Friday, June 29, 2012

Bladder Pal supporting overactive bladder awareness on AUA Foundation site

The American Urological Association Foundation (AUAF) has launched a site to increase awareness of overactive bladder (OAB).  The web presence is part of a multifaceted patient outreach initiative entitled - "It's Time to Talk about OAB."

In the site is a link to Bladder Pal for Apple and Android under the "Assess Your OAB Symptoms" heading. 

The site also has high quality information regarding OAB facts, symptoms, treatment options, and a resource to find urologic care.

I'm happy to partner up with the AUAF on this effort and am glad that many more people around the world have access to Bladder Pal to track their urologic health.

This OAB outreach initiative coincides with the release of new clinician guidelines for OAB that was disseminated at the AUA Annual meeting in May.

Sunday, June 24, 2012

NEAUA 2012 Meeting - my involvement and podium abstract

My American Urological Association annual section meeting (New England) will be taking place in Boston at the Westin Boston Waterfront from September 6-8.   I've been involved with this meeting as a member of the Scientific Program Committee.  My duties on the committee have been to review abstracts as well as participate in planning discussions.  It has been a fun and gratifying experience to shape the structure and content of the meeting.

Here is the preliminary program.

My research group has an accepted podium abstract at the meeting!
It is entitled: "Laser Prostatectomy in the Severely Ill - Outcomes and Feasibility of a Rapid Ambulatory Discharge Pathway".  Dr. Ben Herrick, intrepid Dartmouth Urology resident, is lead author on this study. We show in the abstract that patients who are considered to be "severely ill" by American Society of Anesthesiology classification system can safely and effectively have a rapid ambulatory discharge from the hospital after laser prostate surgery.  In fact, 80% of patients benefited from the ambulatory pathway, 8% were admitted for 23 hour observation, and 11% were in the hospital for longer than 23 hours.

Laser prostate surgery for BPH has reduced bleeding compared to transurethral resection of the prostate (TURP) because of the sealing action of the laser.  As a result, it is feasible to send patients home the same day of surgery with a urethral catheter.  In contrast, patients are routinely admitted to the hospital after TURP.  Such an ambulatory pathway decreases utilization of hospital resources and allows the patient to recover in the comfort of his home.  Decreasing a patient's exposure to a hospital setting also decreases the possibility of hospital based or "nosocomial" errors, falls, and infections.  Though it would seem counterintuitive to send higher risk surgical patients home from surgery the same day, I believe that it is actually safer to do so because of such an avoidance of the hospital environment.  Our data shows that this can be done in a safe and effective manner.

I encourage all those out there to "save the date" and support this meeting in September!

Wednesday, June 20, 2012

AMA tells USPSTF to incorporate specialists in guideline creation

Resolutions were passed at the American Medical Association House of Delegates Meeting admonishing the USPSTF regarding their screening guidelines on mammography and PSA screening.

Here are the passed resolutions: (Source: AUA e-mail alert)

RESOLVED, That our AMA expresses concern regarding recent recommendations by the USPSTF on screening mammography and PSA screening and the effects these USPSTF recommendations have on limiting access to preventive care for Americans.

RESOLVED, That our AMA encourage the USPSTF to implement procedures that allow for meaningful input on recommendation development from specialists and stakeholders in the topic area under study.

Here is coverage from ABC News on the topic. 

The recent USPSTF guidelines for PSA screening were done without the input from the American Urological Association.  This is a big tripping point for me on the guidelines since we urologists are the main doctors who take care of men with prostate cancer.

Further, the USPSTF membership lacks oncologists and urologists. Here are the current members of the USPSTF: 

I applaud the AMA for taking a stand on this. Specialists represent a great resource for the crafting of these guidelines and need to be involved at the ground level, not after the fact.  Not involving main stakeholders who implement such guidelines reduces buy-in from the medical community as well as patients.

Tuesday, June 19, 2012

Men's Health Week table debrief

Last week, I hosted a Men's Health Week table at the Concord Hospital cafeteria on June 12th, 2012.  

The purpose of the event was to increase awareness of the Men's Health Week celebration as well as distribute educational materials regarding men's health concerns.  

We had free granola bars and popcorn at the table, courtesy of the Society of Urologic Nurses and Associates (SUNA).  Special thanks to New Hampshire SUNA Chapter President Kris Green, RN, CURN for the support.

Me at the table

At the table we had free information on:
  • Prostate health
  • Testicular self exam
  • Fatherhood
  • Low testosterone
  • Mens and women's health checklists
  • What women should know about men's health
  • Highway safety

A plethora of free giveaways was graciously provided by the NH Highway Safety Agency.  Many thanks!  Did you know that the #1 cause of death for young men in America is "unintentional injury"?  I have a prior blog post about this issue.

The event was a success with about 150 people coming by.  I had many good conversations with people about men's health issues and was happy that people were not shy about approaching the table.
It was such a good experience that I hope to make this an annual event.

