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Prostate cancer: Diet, ADT and bone health

Written by Community Health Network on 2/25/2014 7:00:00 PM

By Jianan Graybill, MD, FACRO, radiation oncologist and an MD Anderson Cancer Network™ certified physician.

Prostate cancer is the second most common cancer in men worldwide. An estimated 233,000 cases will be diagnosed in 2014. The clinical behavior of prostate cancer ranges from a microscopic, well-differentiated tumor that may never be clinically significant, to an aggressive high-grade cancer that ultimately causes death.

The frequency of a diagnosis of prostate cancer has increased, due largely to the widespread use of serum prostate specific antigen (PSA) screening. Since 1995 the number of incidences of prostate cancer has risen at a rate of about one percent per year.

Almost 80 percent of men currently diagnosed with prostate cancer undergo a biopsy because of a suspicious serum prostate specific antigen (PSA). However, digital rectal examination plays an important role in early detection, as 20 percent of cases have a prostate nodule that prompts the biopsy.

How does my diet impact prostate cancer?
A prostate cancer study published in JAMA (July 22, 2013) reported that diet could help control the spread of prostate cancer. This study analyzed the diet of 4,577 men, specifically the types of fat consumed in various foods. Several other studies have reported a diet high in animal fat may be an important factor in the development of prostate cancer. In particular, intake of large amounts of alpha-linoleic acid and low amounts of linoleic acid appear to be associated with increased risk; this combination is common in red meat and some dairy products. Overall it’s important to eat your vegetables. A diet low in vegetables may be another risk factor for prostate cancer. A case-control study found a higher prostate cancer risk in men who consume less than 14 servings of vegetables weekly, compared with 28 or more servings (adjusted odds ratio 1.54). Also in the news is the benefit of soy. Although few human studies have been conducted, cohort studies have shown a modest protective benefit of soy intake on prostate cancer. Eating a balanced diet full of colorful fruit and vegetables, avoiding foods high in fat and sugar, is always best.

If androgen deprivation therapy is part of my prostate cancer treatment, should I be concerned about bone health and risk of fractures?
Part of the treatment for prostate cancer may involve androgen deprivation therapy (ADT). This therapy increases bone turnover, decreases bone mineral density, and increases the risk of clinical bone fractures. Longer therapy does come with a higher risk of osteoporotic skeletal fractures.

These fractures may occur in up to 20 percent of men within five years of starting ADT. As a result, these conditions can significantly contribute to poor quality of life after prostate cancer treatments. Part of our treatment approach is to identify lifestyle modifications that can improve bone health. Smoking cessation and decreased alcohol consumption are very important.

We also recommend dietary calcium intake (food and supplements) of 1000 to 1200 mg daily and supplemental vitamin D 800 to 1000 international units daily for all men receiving ADT. Finally, doing regular weight bearing or resistance exercises helps to strengthen the bones and muscles which helps improve balance and avoid the risk of falling.

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Prostate cancer answers start here

Written by Community Health Network on 2/24/2014 8:00:00 PM

A discussion with Jianan Graybill, MD, FACRO, radiation oncologist, and an MD Anderson Cancer Network™ certified physician.

There are only a few cancer centers in the country that offer high dose rate brachytherapy. Community Cancer Care is one of them.

Commonly called HDR brachytherapy, this cancer treatment is a form of temporary seed implant used to treat prostate cancer. It is the ultimate conformal therapy.

“HDR Brachytherapy has the ability to shape the radiation dose to fit the (prostate) tumor and avoid normal tissue,” said Graybill.

HDR brachytherapy can be used alone or in combination with other treatment modalities, such as external beam radiation. Guidelines from American Brachytherapy Society recommend that HDR brachytherapy be considered as a way to escalate the dose of radiation in men receiving radiation therapy as their primary therapy for prostate cancer.

HDR brachytherapy is particularly useful in men with intermediate or high-risk prostate cancer because it can provide highly conformal dose escalation to the target region. HDR eliminates the need to have surgery, prolonged hospitalization or protracted external beam treatments. It provides greater patient comfort during and after the procedure and requires minimal recovery time.

A recent quality of life and cost analysis study showed that HDR provides the most cost efficient treatment with the best quality of life outcome. When combined with external bream radiation, HDR and external bream provided increased disease free survival in intermediate and high-risk prostate cancer patient populations compared with external beam radiation.

Cancer treatment at Community

At Community Health Network, we have over 15 years of HDR experience and one of the largest patient populations being treated with it. Our collaboration with The University of Texas MD Anderson Cancer Center allows our physicians to discuss difficult cases with MD Anderson physicians on a real time basis, including the advanced treatment of prostate cancer.

For more information about Community Cancer Care services call 800-777-7775.


Prostate cancer screening: Is it for me?

Written by Community Health Network on 2/22/2014 8:00:00 AM

What do men need to know about watchful waiting in order to catch prostate cancer before it becomes aggressive? Jianan Graybill, MD, FACRO, radiation oncologist and an MD Anderson Cancer Network™ certified physician, explains who should get screened for prostate cancer and outlines current recommendations by age.

Dr. Jianan Graybill, prostate cancer expert at CommunityProstate cancer is the most common cancer in America for men behind skin cancer. One in seven men will be diagnosed with prostate cancer in his lifetime. Although it is the second leading cause of cancer-related death in men (after lung cancer), survival rates are excellent for most patients. Nearly 2.5 million men in the U.S. are survivors of prostate cancer, approximately 20 percent of the total cancer survivor population.

Prostate cancer typically has no symptoms or warning signs in the early stages. For men with advanced disease, these men will typically have urinary symptoms or erectile dysfunction. They may also complain of severe back pain (because the cancer has spread to the spine).

Prostate cancer can often be found early by testing the amount of prostate-specific antigen (PSA) in a man’s blood. Until recently, PSA was routinely obtained from older men as part of their annual physical screening.

However, in May 2012, the U.S. Preventive Service Task Force issued new recommendations

“The Task Force concludes that many men are harmed as a result of prostate cancer screening and few, if any, benefit. A better test and better treatment options are needed. Until these are available, the USPSTF has recommended against screening for prostate cancer.” 

The American Urologic Association responded with this official recommendation to each USPSTF guidelines statement based on scientific evidence. continue reading ...


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