Currently, four out of five prostatectomies are performed laparoscopically using robotic technology. It was hoped that such surgical techniques would demonstrate clear benefits such as fewer side effects when compared to the traditional open radical prostatectomy. A recent article appearing in the January 10th, 2012 issue of the National Cancer Institute (NCI) Cancer Bulletin concluded that older men who chose to remove their prostate glands to treat cancer have a high risk of developing incontinence or sexual dysfunction regardless of whether the surgery was performed laparoscopically using robotics or by traditional open surgery. The article cites a study involving 685 men performed by researchers at Massachusetts General Hospital and published in the January 3rd issue of the Journal of Clinical Oncology. The researchers noted however that future studies involving younger men should be carried out to more fully assess the risks, benefits and cost effectiveness of the two types of surgeries. The skills and experience of the surgeons and their hospital system must also be considered when choosing one type of surgery over another.
I try to read a devotional from the Bible daily. Yesterday I read a portion which could apply to anyone with prostate cancer or any other stress-inducing condition. The Old Testament book of Jeremiah 17 :verses 7-8 state as follows. “Blessed is the man who trusts in the Lord and whose trust IS the Lord. For he will be like a tree planted by the water, that extends its roots by a stream and will not fear when the heat comes; but its leaves will be green, and it will not be anxious in a year of drought nor cease to yield fruit.” One can interpret Biblical passages several ways. Some people read them as a personal preference asking “what do these words mean to me?” But a better approach would be to evaluate the words in terms of “what is God actually saying?” Having prostate cancer can often be likened to “turning up the heat on our lives” or experiencing a time of personal drought and anxiety. We need to remember however that God can use everything in our lives including cancer to point people to Him, to glorify Himself, to provide fulfillment and purpose to our own lives and in short, “to bear fruit”. So what is God actually promising in the verses above? We will all experience some form of “heat” and “drought” in our lives. But first our trust should be IN the Lord, His Word, His nature, His character and His plans. Secondly, our needs will be met (green leaves and watered roots) if we are so grounded. Next we need not be anxious about any of these situations. Finally, our life circumstances will not be wasted but instead be bearing wonderful and lasting fruit in our relationship with the Lord and with those around us.
In November, 2011, I had my six-month appointment with my oncologist at Moffitt Cancer Center, University of South Florida, Tampa. My prostate cancer is in remission and I currently receive no hormonal (androgen deprivation, ADT) therapy with Lupron until my PSA begins to rise. When my micro metastases are not under hormonal control, my PSA doubles in three months hence doctors label my cancer as “aggressive”. But for now, my PSA remains ‘undetectable’ for which I am grateful to God and I am on intermittent therapy to minimize the potential side effects of ADT. I expressed to my oncologist that it was my most sincere prayer that I not die of prostate cancer to which he confidently responded that it was much more likely that I would die of cardiovascular causes instead of cancerous ones. He also specified that I was “too good for participation in clinical trials of new therapies”. I do try to maintain good cardiac health with diet, medication and exercise under the care of a cardiologist.
While I was thankful for the opinions expressed by my oncologist, I recently read several on-line articles dealing with potential cardiovascular and metabolic syndrome side effects related with hormonal therapy. The December 20th, 2011 issue of the Prostate Cancer Foundation Newsletter contained an article which stated that “hormone drugs might not raise heart-related deaths in prostate patients” but for those with a history of heart disease, stroke may pose a higher risk. To further substantiate this conclusion, the December 13th, 2011 issue of the National Cancer Institute (NCI) Bulletin contained an article entitled “Prostate Cancer Trials Show No Link Between Androgen-Deprivation Therapy and Cardiac Deaths.” A new analysis of eight clinical trial results showed no evidence that ADT increased the risk of cardiovascular deaths in the case of patients with non-metastatic, high-risk prostate cancer. The original article had been published in the Journal of the American Medical Association (JAMA) by researchers from the Dana-Farber Cancer Institute who cited an additional benefit that men who had been treated with ADT had a lower risk of dying from prostate cancer and other causes than men who did not. Their conclusions however could not be extrapolated to men with a history of cardiovascular disease who could potentially be harmed by ADT.
