Prostate Cancer: Know the Risk Factors

WebMD Guest Blogger, David McLeod, MD

Prostate cancer is a life-changing illness that afflicts one man in six in the United States. It is the second most common cause of cancer death among American men, and, in 2008, according to the Centers for Disease Control, it is predicted to take over 28,000 lives without warning signs or symptoms.

The Department of Defense allocates a considerable amount of funding each year for research and development of treatment for prostate cancer. As the director of the Center for Prostate Disease Research (CPDR), I am constantly touting early detection. Although prostate cancer is a leading cancer in men, it has a cure rate of more than 90% with early detection and treatment. There is disagreement regarding screening, but the decision to screen is between the patient and his physician.

Research shows there are some obvious risk factors, and those who fall into these categories need to be especially careful. These include:

1. Race: African-American men are more likely to develop prostate cancer than men of other races or ethnic groups, and the disease is likely to advance more rapidly.

2. Weight: Men who are overweight are more prone to develop prostate cancer.

3. Family history: If you have an immediate family member who suffered from prostate cancer, your risk for prostate cancer is nearly doubled.

Should any of these situations apply to you, you should request prostate screening by the age of 40. If none of the above risk factors are present, prostate screening should begin by age 50. This disease can no longer be thought of as only an "old man's disease."

Diet may be another risk factor in this disease. Diets high in red meat and fat have been linked to the onset of many types of cancer to include cancer of the prostate. While it has not been proven as a valid treatment, there is great body of evidence that shows that a healthy lifestyle along with a healthy diet can have drastic effects on the body's ability to resist cancer.

Currently the standard method for early detection of prostate cancer is to have a digital rectal exam (DRE) in which your physician can detect if the prostate is enlarged or might contain a tumor.

This exam, along with a simple blood test to detect a protein (prostate specific antigen - PSA) which is usually elevated when there is a presence of prostate cancer or benign prostate hypertrophy (BPH) should be done together. These tests should be performed annually as part of a routine physical examination.

If you're diagnosed with prostate cancer, talk to your doctor, then get second and third opinions. For more information on prostate cancer, please visit us at: http://www.cpdr.org/

David G. McLeod, MD
Professor of Surgery, Uniformed Services University and
Director, Center for Prostate Disease Research, Walter Reed Army Medical Center

The Military Health System provides optimal health services in support of our nation's military mission - anytime, anywhere.

Tim Russert's Sudden Death

Tim Russert, the 58-year-old host of NBC's "Meet the Press" and NBC's Washington bureau chief, died suddenly of a heart attack Friday while at work.

After an autopsy, NBC News reported that Russert's doctor, Michael Newman, said cholesterol plaque ruptured in an artery, causing the heart attack. Newman also said the autopsy showed an enlarged heart.

Russert had recently returned from a vacation in Italy.

He was a very popular and respected newsman, and the author of a bestseller about his father called "Big Russ and Me."

The irony does not escape us that he died on Father's Day weekend. As a respected and admired journalist, and a father himself, our hearts go out to his family.

If you have any memories or sentiments about Russert you would like to express, please feel free to comment here.

Sean Swint
Executive Editor, WebMD

Get More Sleep: the Payback is Huge

By Charlene Laino
WebMD Guest Blogger

(Baltimore) -- Sharp, energized. Laid back, trim. Those are the words that go through my mind as I seek to describe the crowd I have just left behind.

I am on my way home from SLEEP 2008, the 22nd Annual Meeting of the Associated Professional Sleep Societies, which was held in Baltimore this past week.

I go to dozens of medical meetings each year, but none is quite like this. Instead of crisply ironed button-down shirts and tailored suits, T-shirts and shorts or chinos are the favored attire of the some 5,000 attendees. Nearly all of the top clinicians and researchers who come to hear the 1,000-plus latest developments in the field -- MDs and PhDs alike -- introduce themselves to the press by first name, rather than as Dr. so and so. And in a nation plagued by an epidemic of obesity, the vast majority are trim and in shape.

In the massive exhibit hall, pharmaceutical companies tout their latest drugs and diagnostics, as expected. But again that laid back atmosphere prevails. At one booth, I ask to speak to a medical rep about the benefits of the company's sleeping pill; I am told they are on break. All of them, at 2 p.m.? And then I realize: They probably went off to take a siesta or have a jolt of java, which, as we learned this week, are the best ways to combat the mid-afternoon nods.

