Robotic surgery is the 'Gold Standard' New for Prostate Surgery

Can you imagine a surgeon with four arms and eyes that can look more closely, and the brain can process information continuously without a break? Do you think it's just science fiction? It may be true 20 years ago, but not anymore now.

Welcome to the world of robotic surgery - and find with this wonderful doctor - Dr Da Vinci. Da Vinci Surgical System combines 3-D capabilities of the endoscope and advanced robotic technology, which virtually can extend a hand and eye doctors, into the world of surgery. "Robotic surgery has many advantages. First of all, Da Vinci provides minimally invasive alternative and a good zoom, giving the 3D view of the problem areas. In addition, robotic arms capable of mimicking human hand movements, so they can sew very well," said Dr Tan Eng Choon from EC Tan Urology at Mount Elizabeth Medical Centre.

In addition to ease of surgery, the Da Vinci surgical system gives patients a faster recovery and minimal postoperative pain. Two hospitals in Singapore have invested heavily to robotic systems - Mount Elizabeth Hospital under the auspices of Parkway Group and Singapore General Hospital. According to Dr Tan, the Da Vinci system is very good, especially for prostate cancer, where surgery is often the most common treatment. Conditions affecting the organs of the urinary tract such as bladder and kidney cancer can also take advantage of robotic surgery.

Under normal circumstances, deal with urology surgery of any kind usually creates great anxiety. Traditional open urological surgery - where a large incision is made to access the pelvic organs - has been the standard approach. But open surgery has several weaknesses. Weaknesses include postoperative pain, long recovery time and potential long term impacts are difficult to guess on sexual function and continence.

"The prostate was in a deep cavity in the pelvic area. The organ is small - about the size of walnuts - and difficult to access. It's not just very stuck, but also surrounded by nerves affecting urinary control and sexual function. That's why conventionally, we need a surgical open in cases of prostate. Even so, the surgery is quite difficult to do, "he said.

The prostate is the male reproductive gland that produces fluid found in semen. Located below the bladder and in front of the anus, the prostate surrounds the urethra - the tube that urine from the bladder emptying. Prostate cancer affects the prostate gland and can spread to surrounding structures. Although most patients with prostate cancer showed no symptoms, the doctor can detect prostate cancer during a routine inspection, using a combination of blood test called a PSA and digital rectal examination, or Dre. These problems generally occur in men, especially elderly. With better awareness, detection of prostate cancer is increasingly becoming the trend and rate of death from prostate decreased. Better treatment also leads to more men get more active and productive lives after treatment.

For patients who had been diagnosed early, there are usually several treatment options including conservative approach, radiation therapy and prostatectomy - the surgical removal of the prostate. Treatment of the latter is now a procedure "gold standard" for men below 70 years with cancer in early stages of organs is limited. "The main goal is to eliminate cancer prostatectomy. The second objective is to maintain urinary function and, if applicable, erectile function. Keeping the nerves necessary for erections can be a very important goal for patients. Nerve-nerve through the prostate and are often damaged when prostate removed, "explained Dr Tan.

Fortunately, the choice is not how invasive surgery is now available for many patients who face prostatectomy. The most common choice is laparoscopy, which uses specialized surgical camera and rigid instruments to access and lift the prostate by using several small incisions. But in spite of laparoscopy can be effective on many common procedures, limitations of this technology makes it unusable for more complex cases.

But with the advancement of robotic technology, surgeons can be complex even more efficiently and effectively. "The risk of prostate surgery are now much smaller. Now, we are able to zoom in directly on the area where the nerves and tissue to accumulate. With better clarity and critical anatomical details, which usually exist on the risks of traditional surgery can be avoided, such as incontinence and impotence, "said Dr Tan.

Precision robotic allows preservation length urethral anastomosis and construction of a better water-resistant, thereby reducing the possibility of incontinence. With visuals that can be magnified, nerve dissection and preservation can be done properly, so that male sexual function can be maintained. And unlike conventional surgical expertise to work mostly relies on a surgeon, robotic surgery with computerized to minimize the "vibration of hands" which means reducing the risk of errors due to fatigue.

Da Vinci system was introduced here about three years ago. Since then, Dr Tan has been doing between 70 to 80 cases of prostatectomy using robotic technology. Robotic surgery was first performed in Germany in 2000. Since then, tens of thousands of robotic prostatectomy surgery performed around the world, began the United States, Europe and now Asia. Until 2005, almost 30 percent of all radical prostatectomy performed with robotic assistance.

