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Doctor's Consultation
by Dr. Iain Corness
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Prostate cancer and life expectancy
Prostate cancer is one of those
diagnoses which instills fear into mankind. Women, not having a
prostate, can stop reading, but mind you, they do have their own unique
cancer problems with cancer of the womb.
I was stimulated to write about prostate cancer, following an article in
the journals on prostate cancer and survival rates.
It was reported as where prostate cancer spreads in the body has a
direct effect on survival, research has shown.
Scientists have been able to map typical survival times to specific
organ sites.
The study found that patients whose tumors had only spread to the lymph
nodes had a best prognosis of 32 months.
Those whose cancer had reached the liver had a life expectancy of two
years.
Spread to the bones was associated with a survival time of 21 months and
to the lungs of 19 months.
The research was based on data from nine large Phase III clinical trials
involving 8736 men with advanced prostate cancer. All had undergone
standard treatment with the chemotherapy drug docetaxel.
Professor Susan Halabi, from Duke University, in the US, said, “Smaller
studies had given doctors and patients indications that the site of
metastasis in prostate cancer affects survival, but prevalence rates in
organ sites were small, so it was difficult to provide good guidance.”
The phrase ‘reinventing the wheel’ came immediately to my mind. So, the
further the cancer cells went in the body, the less time you have left
on this earth. This has been noted for years. This is nothing new.
“With the large numbers we analyzed in our study, we were able to
compare all of these different sites and provide information that could
be helpful in conveying prognosis to patients. This information could
also be used to help guide treatment approaches using either hormonal
therapy or chemotherapy.”
Nearly 73 percent had experienced metastasis, or spread, to the bones.
Men with lymph involvement only made up the smallest group, accounting
for just 6.4 percent of the total.
Patients with liver metastasis represented 8.6 percent, while those with
lung disease made up 9.1 percent.
“These results should help guide clinical decision-making for men with
advanced prostate cancer,” said Prof Halabi.
(The findings are published online in the Journal of Clinical Oncology.
Originally published as Prostate life expectancy depends on spread.)
Now let’s look at these frightening statistics again. The figures that
were quoted came from men who already had advanced prostate cancer, not
all men. Other statistics show that prostate cancer is a disease of
aging, and we are all living longer. The statistics show that by age 50,
almost 50 percent of American men will have microscopic signs of
prostate cancer. By age 75, almost 75 percent of men will have some
cancerous changes in their prostate glands. Do the math. By 100 we’ve
all got it!
So does this mean that life really ends at around 76? Fortunately no.
Most of these cancers stay within the prostate, producing no signs or
symptoms, or are so slow-growing, that they never become a serious
threat to health. The good news is you die of something else before the
prostate gets you! You die with it, rather than from it.
The real situation is that a much smaller number of men will actually be
treated for prostate cancer. About 16 percent of American men will be
diagnosed with prostate cancer during their lives; 8 percent will
develop significant symptoms; but only 3 percent will die of the
disease. Put another much more positive way, 97 percent won’t die from
prostate cancer.
The researchers were dealing with the three percent group. It is then no
wonder that the numbers looked bad.
While prostate cancer can be ‘aggressive’, breaking out from the
prostate gland itself and attacking other tissues, including brain and
bone, fortunately this is the minority scenario. The great majority of
prostate cancers are slow growing, and it can be decades between the
early diagnosis and the cancer growing large enough to produce symptoms.
So let’s get the “blood test” out of the way. The blood test is called
Prostate Specific Antigen, or PSA, and the actual number isn’t as
important as the rate of change.
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Are you waiting for an MRI?
Many of the advances in medical
treatment have come from more accurate diagnosis. That has often come about
through advances in technology and an MRI (magnetic resonance imaging) is
one of these. The procedure is similar to an X-Ray, in the fact that the end
result shows the internal structures of the body but without the use of
X-rays. MRI uses a large magnet, radio waves, and a computer to produce
these images.
Some folk are a little apprehensive about these newer tests, but the risks
to the average person are negligible. The MRI uses magnetic fields, rather
than radio-active imaging. However, the magnetic field is very strong. Walk
into the examination room and the MRI can wipe the details from the magnetic
strip on your credit card, stop your watch and even pull the stethoscope
from the doctor’s pocket!
People who have had heart surgery and people with the following medical
devices can be safely examined with MRI: surgical clips or sutures,
artificial joints, staples, cardiac valve replacements (except the
Starr-Edwards metallic ball/cage), disconnected medication pumps, vena cava
filters or brain shunt tubes for hydrocephalus.
However, there are some conditions may make an MRI examination inadvisable.
Tell your doctor if you have any of the following conditions: heart
pacemaker, cerebral aneurysm clip (metal clip on a blood vessel in the
brain), pregnancy during the first three months (we are just being super
cautious here), implanted insulin pump (for treatment of diabetes),
narcotics pump (for pain medication), or implanted nerve stimulators
(“TENS”) for back pain, metal in the eye or eye socket, cochlear (ear)
implant for hearing impairment, or implanted spine stabilization rods.