Hormonal prostate cancer therapy has recently been associated with blood clots. An article by Amy Norton published December 1, 2011 by Reuters Health, stated that hormonal therapy for prostate cancer “may raise the risk of potentially-dangerous blood clots” according to a U.S. study led by Dr. Behfar Ehdaie of the Memorial-Sloan Kettering Cancer Center in New York and published in the journal Cancer. Dr. Ehdaie cautions that for men weighing their options for prostate cancer treatment, the risk of blood clots and other side effects needs to be balanced against potential benefits. It is not proven that hormonal therapy itself is the direct cause of the blood clots but men on ADT had a 56% greater chance of developing a blood clot. The clot risk also increased the longer a man was on the treatment. It is possible that hormone therapy’s negative effects on metabolism might increase a man’s fat mass. Men are urged to discuss the risks and benefits of hormonal therapy and other treatments with their physician.
The Prostate Cancer Research Institute (PCRI) publishes a newsletter called “PCRI Insights” to which I strongly suggest an on-line subscription. The last issue I received was the November issue. The general website for the PCRI is http://prostate-cancer.org/pcricms. It is also listed in the Medical Resources section of this website. The November issue (Vol. 14, No. 4) included a feature article on Provenge (Sipuleucel-T), the immunotherapy from Dendreon approved by the Food and Drug Administration for treatment of metastatic, hormone-refractory, asymptomatic prostate cancer patients. The article described in detail how Provenge works as well as its availability, eligibility and cost.
Also included was an article entitled “What’s Your Shade?” citing a method formulated by Harvard’s Dr. Anthony D’Amico by which the stage of one’s prostate cancer can be described by compiling five factors: PSA, Gleason score, percentage of biopsy cores, and results of rectal and pelvic MRI scans. The goal of identifying one’s “shade” is to ascertain potential risk of relapse (low, intermediate or high) after local therapy and subsequent treatment options if needed. The Johns Hopkins Prostate Cancer Health Alerts issue of January 12th, 2012 contained a very informative discussion of the TNM (tumor, nodes, metastasis) staging system as used to describe a cancer’s clinical stage or how far it has spread.
The PCRI Insights also contain short highlights and abstracts from recent prostate cancer conferences. The November issue contained updated information on several therapies under development including Ipilimumab (Yervoy), MDV3100, ARN-509 (Prostvac VF) and XL-184 (cabozatinib). In a section on conference summaries, it was noted that C-11 radio-labeled acetate PET scanning was a better method of detecting cancer metastases than the current FDA and Medicare-approved ProstaScint methodology. While information in the PCRI Insights may not be applicable to everyone’s specific medical condition, it provides an excellent overview of the current status of diagnostics and treatments.
There are always moments in the life of a man who has prostate cancer when peace of mind is in short supply. Personally, I experience times of anxiety as My Story in this website reveals. But God has something very special to say to us about His gift of peace. Isaiah, the Old Testament prophet, wrote the following in Isaiah 26:4-5. “The steadfast of mind Thou wilt keep in perfect peace because he trusts in Thee. Trust in the Lord forever, for in God the Lord, we have an everlasting Rock.” The words “perfect” and “peace” are actually one single Hebrew word– “shalom”. Shalom refers not just to the absence of disease, conflict or worry but the perfection of security, joy, prosperity and serenity. It is the “peace of God which surpasses all understanding” and which “guards our hearts and minds in Christ Jesus” according to Philippians 4:7. Remember also that God’s purpose of trials in our lives is to “perfect” our faith in Him according to James 1:2-4. This “perfect peace” comes to anyone who places his complete trust in the all-powerful, all-loving, sovereign grace of the Lord-the Rock eternal (Is. 26:4). While God uses physicians and medical science to perform wonders in the lives of prostate cancer patients, when we trust in anything or anyone more than the living, personal and eternal God, we actually practice idolatry. Only by trusting in our relationship with God through Jesus Christ, can we experience and possess true “shalom.”