This incredible growth was triggered by the Da Vinci system excellence. But this technology also brings bandrol high prices - on average, 40 percent of the cost of robotic surgery is more expensive. But its superiority to defeat these extra costs.

"Da Vinci's operating costs by approximately $ 35,000, but this robot-assisted surgery provides better clinical results, and the amount of blood lost is smaller, so if you count all the profits, higher costs remain reasonable," he said. As another surgery, this advantage can not be guaranteed, because the operation is specific to each patient and procedure. Although prostatectomy with the Da Vinci surgical system is considered safe and effective, but this procedure may not be suitable for everyone.

"Patients should always ask your doctor about treatment options that are available, before deciding which option best fits with the case," said Dr Tan. In addition to the benefit of patients, this system also eliminates muscle tension on the doctors, because doctors simply sitting at the console and busied himself with the appearance of an enlarged prostate and pelvis.

Led to the mushrooming popularity of robotic surgery robotic centers around the world. "Robotic prostatectomy experienced rapid growth as a treatment option for prostate cancer in the United States today. Asia also seem to follow this trend as seen in the increasing number of Da Vinci system is applied to accommodate the increasing number of men diagnosed with early prostate cancer," Dr Tan protracted .

In addition to prostate cancer and other urological problems, the Da Vinci surgical system may also be used for several conditions ginealogi. But beyond that, for now its use is still limited. "Given the current design of robotic systems, only some types of surgery can be done with this approach. But advances in technology ahead, for sure we will witness the development and expansion of the scope of its use," concluded Dr. Tan.

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Know more about prostate disorders

Prostate disorders is one of the dreaded disease among elderly men. Why not? Prostate gland often causes problems in the lives of men. Based on data, not less than 70% of older men having prostate cancer. Prostate cancer usually began stalking men aged 50 years, and ten years later are often dangerous.

According Rainy Subdivision Umbas of Urology, Department of Surgery Faculty of medicine / RSCM, in one seminar in Jakarta, the incidence of prostate cancer in the United States is that often occurs in men. Unfortunately until now Indonesia has not had prostate cancer patient data is complete. However, based on data from 13 faculty of medicine in Indonesia, including 10 prostate cancer danger disease that often befall the Adam.

Is it just prostate cancer, which often disturb you? Apparently not! Many disorders are pleased to approach your prostate. Get to know 'He deflected it so that you are ready'.



KNOWING THE PROSTATE

The prostate is a gland in men that lies between the pubic bone and the axis of the intestine. Due to stimulation of testosterone produced by testes, prostate produces semen. The prostate surrounds the upper urinary tract, where the flow of urine from the bladder to the outside.

When a man enters puberty, his prostate the size of walnuts. This size is normal and does not suppress the urinary tract. Men by the age of 50 years, most have an enlarged prostate that causes urinary tract urine stressed that expenditure to be difficult and slow.

This barrier makes the bladder must work harder to remove the urine, causing the bladder muscle wall thickening and size of the enlarged bladder. If these conditions are not addressed, incomplete urine expenditure and the remaining urine was left dapt cause bladder infections that can spread to the kidneys so that renal work disrupted.



EFFECT prostate enlargement.

Enlarged prostate cause frequent urination with symptoms of weak stream of urine and not exhaustive. Pain urinating frequently appear. If allowed to prostate enlargement can be clamped urine funnel more and worse so that you can no longer remove the urine.


SUMMARY OF PROSTATE PROBLEMS

· Hypertrophy.

Enlargement of the prostate gland is called hypertrophy .. prostate enlargement is a complaint that is usually found, due to the growth of prostate tissue in the urethra (urine channel) so that the narrow cavity of the urethra. When the growth of this network grew, the urethra becomes increasingly pinched, stunted urine flow.

· Prostatitis

Inflammation/ prostate infection. This inflammation often accompanies benign prostatic hypertrophy. Infections also cause prostate swelling prostate tissue thus inhibiting the flow of urine. In prostatitis, the urine is often purulent, hot urination and ejaculation.

· Cancer

Prostate cancer usually starts from the surface of the prostate gland. Prostate cancer can be felt at the time of inspection. Normal prostate tissue will feel soft, while the malignant tumor or cancer will be felt harder. Must be aware that prostate cancer often does not cause obstruction to the flow of urine.