And then there is the unexpected. I am drawn to one booth that is displaying what appears to be really cool sunglasses with tinted orange lenses and black wraparound frames. It turns out they are "LowBlueLights" eyeglasses; according to the company's literature, they improve sleep by increasing the production of the hormone melatonin, our body's natural sleep aid.

Making my way though a particularly large crowd at another booth, I hear of the benefits of the "Anti-Snore Shirt": Three foam inserts sewn onto its back prevent you from rolling onto your back and snoring at night.

But I digress. Back to the order at hand: Why is this group so sharp, yet so laid back? So energetic, so slim?

"It's because we're sleeping well," one attendee half-jokingly remarks. In fact, I think she may have hit the nail on the head.

What we have learned over the past decade, you see, is that getting enough z's may hold the key to everything from winning the battle of the bulge to boosting memory to performing better at work or school to living longer.

The fact that getting a good night's sleep can help combat obesity is one that really grabs my attention. Instead of having to count calories and watch every gram of fat intake, can simply getting a little extra shut-eye each night really help maintain a healthy weight?

There's no doubt about it, according to Sanjeev Kothare, MD, a spokesman for the American Academy of Sleep Medicine (AASM) and a sleep specialist at Harvard Medical School. In fact, he thinks sleep deprivation is the No. 1 reason we have an epidemic of obesity in the U.S.

A bold statement, but research has consistently shown that people who don't get enough sleep at night are more likely to be overweight or obese. And this week, we came a few steps closer to understanding the complex link between sleep and obesity, with one study showing that people who only log about 5 hours of sleep at night tend to snack more throughout the day.

The relationship appears to work the other way, too: Another study showed that the more fat you consume each day, the less likely you are to get a good night's sleep and to feel restored in the morning.

So now to the really big question: As a nation of workaholics, with many of us looking at sleep as a waste of time, how in the world are we going to fit the recommended seven or eight hours of z's into our schedules?

One expert recommends spending a little less time text messaging and chatting on our cell phones. His study showed that teens who use their phones more than 15 times a day have more trouble falling asleep and staying asleep than those who use their phones sparingly. Although only teenagers were studied, many adults can probably take a lesson here, too.

Another researcher suggests that you try to go to bed earlier and then get up a half-hour earlier one day, stick with that schedule for three days or so, and then advance your schedule another 30 minutes. His study showed that college students who are "morning people" have higher GPAs than night owls.

Practical? Perhaps not. While I was at the poster presentation, a puzzled undergrad from Johns Hopkins asks me, "What's a morning person?" I explain. His reply: "There are people like that?"

I laugh, but in truth, getting to bed and waking up earlier is simply unrealistic for many people, especially college students, says AASM spokesman Dennis Nicholson, MD, medical director of the sleep disorder center at Pomona Valley Hospital, in California.

Nicholson says that a smarter way to deal with the problem is to adapt your schedule to your biological clock: If you're a night person, schedule your classes or workday to start later, for example. Be creative: With telecommuting, maybe you can work at home for an hour in the morning, thereby missing rush hour. Voila, you have gained an extra 15 minutes you can devote to sleep each morning.

Another expert points out that proper sleep boosts your memory and performance; thus you'll need less time to perform the task at hand. Hmmm.

As a workaholic myself, the idea of cutting into my day to grab a few extra winks seems downright scary. I need to be up first thing in the morning to ensure no big stories have broken overnight. I need to write into the wee hours to ensure all my assignments are filed. But I am so impressed by the sleep crowd this week, I decide to give it a try: Since Monday, I have gradually sneaked an extra half-hour into my woefully short sleeping schedule.

Of course this barely qualifies as an experiment as far as science goes. But I have to tell you, I feel a bit more energized. I have been a bit more productive during the day. And I even lost half a pound.

I think these guys are on to something.

View From ASCO: Cancer Advances Made in Baby Steps

By Charlene Laino
WebMD Guest Blogger

(Chicago) -- As Len Lichtenfeld, MD, deputy chief medical officer at the American Cancer Society, likes to remind me almost every time we speak, the field of cancer advances not overnight, but in a series of baby steps. And such was the case at the annual meeting of the American Society of Clinical Oncology (ASCO), which started Friday and ended Tuesday.