MRI is also different from X-Rays in what it can pick up. The MRI can detect
tumors, infection, and other types of tissue disease or damage. It can also
help diagnose conditions that affect blood flow. Tissues and organs that
contain water provide the most detailed MRI pictures, while bones and other
hard materials in the body do not show up well on MRI pictures, as opposed
to X-Rays which do show bone well but not soft tissue. For these reasons,
MRI is most useful for detecting conditions that increase the amount of
fluid in a tissue, such as an infection, tumors, and internal bleeding. In
some cases a contrast material may be used during the MRI scan to enhance
the images of certain structures.
I think most people are familiar with the standard X-Ray procedure, stand
there, breathe in, hold it, now breathe out routine, but MRIs are a little
different. These are done with you lying there and inserted into the MRI
scanner, which is like a tunnel. Those people who are claustrophobic can
have a little problem here, as the MRI “tunnel” is very tight. When I had my
own MRI done I noticed that my nose was close to the top of the tunnel and
both elbows were brushing the sides, and I am considered a reasonably slim
individual. I have to say that although not claustrophobic, I do not
particularly like being in enclosed spaces, and found that the best way to
endure the MRI was to pretend I was lying relaxing in a field.
During the procedure, which can take up to an hour, you can hear the
operator talking to you, and he or she can hear your reply, but you still
will feel rather isolated in your magnetic tunnel. You can also hear (and
feel) muffled thumps and groans that come from the tube, which can be
somewhat unsettling.
In the cases where a contrast material is to be used during the MRI scan to
enhance the images of certain structures this may help evaluate blood flow
for example, detect some types of tumors, and locate areas of inflammation.
The contrast material is injected via a vein, and the MRI operator will
advise you when this is being injected. You may feel a warmth or even
tingling feeling as this is happening, but this is not worrisome.
The radiologist then reviews the pictures produced which takes quite some
time, and will advise you of the outcome. I hope it will be good news!
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Yellow Liver, Yellow Liver (sing along)
What is your most important organ?
Ask any man and he will undoubtedly point to his bladder’s siphon hose.
But it isn’t. The liver is one of the more important organs you possess.
Without it you will die, whereas you can get by without a kidney, or a
lung or a thyroid, or even Willy the Wonder Wand (a delicacy enjoyed by
Isaan ducks, I believe)! Yes, I’d rate my liver fairly highly.
Think of your liver as a filtering and de-toxifying device. Chemicals
are taken up by the liver, to be broken down into non-toxic chemicals,
all to protect your system. Clever organ your liver, to know what’s good
for you and what isn’t.
The most well-known liver toxin is our old friend Ethanol, more usually
referred to as booze. There is “common wisdom” that says certain types
of booze are more damaging than others, but that just isn’t so.
Irrespective of the color or shape of the bottle it came in, ethanol is
ethanol, is ethanol. It is the percentage of alcohol that is the
important factor. That alcohol affects the liver is generally accepted,
with the end result being called Cirrhosis, a fibrous hardening of the
liver which then becomes unable to carry out its job correctly. Toxins
build up. You feel unwell and it’s all downhill from there.
Some proprietary or prescription drugs can produce an inflammation of
the liver tissues too. Or worse, produce a breakdown of the liver tissue
itself. Amongst these is the headache medication paracetamol (the
ubiquitous medication you can even buy in the corner stores), but before
you throw them out of your bathroom cabinet, it requires some heavy and
very frequent dosage of paracetamol to do this.
Other prescription items that may produce liver problems include
Methyldopa, several penicillins, Simvastatin (the cholesterol lowering
drug), Diclofenac (a non-steroidal anti-inflammatory) and Ketoconazole
(anti-fungal). But it is rare – so don’t stop taking your prescriptions
yet!
Prescription drugs can be dangerous (even though you can get most of
them over the counter in Thailand), but that’s why they have a PI
(patient information) leaflet inside the box (the bit you throw away and
don’t read). Probably if you read it, you wouldn’t take it!
However, what about “Health food” preparations? The purveyors of these
all cite the fact that the ingredients are “natural” so everyone assumes
that this means “safe”. Not so, I’m afraid. Lead, for example, is a
naturally occurring compound, and not much good for young kidneys.
However, since we are talking about liver problems, hands up all those
of you who have heard of Echinacea? Supposedly fixes everything from
falling hair to fallen arches – but is it “safe”? Well, Echinacea, along
with Kombucha Tea are two of the commonest compounds showing a
well-documented history of being toxic to the liver. So if you’re
sipping Kombucha tea because you’ve drunk too much alcohol last night, I
would suggest that you change to water, or go back to booze (stop
hangovers – stay drunk)!
