For American men, prostate cancer is the most common type of cancer, with 200,000 new cases diagnosed last year. The only way to definitively confirm the presence of cancer is by biopsy of the prostate. While it is widely recommended for men who are suspected of having the disease, stories have turned up in the media suggesting that prostate biopsies carry the risk of spreading cancer cells, increasing the likelihood of recurrence. Could the very test that diagnoses prostate cancer cause its spread? I posed this question to J. Stephen Jones, MD, who is the chairman of the department of regional urology at the Cleveland Clinic Glickman Urological and Kidney Institute and author of The Complete Prostate Book.
WHO NEEDS A BIOPSY?
The possibility that a man might have prostate cancer is first identified through early detection tests such as the prostate-specific antigen (PSA) blood test and a digital rectal exam (DRE). If either suggests the possibility of prostate cancer, a prostate biopsy is the next step, says Dr. Jones. In the US, this is most commonly done with an ultrasound probe placed in the rectum and a core needle biopsy. Guided by the probe, the doctor inserts a narrow needle through the rectal wall into the prostate gland. When the needle is pulled out, it removes a sample of tissue. Usually performed under general anesthesia, this process is typically repeated 10 to 12 times or more in order to obtain tissue from different parts of the prostate.
Regarding this frequently asked question about spreading prostate cancer, Dr. Jones maintains that needle biopsy does not pose significant risk. “This is primarily based on old wives’ tales,” he said. “Since metastasis occurs when cells break off and spread through the bloodstream, it makes sense that a needle placed through cancerous tissue might break off some cells. But in fact, this occurs only rarely, with certain types of high-grade cancers such as kidney cancer. Prostate cancer is not one of those types.” Dr. Jones told me that he does not know of a single case reported where this occurred following a transrectal biopsy.
A DIFFERENT BIOPSY THAT SHOULD BE AVOIDED
On the other hand, there is another type of biopsy for prostate cancer called a transperineal biopsy, that in a very few instances, has been associated with cases of spreading cancer, Dr. Jones acknowledged, noting that this is rare. “The only data that has ever shown that a prostate biopsy may pose a risk are associated with transperineal biopsies, in which tissue is collected by a thin needle that is inserted through the skin between the scrotum and rectum and into the prostate,” explained Dr. Jones. This procedure is more common in Italy, where there have been occasional reports of needle tracking cancer spread. Some doctors believe this type of biopsy provides better information on the location of the cancer than the transrectal approach, but this is controversial, Dr. Jones said. While the transperineal approach remains very uncommon in this country, Dr. Jones said this procedure may be seeing a small resurgence in the US based on this potential benefit.
In contrast, transrectal biopsies are considered generally quite safe and effective for diagnosing prostate cancer, with few associated risks, and even those occurring in only about 1% of patients. The most common associated problems include blood in the rectum or urine that lasts for a few days or blood in the semen for a few weeks. More significant risks include heavy bleeding in urine/stool, urinary retention and infection.
A prostate biopsy should be performed by a urologist, not a family practitioner or internist. Also, suggested Dr. Jones, be sure to ask your urologist about the number of core samples to be taken. He said research indicates the importance of sampling at least eight to 10 cores. “Less than that, one has a significant chance of missing cancer, and it may mean, frankly, that the doctor hasn’t kept up with the latest understanding of biopsy procedures,” he said.
Dr. Jones states that all forms of prostate biopsy are highly accurate, especially if the results are positive. If biopsy results are negative, however, there is a one-in-four risk that a small tumor may have been missed, he notes. So men must continue to be on alert and should be checked regularly.

Source(s): ??J. Stephen Jones, MD, is chairman of the department of regional urology at the Cleveland Clinic Glickman Urological and Kidney Institute, and is associate professor of surgery (urology) at Cleveland Clinic Lerner College of Medicine at Case Western Reserve University. He is author of The Complete Prostate Book (Prometheus) and Overcoming Impotence (Prometheus).

Laura, good boyfriend stuff above.

Women of Iran, right on! I was in the bank this AM and the news was on – headline: ‘protests in Iran continue – women are out in forces’ I have to say I was and am filled with pride for you. Keep up the protesting, wish I could be there, but you’ve got Madaline and I’m a wuss next to her : ) this girlZ thoughts are with you.

Caio for now, Zen Lill

How Global Warming Threatens Your Health

Georges C. Benjamin, MD
American Public Health Association

he World Health Organization estimates that 150,000 deaths annually, mostly in Africa and Asia, are caused by climate change — primarily related to increases in the planet’s surface temperature (commonly known as global warming). The death toll is expected to double in the next 20 to 30 years.
Latest development: Health implications are also starting to be felt in the US.

