Category: Diagnostics, Genetics, Imaging

For the most part, MRI imaging for prostate cancer is safe. In some cases, contrast agents are needed to be injected into the human body in order to get a better picture or scan. Many of the contrast agents utilized contain the heavy metal, gadolinium. These injected agents help physicians see internal organs, blood vessels and other tissues more clearly.

In late 2017, the FDA declared that all gadolinium-containing contrast agents must carry the warning about how they could be retained in the body and potentially cause kidney injury. Most of the gadolinium is eliminated by the kidneys. If one’s kidney function is normal, there has been no direct link with these contrast agents to any specific health issue.  The brand name Gadavist (gadobutrol) is often used for MRI screening of prostate cancer and active surveillance. Much lower levels of this agent are used compared to other agents. The FDA is now asking the manufacturers of gadolinium agents to conduct more human and laboratory studies to determine the safety of these agents. Thus far, the one real adverse effect noticed with these agents is in a small group of patients with pre-existing kidney failure, a condition known as nephrogenic systemic fibrosis. More recently, researchers in Belgium and Japan expressed concern that gadolinium-based contrast agents showed preliminary evidence of depositing in the part of the brain called the cerebellum.

Here is a list of eight (8) of the most widely used gadolinium contrast agents and their brand and generic names and levels of concern. The following three have lower levels of retention and are of less concern; a) Dotarem (Gadoterate Meglumine); b) Gadavist (Gadobutrol); and, Prohance (Gadotridol). The following five have high levels of retention; a) Eovist (Gadoxetate Disodium); b) Magnevist (Gadobenate Dimeglumine); c) Multihance (Gadobenate Dimeglumine); d) Omniscan (Gadodiamide); and e) Optimark (Gadoversetamide).

The body retains less gadolinium when using agents that have what is known as a macrocyclic (large rings) chemical structure, as in Dotarem, Gadavist and Prohance. Gadolinium agents that have a linear chemical structure have higher levels in the body after using them.

So the next time you have an MRI with contrast, inquire which of the gadolinium agents are being used. If it is one with linear structure or higher retention, one should ask for alternatives or seek out another imaging facility.

This post is an excerpt from an article written by Mark Moyad, MD, MPH, Jenkins / Pokempner Director of Alternative Medicine, University of Michigan Medical Center. It was published in the summer 2018 issue of the Prostate Digest, Volume 21, Issue 2, published by the Prostate Cancer Research Institute.

P.S. So now you know how to respond when you see one of those notorious lawyer ads on TV asking if you “have ever taken an MRI with contrast and developed _______. You may be entitled to substantial compensation.”

In early May, the United States Preventive Services Task Force (USPSTF) finalized its new prostate cancer screening recommendation, which upgrades its recommendation for men 55 – 69 years old to a C rating. While the updated rating is a step forward, many say it’s not enough. The decade-long message that discouraged men from getting tested has led to an unprecedented increase in prostate cancer deaths this year – an anticipated 10 percent jump, according to the National Cancer Institute. The previous recommendation deterred men from a simple blood test and was a barrier to early detection (which would have saved countless lives).

“The fact is 99 percent survive prostate cancer when it’s caught early,” according to Jamie Bearse, CEO of ZERO – The End of Prostate Cancer. “Left unchecked, survival rates plummet to 30 percent if prostate cancer is found in an advanced stage. Unfortunately, the C rating is still insufficient and dangerous for high-risk men or men who – without testing – will develop unchecked aggressive or advanced disease.”

The new rating from the USPSTF stipulates that with regard to the prostate-specific antigen blood test (PSA), there is “at least a moderate certainty that the net benefit is small”. The previous D rating – which remains in place for men 70 and over – labeled the PSA test as doing “more harm than good,” and strongly discourages physicians from using the test for men at risk for the disease. At ZERO, we meet active and vibrant men 70 and older leading amazingly impactful lives. We believe these men deserve to know their PSA levels and make an informed, personal decision about options should they develop the disease.

“We need to make sure men know that PSA testing leads to a life-saving diagnosis,” Bearse said. “We’re hearing about advancements in screening and diagnostic tools every time a medical journal publishes a new issue. The technology exists to put men with aggressive disease on the right treatment pathway while not harming those with indolent tumors.”

See the following link and short video for more information.