I go every year. It's a five-day cancer marathon, with some 33,000 attendees racing to hear as many of the 4,000-plus presentations as possible; all the regulars know to bring their running shoes. The abstract book is the size of the Manhattan telephone directory; just figuring out where you want to be (and then actually finding the room in the colossal McCormick Place Convention Center without injuring your shoulder carrying your overstuffed conference bag) is a major challenge.

In the enormous exhibits area, pharmaceuticals companies offer everything from personalized ballpoint pens to the latest computer gadgets to well-needed jolts of espresso in an effort to attract doctors to hear about -- and hopefully then prescribe -- their drugs and diagnostics. At publication booths, the giveaways are typically less extravagant -- chocolate's quite popular. But all they're asking is that you consider signing up for their journal or buying their book.

As the world's largest cancer gathering, ASCO is also considered the forum to unveil new research. It's the place where we first hear of those rarest of events -- true breakthroughs that will transform practice. And indeed, we got spoiled for a while, with breakthrough targeted drugs like Herceptin, Gleevec, Erbitux and Avastin hitting home runs every year.

This year was more typical; there were few real surprises. We heard about some new ways to use existing drugs. And perhaps more importantly, we got a baby step closer to the holy grail of personalized medicine -- tailoring treatment to each individual based on his or her genetic makeup.

"They might not have been huge breakthroughs, but there were some real wins," says Julie Gralow, MD, chair of ASCO's communications committee and a cancer specialist at the University of Washington.

Top on her list: Research "defining who will respond to targeted therapies like Erbitux, as least in colorectal cancer."

Gralow is referring to a large international study that showed that that the two-thirds of patients with colon cancer who have a normal, or wild type, version of a cancer-associated gene are more likely to respond to initial treatment with Erbitux plus chemotherapy than to chemo alone.

People with a mutated KRAS gene, on the other hand, gain no benefit from Erbitux. So why is that so important?

Since treatment with drugs like Erbitux can cost thousands and thousands of dollars, KRAS testing will allow doctors to predict the two-thirds of patients who will benefit. There's no sense giving it to the other third.

There was other news about Erbitux this week too -- it prolonged survival in advanced lung cancer patients, albeit for only a little over a month. To the cynic, the fact that a four or week five improvement in survival made headlines at all might make it seem like we were desperate for news.

And as a one-liner, it is just a blip on the landscape. But when you start delving into the details of the research, you'll see that the researchers are already beginning to pinpoint who will benefit and who won't -- yup, another step toward personalized medicine.

Caucasian patients, for example, lived a median of 10.5 months when they got Erbitux plus chemo -- survival rates previously unheard of in advanced lung tumors. Asian patients, on the other hand, appeared to gain no benefit from the targeted drug. Further testing that may better define who will benefit and who won't is underway.

There were other advances it personalized medicine as well.

Researchers showed that a genetic fingerprint in the blood may be able to spot lung cancer in smokers early, when there is still a chance of a cure.

David M. Johnson, MD, deputy director of the Vanderbilt-Ingram Cancer Center in Nashville, says that researchers at Vanderbilt are testing a similar type of test, one designed to determine whether lung cancer patients will benefit from the targeted drug Avastin.

"The idea of all these personalized medicine studies is help us to better detect and select patient patients for treatment," he says.

Lichtenfeld says that no matter which cancer you're talking about, small steps will eventually mean big gains. His favorite example is colon cancer, where people with advanced disease had a 50-50 chance of living six months in the early 1970s. Now, with targeted, more personalized treatment, half of them can expect to live nearly two years.

Baby steps.

Nation's Teens: Some Still Riskier Than Others

WebMD Guest Blogger
Howell Wechsler, EdD, MPH is the director of the CDC's Division of Adolescent and School Health (DASH). DASH promotes the health and well-being of children and adolescents to enable them to become healthy and productive adults. Wechsler earned his doctorate in health education from Teachers College at Columbia University, a master's in public health from Columbia, and a bachelor's degree in journalism from Northwestern University.

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The Youth Risk Behavior Survey

The teen years are a time of risk-taking, and a new study done by the CDC shows that for some it's worse than others.

