PSA

Prostate Cancer Diagnosis? Eat Less Omega-6 fats and More Omega-3 fats

/ SupremeCmdr / Leave a comment

To determine whether diet or supplements can play a role in managing prostate cancer, the UCLA-led team conducted a prospective clinical trial, called CAPFISH-3, that included 100 men with low risk or favorable intermediate risk prostate cancer who chose active surveillance. Participants were randomly assigned to either continue their normal diet or follow a low omega-6, high omega-3 diet, supplemented with fish oil, for one year.

The findings, published in the Journal of Clinical Oncology, show that a diet low in omega-6 and high in omega-3 fatty acids, combined with fish oil supplements, significantly reduced the growth rate of prostate cancer cells in men with early-stage disease.

University of California – Los Angeles Health Sciences. “A low omega-6, omega-3 rich diet and fish oil may slow prostate cancer growth.” ScienceDaily. http://www.sciencedaily.com/releases/2024/12/241213211326.htm (accessed December 13, 2024)

Another reminder I should get my PSA level checked.

Prostate Cancer Diagnosis? Eat More Veggies

/ SupremeCmdr / Leave a comment

In this cohort study of 2062 men with prostate cancer, higher intake of plant foods after prostate cancer diagnosis was associated with lower risk of cancer progression. These findings suggest nutritional assessment and counseling may be recommended to patients with prostate cancer to help establish healthy dietary practices and support well-being and overall health. Plant-Based Diets and Disease Progression in Men With Prostate Cancer – https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2818122

This reminds me I should get my PSA level checked at my next annual visit.

Last reading was 0.64 back in 2022.

New Blood Test Improves Prostate Cancer Screening – the Stockholm3 test

/ SupremeCmdr / 4 Comments

On July 9 2021, results from the STHLM3MRI study were presented in The New England Journal of Medicine, indicating that over-diagnosis could be reduced by substituting traditional prostate biopsies with magnetic resonance imaging (MRI) and targeted biopsies. The new results, now published in The Lancet Oncology, show that the addition of the Stockholm3 test, which was developed by researchers at Karolinska Institutet, can be an important complement. It is a blood test that uses an algorithm to analyze a combination of protein markers, genetic markers and clinical data.

Karolinska Institutet. “New blood test improves prostate cancer screening.” ScienceDaily. http://www.sciencedaily.com/releases/2021/08/210813100313.htm (accessed August 14, 2021).

AUA Recommends Against Routine Prostate Cancer Screening – AAFP

/ SupremeCmdr / Leave a comment

In a significant about-face, the American Urological Association (AUA) recently published clinical guidance that recommends against performing all routine prostate-specific antigen (PSA)-based screening for prostate cancer, as well as all screening in men older than 70, men younger than 40 and average-risk men ages 40-54.

via AUA Recommends Against Routine Prostate Cancer Screening — AAFP News Now — AAFP.

Life insurance companies will undoubtedly continue to run PSA tests.  Think about how long it took us to stop ordering CXR’s.

NEJM Resident eBulletin – Elevated PSA

/ SupremeCmdr / Leave a comment

Teaching Topic

Elevated PSA

Case Records of the Massachusetts General Hospital

Case 9-2012: A 67-Year-Old Man with a Persistently Elevated PSA Level

D.S. Kaufman and Others

CME Exam

At least 30% of clinically important prostate cancers may be missed during transrectal ultrasound-guided biopsy, and the results are not improved if more than 12 cores are taken (so-called “saturation biopsies”).

Clinical Pearls

Clinical Pearl  What is a Gleason score?

The Gleason score is the sum of the two most common histologic grades in a prostate-gland tumor, each of which is rated on a scale of 1 to 5, with 5 being the most cytologically aggressive. It correlates with prognosis. A higher score is more likely to be seen with disease that is not confined to the prostate, and is also correlated with poorer response to treatment of localized disease.

Clinical Pearl  What are the criteria for active surveillance in prostate cancer?

