to 15 years. Specifically, the researchers report, just two of 1,298 men enrolled over the past 20 years in a so-called active surveillance program at Johns Hopkins died of prostate cancer, and three developed metastatic disease.

Our study should reassure men that carefully selected patients enrolled in active surveillance programs for their low-risk prostate cancers are not likely to be harmed by their disease,” says H. Ballentine Carter, M.D. , the Bernard L. Schwartz Distinguished Professor of Urologic Oncology and director of adult urology. Carter acknowledges that outcomes in the current study may be due to doctors’ careful selection of patients for active surveillance. “With longer follow-up, the data may change, but they’re unlikely to change dramatically, because men in this age group tend to die of other causes,” he says. Most of the men in the study were also Caucasian, and Carter cautions that these outcomes may not apply to African-American men, who tend to have more aggressive cancers.

For the study, described online Aug. 31 in the Journal of Clinical Oncology, men with prostate tumors classified as low or very low risk for aggressiveness opted to enroll in an active surveillance program at The Johns Hopkins Hospital. Their risk level was determined, in part, by Gleason scores, in which pathologists evaluate the aggressiveness of the cancer from prostate biopsy tissue.  When the study began in 1995, Carter says, urologists performed annual biopsies on the men in the program until they reached age 75. Now, doctors no longer require annual biopsies among the lowest risk groups, but when they do perform a biopsy, they use MRI-guided technology and will often ask pathologists to check biopsy tissue levels of proteins made by the PTEN gene, a biomarker for prostate cancer aggressiveness. Of the 1,298 men, 47 died of nonprostate cancer causes, mostly cardiovascular disease; nine of the 47 had received treatment for their prostate cancer. Two men died from prostate cancer, one after 16 years in the active surveillance program. In the second man’s case, Johns Hopkins doctors recommended surveillance, but the patient sought monitoring at another hospital and died 15 months after his diagnosis.  Three men in the program were diagnosed with metastatic prostate cancer.

Overall, the researchers calculated that men in the program were 24 times more likely to die from a cause other than prostate cancer over a 15-year span.  After 10 and 15 years of follow-up, survival free of prostate cancer death was 99.9 percent, and survival without metastasis was 99.4 percent in the group.  Some 467 men in the group (36 percent) had prostate cancers that were reclassified to a more aggressive level within a median time of two years from enrollment in the active surveillance program. For men with very low-risk cancers, the cumulative risk of a grade reclassification to a level that would have generally precluded enrollment in the program over five, 10 and 15 years was 13 percent, 21 percent and 22 percent, respectively. For men with low-risk cancers, this risk increased to 19 percent, 28 percent and 31 percent. Over the same time frames, the cumulative risk of a grade reclassification to a level that would be considered potentially lethal in most cases but still curable was no more than 5.9 percent for both very low and low-risk prostate cancers, Carter says.  Also among the group, 109 men opted for surgical or radiation treatment despite the absence of significant change in their prostate cancer status. In those whose cancers were reclassified, 361 opted for treatment.  “The natural progression of prostate cancer occurs over a long period of time, some 20 years, and most men with low-risk prostate cancer will die of another cause,” says Carter, a member of the Johns Hopkins Kimmel Cancer Center. “There is a careful balance, which is sometimes difficult to find, between doing no harm without treatment and overtreating men, but our data should help.”  Carter estimates that 30 to 40 percent of U.S. men with eligible prostate cancers opt for active surveillance, compared with Scandinavian countries, where use of the option is as high as 80 percent. The reasons for less use in the U.S., he says, could stem from fear of losing the opportunity for a cure.

Carter says one of the benefits of active surveillance is reduction in the rates of complications and costs of prostate cancer treatments. In a recent report, 20 percent of men undergoing a prostate cancer treatment – radiation or surgery – were readmitted to the hospital within five years of treatment for a complication related to the original treatment.  Our goal is to avoid treating men who don’t need surgery or radiation. The ability to identify men with the most indolent cancers for whom surveillance is safe is likely to improve with better imaging techniques and biomarkers,” says Carter.  Active surveillance is included in best practice guidelines for doctors developed by the National Comprehensive Cancer Network, a group of the nation’s top cancer centers. Carter recommends that men see urology specialists to be monitored in an active surveillance program.