Thursday, June 14, 2012

My Men's Health Week message in the Concord Monitor

This week, I wrote an op-ed piece regarding Men's Health Week and submitted it to my local papers.

Thank you, Concord Monitor, for publishing the letter.

Here is the article. 

Earlier in the week, I hosted a Men's Health Week awareness table at my hospital that went very well.  I'll post about that later, since I have several nice pictures of the event.  Stay tuned.

Hope you are all having a good Men's Health Week, and Happy Father's Day in advance!

Thursday, June 7, 2012

Next week is Men's Health Week 2012!

Do you know when Men's Health Week is?  It's easy to remember.  It's the week up to and including Father's Day.  This year it's June 11-17, 2012.  Actually, the whole month of June is designated as Men's Health Month.

Here is a link about Men's Health Month and Men's Health Week from the Men's Health Network - a great resource for men's health advocacy.

On Tuesday, June 12th I'll be hosting a Men's Health Week table in the Concord Hospital cafeteria in Concord, NH from 8am to 2pm.  There will be free munchies, swag, brochures about men's health conditions as well as injury prevention materials (check out this prior post on young men and "unintentional injury").  If you are reading this and can drop by please do so to support our efforts!

Going into the week here are my public service messages:

Men - Get medical care and be responsible for your health - not only for you but for your loved ones too.

Women - Tell the men in your lives to get medical care and be advocates for their health needs.

Tuesday, June 5, 2012

Zytiga (abiraterone) for advanced prostate cancer before chemotherapy - ASCO 2012

Testosterone is a major fuel for prostate cancer growth.  Despite use of agents to induce clinical castration, men can continue to have advancing disease.  Zytiga (abiraterone) is pill that directly suppresses the synthesis of testosterone at multiple points in the body to further decrease testosterone production.   It is currently FDA approved for advanced castrate resistant prostate cancer after use of Taxotere (docetaxel) chemotherapy.  This indication restricts to use of this agent to the most advanced cases.

At this year's American Society of Clinical Oncology (ASCO) meeting, there was an exciting abstract about treating men suffering from advanced castrate resistant prostate cancer with Zytiga (abiraterone) before using chemotherapy.  Abiraterone caused improvement in progression free survival, time to narcotic use, time to use of chemotherapy, time to deterioration in clinical performance status, and time to PSA progression.  The study was terminated early due to the degree of improvement at interim analysis.

Here are links to media coverage of this abstract:
Reuters for a general audience.
Medpage Today coverage - more technically inclined.

This will likely lead to an expanded FDA indication in the future for use prior to chemotherapy.  Men will then have earlier access to this oral agent to combat the disease.

Saturday, June 2, 2012

My take on USPSTF final prostate cancer screening guidelines

The US Preventive Services Task Force (USPSTF) released its final prostate cancer screening guidelines on May 21st, 2012, during the American Urological Association Annual Meeting (curious my opinion).

The task force recommended against PSA-based screening altogether for prostate cancer by giving the practice a "D" rating.  From the USPSTF grade definitions site this means: "The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits."  The task force suggests that healthcare providers: "Discourage the use of this service." This recommendation is no different than the draft recommendations issued in October, 2012 despite vocal opposition from many sources.

The American Urological Association (AUA), American Cancer Society (ACS), and National Comprehensive Cancer Network (NCCN) have issued guidelines recommending men to have discussions with their healthcare providers regarding the risks and benefits of prostate cancer screening.

AUA Guideline
ACS Guideline
NCCN Guideline

The AUA has expressed its vigorous opposition to the the final USPSTF recommendation.  AUA President, Dr. Sushil Lacy, released this statement about it on behalf of its members.  The AUA also has a website about the issue and prepared a fact sheet about PSA testing for its members.

My take:
The PSA screening controversy is a complex issue.  There are many factors involved in screening such as age, expected longevity, race, family history, and urologic symptoms.  I believe that at this time, the USPSTF blanket recommendation is too simplistic.  I urge men to talk further with their healthcare providers regarding this issue and consider referral to a urologist if there are still lingering questions about prostate cancer screening.  Also, the diagnosis of prostate cancer does not necessarily mandate treatment.  Depending on the clinical scenario, monitoring of the disease or "active surveillance" can be a viable option for many men.

Friday, June 1, 2012

Useful prostate cancer video from NH Prostate Cancer Coalition

A very informative video from the New Hampshire Prostate Cancer Coalition (NHPCC) about prostate cancer and prostate cancer screening was just uploaded to their website.  It features Dr. William Santis, my partner, who is Director of Prostate and Urologic Cancer at Concord Hospital.

He honestly explains in layman's terms prostate cancer screening as well as the screening controversy.  The video has a nice diagram of the lower male urinary tract as well as useful facts about prostate cancer.

Please check out the video and post any feedback so I can relay this the NHPCC and Dr. Santis.