Others for sale in the Health Food shops with known toxic effects on the
liver include Evening primrose oil, Valerian, Chaparral, Japanese
Daisaiko-to (for dyspepsia), Chinese Jin-bu-huan and several forms of
herbal teas such as those from Heliotroprium, Senecio crotalaria and
Symphytum. Makes you think that the shops that sell them may be
incorrectly named, doesn’t it!
So how can we see what stage your liver is at after the onslaught of
liver toxins? There is a new test called Fibroscan which can show if
your liver is in trouble. My hospital’s Gastrointestinal and Liver
Center can arrange it for you.
But while the column this week seems to be spreading doom, gloom and
disaster, it’s not quite that bad. The liver is a very powerful organ
and is capable of regenerating itself quite quickly, so in most cases of
toxicity following ingestion of chemical compounds (including alcohol),
by stopping taking it the liver recovers and the patient feels well
again.
So remember that if you are taking anything regularly and you feel
unwell, it may be the liver – but tell your doctor everything you have
been taking! And no thanks, I’ll give the herbal tea a miss today.
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Saviors or killers?
It appears to me, after my many years
of using a stethoscope, that the world has become a very cynical place for
medicine. Blame it on 9-11 if you like, but the conspiracy theorists are
getting very noisy. Or perhaps they have the ear of the journalists. Or
perhaps the journalists find conspiracy an easy subject with which to fill
newspapers.
The latest to bring the wrath of public opinion on its
head is the statin group. One reporter stating: “Cholesterol has been
demonized and statin drugs (Zocor, Crestor, Lipitor, Baycol, Mevacor or
Altocor, Pravachol, Lescol, Livalo) have been touted as miracle drugs for
lowering cholesterol, yet as we’ve seen use of statins increase we’ve seen
heart disease as well as diabetes increase. Obviously, something’s wrong
with the theory that statins are beneficial.
“Unfortunately, entrenched interests, pharmaceutical
companies who hold the patents and manufacture statin drugs and doctors who
profit from dispensing these drugs won’t let it go without a fight. There’s
simply too much money riding on this false hypothesis that cholesterol is
BAD and conversely statin drugs are good. Statin drugs are a multi-billion
dollar business with the US accounting for about $20 billion of that profit
per year.”
The purveyors of doom cite the side effect profile of the
statins.
• Muscle aches, tenderness, or weakness (myalgia)
• Memory loss
• Drowsiness
• Dizziness
• Difficulty sleeping
• Cataracts
• Loss of appetite
• Weight gain
• Abdominal pain or cramping
• Bloating or gas
• Nausea or vomiting
• Diarrhea
• Constipation
• Liver failure
• Acute kidney failure
• In rare cases a potentially fatal condition called
rhabdomyolysis, where muscles break down and cause kidney failure.
• Headache
• Flushing of the skin
• Rash
Now, I am not going to deny that these side effects may
occur, but to what extent? In the studies on people who had not already
suffered from a heart attack or stroke, the rate of new-onset diabetes for
people on statins was 2.7% and on placebo was 2.2% for example.
The research was carried out by researchers from Imperial
College London and the London School of Hygiene and Tropical Medicine. A
study of 83,880 patients, only a small minority of symptoms reported on
statins are genuinely due to the statins; almost all reported symptoms
occurred just as frequently when patients were administered placebo.
New-onset diabetes mellitus was the only potentially or actually symptomatic
side effect whose rate was significantly higher on statins than placebo;
nevertheless, only one in five of these new cases were actually caused by
statins.
The author of the article proposed, “Does administration
of a cholesterol lowering drug that has so many negative side effects,
actually increases diabetes, may lead to dementia, Alzheimer’s, liver and
kidney failure, and depletes molecules essential for heart function really
make sense?”
If the above statement were true, I would look more
kindly on the article, but it is a gross exaggeration of the real-life
situation. New cases of diabetes occurred in 2.2% of people taking placebo
(dummy) and 2.7% of people taking a statin, which is 0.5% more and
potentially reversible.
And as a representative of the group the writer called
“doctors who profit from dispensing these drugs” this is again a gross
exaggeration, inferring that all doctors are on the take. Or perhaps there
was some conspiracy to deliberately ignore me? I have never received
financial sweeteners, not even a holiday in the Bahamas. Where did I go
wrong, I wonder?
But when discussing side effects we should also look at
some other medications we use and look at their side effect profile. One
goes by the chemical name C2H6O and has the following side effects:
Slurred speech
Drowsiness
Vomiting
Diarrhea
Upset stomach
Headaches
Breathing difficulties
Distorted vision and hearing
Impaired judgment
Decreased perception and coordination
Unconsciousness
Anemia (loss of red blood cells)
Coma (which can lead to death)
Blackouts (memory lapses)
That is quite a list of dangerous side effects, so should
we mount a campaign to ban this substance? Especially when it is shown that
people are using C2H6O as a recreational drug!
Perhaps at this point I should also admit that C2H6O is
also known as ‘ethanol’, which is also known as alcohol. Would you really
like to ban it?
See you down the pub!
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