 


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More Evidence for the Positive Effect of Statins and Metformin in High-Risk Prostate Cancer.

bjgabrielsen : September 21, 2015 12:05 am : 2015, General Patient Information

A total of 22,110 high-risk prostate cancer patients were evaluated of which 1,365 died of prostate cancer.  The study authors concluded that the use of a statin medication in combination with metformin was associated with a 43% reduction in prostate cancer mortality.  The benefit was present in all men but was present to a larger degree in men with obesity.

The preceding abstract was presented at the 2015 meeting of the American Society of Clinical Oncology (ASCO) by Dr. Grace L. Lu-Yao of the University of Medicine and Dentistry of New Jersey.


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Stereotactic Body Radiation (SBRT) and CyberKnife in the Treatment of Prostate Cancer

bjgabrielsen : September 19, 2015 1:27 am : 2015, Treatment Information

Stereotactic Body Radiation (SBRT) accurately delivers very high doses of external radiation beams to the whole prostate gland thereby treating the tumor within while minimizing extra-prostactic radiation exposure to the adjacent normal tissues.  Because SBRT delivers a much higher dose of radiation during each treatment visit, the overall treatment time is sharply reduced. Generally a full course of therapy can be completed in 4-5 sessions over the course of 1-2 weeks.  Other radiation treatments for prostate cancer often require approximately 35-45 sessions over 6-9 weeks.  SBRT for low and intermediate-risk prostate cancer is covered by Medicare in all 50 states and the District of Columbia.  In addition, most private insurance payers and health exchange insurers cover SBRT treatment for prostate cancer.  A full report on SBRT was published in the January 22nd, 2015 issue of Frontiers of Oncology.  The full article can be viewed at http://journal.frontiersin.org/article/10.3389/fonc.2014.00369/abstract.

The prostate gland can move unpredictably throughout the course of treatment making the ability to track, detect and correct for motion during treatment critically important.  CyberKnife is one of several SBRT systems available but it is the only system that is entirely robotic.  In fact. the prostate has been documented to move as much as 5 millimeters in less than 30 seconds because of normal patient bodily functions such as filling the bladder, gas in the bowel or even slight patient movement during the procedure.  Unlike other radiation treatments, the CyberKnife system continually tracks and automatically corrects the radiation beam to adjust for movement of the prostate in real-time throughout the entire treatment session.  This capability enhances the doctor’s ability to accurately deliver high doses of radiation to the intended target while still preserving the surrounding healthy tissue to minimize potential side effects.  For contact information for centers specifically offering the CyberKnife System for prostate cancer, visit http://www.cyberknife.com.


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Radiation Cystitis – An Undesirable Potential Side Effect of Radiation Therapy

bjgabrielsen : September 15, 2015 1:32 am : 2015, General Patient Information, Treatment Information

I was recently made aware of an unexpected, undesirable side effect of prostate cancer radiation therapy called radiation cystitis which first occurred more than ten years after radiation treatment.  This can be caused by the incidental irradiation of the bladder during radiation therapy for prostate cancer.  Radiation cystitis is  characterized by blood in the urine (hematuria) and can manifest itself from 2 months to greater than ten years after treatment.  A teaspoon of blood can easily color the urine but more significant amounts of blood can be a sign of more serious conditions including bladder cancer.  Radiation treatment of the pelvic area can cause inflammatory changes in bladder tissue and its vasculature.  This particular patient suddenly encountered heavy bleeding for several hours during urination.  Eventually he could not urinate at all due to blood clot blockage which was accompanied by severe abdominal pain.  He had to undergo catherization and his bladder was irrigated to flush out any clots.  A subsequent CT scan and cystoscopy revealed bladder vascular changes but showed no pathological evidence of bladder cancer.  There are a number of possible treatments for radiation cystitis including hyperbaric (greater than atmospheric pressure) oxygen therapy consisting of significant number of daily treatments.  Useful links providing additional information include: a) an overall review of radiation cystitis;  b)  a series of testimonials from actual patients; c) a urology textbook review of radiation cystitis.  Unfortunately, I could not find any reviews suitable for the layman.  In summary, any unusual bleeding upon urination after radiation therapy should be discussed with your health care provider to differentiate mild causes from more serious ones.


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