LUNG DISEASES

Higher temperatures cause an increase in ground-level ozone, a gas that irritates the airways and increases the risk for asthma and other lung diseases — and exacerbates symptoms in those who already have any pulmonary disorder.

What to do: If you or a family member has a pulmonary condition or you’re healthy but planning to spend a good deal of time outdoors, check the daily ozone forecast. It’s available online at EnviroFlash (www.enviroflash.info), a program sponsored by the Environmental Protection Agency.

HAY FEVER AND MOLD

The increase in the atmospheric gas carbon dioxide (CO2) can stimulate pollen-producing plants to release more pollen, which exacerbates symptoms in people with hay fever as well as asthma. Rising temperatures and CO2 levels also increase the growth of molds, which attach to pollutants in the atmosphere and more readily enter the lungs.

What to do: If you or a family member has allergies or asthma, check daily pollen reports. The National Allergy Bureau (www.aaaai.org/nab) provides daily pollen and mold counts for many US states. Limit your time outdoors on “high pollen” days.

HEATSTROKE

We’re seeing more heat waves nationally. In areas that once had just a few hot days a year, now there might be stretches of four, five or six days of temperatures that are 10 degrees or more above average high temperatures for a region. Heat can be deadly, particularly for the elderly.

Older adults don’t sweat as much, so they’re less able to dissipate heat. Result: Their body temperature can rise to dangerous levels — and stay there.

People with impaired mobility or those taking diuretics (which promote the excretion of fluids) have a very high risk for heat-related conditions, such as heatstroke (a potentially deadly condition that causes raised body temperature and loss of consciousness). People who are overheated often feel weak, making them less able to get up for a drink of water. The combination of low fluid intake and decreased sweating is extremely dangerous.

What to do: Anyone at risk for overheating (as previously described) should have access to an air conditioner or, at a minimum, a fan. If mobility is an issue, fill a pitcher of cool water and keep it nearby. If you have difficulty getting around, consider buying an alert bracelet so you can summon help in an emergency. Even if you’re in good health, drink two to four glasses of cool water per hour in extreme heat or while physically active.

MOSQUITO-BORNE DISEASES

Worldwide, 350 million to 500 million people get malaria (an infectious disease that causes high fever and chills) every year, and more than 1 million die from it.

Malaria and other mosquito-borne diseases haven’t been a significant threat in the US since the early 1950s, following a successful eradication program using drainage, removal of mosquito breeding sites and pesticides. But that could change with global warming. Warmer temperatures allow mosquito populations to proliferate. According to the most recent CDC data, 1,337 cases of malaria, including eight deaths, were reported in the US in 2002.

Right now, there’s an epidemic of dengue fever (a mosquito-borne infectious disease that causes severe joint pain, headache, fever and rash) in South America. If temperatures continue to rise in the US, an increase in dengue fever (cases have been reported in Hawaii) will almost certainly occur here. A similar increase in West Nile virus (a mosquito-borne illness that causes flu-like symptoms) also could occur in the US.

What to do: To reduce mosquito populations, remove breeding sites. After it rains, look for places where water accumulates — for example, in flowerpots — and dump it out as soon as possible. Cover barbecue grills and other outdoor water “traps.” Maintain rain gutters so that there is no standing water. Mosquitoes are attracted to as little as one teaspoon of standing water, and their eggs typically hatch within 48 hours.

Also helpful: Keep fish in backyard ponds. Many species, including mosquitofish and bitterlings, eat mosquito larvae. If you live in a warm, damp area where mosquitoes proliferate, wear long sleeves and pants whenever possible, and/or use a repellent, such as one containing DEET or picaridin. Or stay indoors during the early morning and at dusk, when mosquitoes are most active.

WATERBORNE INFECTIONS

With global warming, extreme storms and floods are likely to occur more often. These pose obvious risks for those in coastal areas — but inland regions aren’t necessarily safe.

Drowning and/or water damage are obvious concerns. A bigger issue is water quality. Many metropolitan areas have sewage systems that can’t handle severe downpours — water from the sewers can overflow into clean water supplies, causing outbreaks of potentially fatal bacterial infections.

What to do: Following severe downpours or floods, tune in to news channels for up-to-date reports on water quality. If there are concerns about water quality, keep a stockpile of bottled water… boil (for at least one full minute) water used for cooking, cleaning and bathing… and wash your hands often with soap and disinfected water.

Bottom Line/Health interviewed Georges C. Benjamin, MD, an internist who serves as executive director of the American Public Health Association, http://www.apha.org, and professorial lecturer at George Washington University School of Public Health, both in Washington, DC. He is former secretary of the Maryland Department of Health and Mental Hygiene, and is a leading expert in emergency preparedness.

Please let Madaline know that we will continue to try to get our men to stand for total equality for women.

Aghigh

The government is investigating the crooks.

Mary