DNA sequencing of a person’s tumor can be very important in determining treatment plans among other potential applications. The National Cancer Institute (NCI) today published an excellent review of methods used to obtain a person’s genetic information and how this information could be applied. It is written in a way that can be clearly understood by non-medical personnel. See the following link.

Men ages 55-69 who don’t get PSA (prostate-specific antigen) screening tests for prostate cancer may want to reconsider that choice based on an April 2017 recommendation from the United States Preventive Services Task Force (USPSTF), a government advisory medical panel who evaluate the benefits and harms of health services. A few years ago, this same panel discouraged many men from having the PSA test.

As  most of you know, the PSA test measures a protein level that rises both in men with prostate cancer and other prostate disorders. The test has several shortcomings including the risk of a  false-positive result.  Only about one in four men with an elevated PSA level who undergoes a prostate biopsy actually has prostate cancer according to the National Cancer Institute. However, a biopsy can have serious side effects such as bleeding, infection and pain. Up to half of prostate tumors identified by the PSA test and confirmed by a subsequent biopsy are harmless and will never cause symptoms or death. Yet many men proceed to treatment with surgery or radiation for low-risk cancers even though treatments can cause long-term side effects such as incontinence and erectile dysfunction.

In 2008, the USPSTF advised men 75 and older to pass on PSA screenings concluding that the potential harms outweighed the benefits of cancer detetction. In 2012, the panel extended the recommendation to include all men saying in essence “do not screen” resulting in a serious decline in PSA screening. Meanwhile the number of men over 75 diagnosed with prostate cancer that has metastasized rose from 7.8% to 12% according to the Journal of the American Medical Association Oncology. Authors of the study suggested that the decline in PSA screening led to the rising number of men being diagnosed with advanced prostate cancer.

The USPSTF has now reversed its course to some extent encouraging men ages 55 to 69 with average risk to discuss PSA testing with their doctors and share the responsibility for deciding whether or not to be screened for prostate cancer. The group still discourages testing for men younger than 55 or older than 69. Other groups such as the American Urological Association advise men with a family history of prostate cancer or African-American ancestry to begin screening  (including a digital rectal exam) before age 55. It is also reasonable for select healthy men in their early 70’s to request screening too since they may live an additional 15-plus years.

It is suggested you ask your doctor if you should be screened and why. For more information on prostate symptoms, see the Sept. 25th post. If you decide to be screened, discuss how often you should be tested; every other year makes sense for many men while annual testing may be preferable for those with risk factors.

Risk factors include age, race and family history. As you get older, the risk of developing prostate cancer increases dramatically. The average age at diagnosis is between 65 and 70 years. Black men are at highest risk whereas rates for white men and hispanics are 40-50% lower. Asian, Pacific Islander and American Indian men have the lowest rates. You have double the risk if you have a first-degree relative (father or brother) with prostate cancer. Second-degree relatives (uncle or grandfather) with prostate cancer confer only a small risk increase.

(Much of this material was taken from the Sept. 2017 issue of the University of California Berkeley School of Public Health Newsletter.)

 

An article from Fox Chase Cancer Center in Philadelphia published Sept. 21st in the U.S. National Library of Medicine MedlinePlus described a list prostate cancer symptoms. Prostate cancer symptoms may be confused with signs of other common but noncancerous disorders, such as benign prostatic hyperplasia. Symptoms of prostate cancer may include: trouble starting to urinate; weak or interrupted flow of urine; urinating more often, particularly during the night; trouble emptying the bladder; pain or burning during urination; bloody urine or semen; painful ejaculation; and/or chronic pain in the back, hips or pelvis. Although about 1 in 7 men will be eventually be diagnosed with prostate cancer in his lifetime, the warning signs of the disease are often vague and may be confused with other conditions.

Prostate cancer is rare in men younger than 40 years old but once they reach 50, the risk increases. Nearly 6 out of 10 men with prostate cancer are older than 65 years old, the Fox Chase specialists said. Black men are more likely than men of other races and ethnicities to be diagnosed with prostate cancer and die from the disease. Black men are also more likely to develop advanced disease and have the condition at a younger age.

Genetics may also play a role in why some men develop prostate cancer. Men whose father or brother have the disease are more than twice as likely to also be diagnosed. The risk increases if several family members are affected and if these men were diagnosed at a younger age. Men who are 55 and older should discuss their risk factors for prostate cancer with their doctor and determine if screening is right for them.