The CDC's Youth Risk Behavior Survey (YRBS) measures critical health risk behaviors among high school students across the nation. The 2007 YRBS data show that the percentage of students engaging in risk behaviors has decreased since the early 1990s. Unfortunately, Hispanic students have not matched the progress made by African-American and white students in reducing certain risk behaviors:

• The percentage of Hispanic students who have had sexual intercourse and have had sex with four or more persons during their life has not changed since the early 1990s, but it has decreased among African-American and white students.

• The percentage of Hispanic students who were taught in school about HIV/AIDS has not changed since the 1990s, but it has increased among white and African-American students.

There is good news. The percentage of Hispanic students who smoke cigarettes, use drugs, drink alcohol, and have ridden with a driver who has been drinking alcohol has decreased since the 1990s. African-American and white students also made progress over time in most of these behaviors.

These trends show that we are making some progress, but more work needs to be done to reduce health risk behaviors for all students.

Parents especially can serve as positive role models for children and teens by talking to them about the importance of making healthy choices.

But all of the responsibility for change does not simply lie in the hands of the teens and their parents. Schools, school boards, and administrators must also work together to implement policies and programs that promote the health and safety for students. For information on this study or other resources, visit www.cdc.gov/HealthyYouth.

Howell Wechsler, EdD, MPH
Director, Division of Adolescent and School Health
National Center for Chronic Disease Prevention and Health Promotion

Sen. Kennedy Undergoing Brain Surgery

June 2, 2008 -- Sen. Edward Kennedy will undergo brain surgery for his brain cancer this morning at Duke University Medical Center in Durham, N.C.

The Associated Press reports that Kennedy will get "targeted" brain surgery, followed by chemotherapy and radiation..

Duke neurologist Allan Freidman, MD, will perform Kennedy's brain surgery, which is expected to start at 9 a.m. and last about six hours, followed by a week of recovery at Duke University Medical Center, according to the Associated Press.

Sen. Kennedy, 76, has a type of brain tumor called a malignant glioma. Doctors at Massachusetts General Hospital announced Kennedy's brain cancer diagnosis on May 20. The next day, Kennedy was discharged from Massachusetts General Hospital.

Since then, brain cancer survivors who have dealt with similar types of brain cancer have encouraged Sen. Kennedy to remain hopeful.

In a statement quoted by the Associated Press, Kennedy says he is "deeply grateful" to everyone who has expressed support "as I tackle this new and unexpected health challenge."

Sen. Ted Kennedy Has Brain Tumor

A grim diagnosis for U.S. Sen. Edward Kennedy. He has a malignant brain tumor, according to a statement today from Massachusetts General Hospital, where the 76-year-old senator was sent after having a seizure at his home in Cape Cod on Saturday.

The statement comes from Lee Schwamm, MD, vice chairman of the neurology department at Massachusetts General Hospital, and Larry Ronan, MD, a primary care doctor at the hospital.

"Over the course of the last several days, we've done a series of tests on Sen. Kennedy to determine the cause of his seizure. He has had no further seizures, remains in good overall condition, and is up and walking around the hospital. Some of the tests we had performed were inconclusive, particularly in light of the fact that the senator had severe narrowing of the left carotid artery [which supplies blood from the heart to the brain] and underwent surgery just six months ago.

"However, preliminary results from a biopsy of the brain identified the cause of the seizure as a malignant glioma in the left parietal lobe. The usual course of treatment includes combinations of various forms of radiation and chemotherapy. Decisions regarding the best course of treatment for Sen. Kennedy will be determined after further testing and analysis. Sen. Kennedy will remain at Massachusetts General Hospital for the next couple of days according to routine protocol. He remains in good spirits and full of energy."

Sen. Kennedy's office has not yet released a statement.

A glioma is the most common type of brain cancer, that begins in glial cells, which are cells that surround and support nerve cells. Determining the specific type of the cancer, and how far it is along, is crucial to the type of treatment Sen. Kennedy will get, and will have a lot to do with his chances for long-term survival.

Average survival rates can range anywhere from a year for an aggressive glioma to five years for less advanced cancer.

Surgery often is not a viable option, but is sometimes done to help relieve pressure on the brain.

WebMD will continue to update this story as it develops. For more, read the news story here.

Michael W. Smith, MD
Chief Medical Editor, WebMD

Sean Swint
Executive Editor, WebMD