The authors report that criteria for active surveillance for prostate cancer include a PSA level less than 10 ng per milliliter. While the decision to carry out active surveillance is one that must be individualized, in general, in addition to having a relatively low PSA, patients with early clinical disease stage and a Gleason score indicating well or moderately differentiated tumor may be considered for active surveillance.

Morning Report Questions

Q. What is transperineal template-guided mapping biopsy (TTMB) of the prostate?

A. Traditional transrectal ultrasound-guided needle biopsy of the prostate allows excellent and convenient sampling of the posterior aspect of the prostate gland, where prostate cancers most commonly originate. On occasion, however, the cancer may arise either centrally or anteriorly and may be beyond the reach of a biopsy needle inserted through the rectum. However, the anterior gland can be reached through a perineal approach, a technique that is used to insert radioactive seeds into the prostate gland for the purpose of treatment (brachytherapy). Precision is needed to ensure that the needles are placed correctly. To achieve this, transrectal ultrasonography is used to visualize the needles, and the needles themselves are passed through holes in a template (grid) that is secured against the perineum. The perforations ensure that the needles are inserted in parallel and with a known relationship to one another. The “repurposing” of this brachytherapy technique for prostate biopsy is known as TTMB, or “grid” biopsy, and the template may be used to insert biopsy needles precisely to any location in the prostate gland.

Figure 3. Transperineal Template-Guided Mapping Biopsy of the Prostate.

Q. What are the indications for consideration of TTMB?

A. A PSA level higher than expected for the size of the gland should prompt consideration of TTMB for better sampling of the prostate. Biopsies performed with the use of templates are important for carefully selected patients in whom there is an unexplained discordance between PSA readings and findings on examination of biopsy specimens obtained via transrectal approach. One quarter of patients who undergo TTMB after at least one negative specimen obtained by transrectal ultrasound-guided biopsy will have positive results on TTMB. Up to half of these patients have cancers with a Gleason score of 7 or higher. In patients with two or more negative specimens from transrectal ultrasound-guided biopsies, the most common finding in specimens obtained by TTMB was cancer in the anterior lobes. The morbidity associated with TTMB is greater than that associated with transrectal ultrasound-guided biopsies; there is a higher incidence of acute urinary obstruction. Overall, the costs associated with TTMB (e.g., the costs of general anesthesia, the operating room, and the processing of a large number of tissue cores) render it far more expensive than transrectal ultrasound-guided biopsies.

Prostate-Cancer Screening — What the U.S. Preventive Services Task Force Left Out — NEJM

/ SupremeCmdr / Leave a comment

These approaches to managing serial PSA levels reflect either a fundamental misunderstanding of — or an unwillingness to acknowledge — PSA’s limitations as a marker for early prostate cancer. Observational studies show clearly that PSA levels fluctuate spontaneously, moving above or below whatever threshold clinicians deem worrisome. In addition, random biopsies can detect prostate cancer in 12% of men with PSA levels below 2 ng per milliliter and in 25% of men with levels between 2.1 and 4.0 ng per milliliter4; the latter figure approximates the prevalence often reported for men with levels between 4.0 and 10.0 ng per milliliter. When the PSA goes up — for example, from 3.0 to 4.0 ng per milliliter — and triggers a biopsy that reveals cancer, clinicians refer to “PSA-detected cancer.” But many of these cancers are not really detected by PSA screening; they are incidental findings against a background of randomly fluctuating PSA levels and an age-related increase in prostate-cancer incidence.

via Prostate-Cancer Screening — What the U.S. Preventive Services Task Force Left Out — NEJM.

Stratifying Risk — The U.S. Preventive Services Task Force and Prostate-Cancer Screening — NEJM.

I realize today is the day after Thanksgiving and I’m working.  But medicine never stops and a life underwriter has to do what a life underwriter does on her day off.  Read medical journals!  Check out these articles from NEJM.  Time to change our PSA underwriting guidelines?  I think so.  Call me if you need help with this.  I have a mortgage, one undergraduate, and one medical student to support.

Speaking of the medical student I was trapped this Thanksgiving in the car and listened to over five hours of lectures on neurology and hematology during the ride.  To tell the truth, I enjoyed the lectures.

Medicine never takes a day off nor do expert life underwriters.