PROSTATE EXAMINATION

Many of the physical examination or laboratory that must be done to know the full picture of your prostate condition. This examination includes: medical history, physical examination, laboratory examinations and other tests that can support the results of the examination.

MEDICAL HISTORY

Usually your doctor will ask faced with complaints, other diseases that you are natural, history of illness in the family, is allergic to certain medications and what treatment you have ever lived.

· Physical examination.

The doctor will perform digital rectal examination is palpability of the prostate through the anal opening. Tactile can detect enlargement or abnormalities that occur in the prostate. According to Rainy, digital rectal examination is an easy and inexpensive examination in detecting prostate cancer with accuracy up to 21-53%.

· Laboratory examination.

To find out a lot of laboratory examination of prostate disorders are available, including the PSA test (Prostate Specific Antigen) blood tests and urinalysis (examination of urine).


PSA TEST

PSA tests are used to detect levels of specific proteins in the blood. High levels of these proteins can indicate the likelihood of prostate cancer. Cancer associations in the United States (the American Cancer Society) recommend that every man aged 50 years and over undergo PSA testing.

BLOOD TEST

Blood tests can also find the decline in kidney function caused by the formation of urine collection is suspended due to prostate enlargement.

Urinalysis

Urine examination is important to know the signs of prostate disorders. Abnormalities found in the urine can cause an infection in the urethra or urine content.

Based on the results found from the above examination, the doctor recommends to run checks like below to confirm the diagnosis.

IVP

(Intra Venous Pyelogram) is an examination of the urinary tract with X-rays, to detect urinary tract system disorders such as kidney stones or bladder tumor content. Cystoscopy is a examination of the content of urinary and prostate using a tool called sistoskop, to detect the cause of obstruction in the urinary bladder. Ultrasound (USG) is the examination by using sound waves to obtain a "three dimensions" of the organs in check. Effectively to identify and measure the size of the prostate or tumor.

MRI (Magnetic Resonance Imaging) and CT (Computed Tomography)

Is an accurate method of examination to obtain a clear picture of the prostate tissue.

THERAPY PLANNING

After the evaluation to the results of the examination, the doctor will provide appropriate treatment. When prostate infection and stretched in its early stages, doctors usually prescribe drugs that should be at least as long seminggu.selain consumption was also a doctor will recommend bed rest (bed rest) and a lot of drinking. But if there is benign prostatic hypertrophy, the treatment given in adapted conditions and symptoms that you experienced.

Should OPERATION?

If you have an enlarged prostate, it is very difficult to dispose of urine, bleeding, decreased renal function, or recurrent infections in the bladder, you may be a 'prospective' patients who have undergone prostate surgery prostatectomy alias.

WHAT IS prostatectomy?

Prostatectomy is the surgical removal of the prostate tumor tissue. Most of these operations succeeded in removing blockages to improve the flow of urine. Based on research, this operation does not interfere with your sexual abilities.

Prostate surgery there are two kinds:

· TOURS (Trans Urethmal resection). A tool called resektoskop rod inserted through the urethra of the penis. Through this allows doctors to view the prostate and surrounding area, and cut the tissue blocking the urinary tract tumors. After rinsing with water was performed and tumor tissue removed through resektoskop.

· Open prostatectomy. This operation is done by slashing the abdomen. Operations of this kind can lift the tumor tissue and bladder stones as well. The doctor will remove tissue tumor through the bladder (suprapubic), through the wall of the prostate gland (retropubik), or via the perineal area, ie the area between the testicles and anus.

After surgery is completed, the catheter will be placed through the penis shaft. Verge of defeat serves to keep the flow of urine remains current. This catheter is usually placed for 2-4 days (after surgery TUR) or one week (after open prostatectomy surgery).

RECOVERY PERIOD

Healing after surgery takes 2-6 weeks. During the period of healing, it is recommended to drink lots of fluid to drain bladder contents. TOURS first month after surgery you might experience bleeding due terkelupasnya surgery scar tissue in the bladder. With bed rest and lots of drinking, usually the bleeding will soon stop. If after six weeks is still a lot of bleeding to a doctor immediately.

BIO ENERGY POWER ON THE PROSTATE.

Prostate enlargement or hypertrophy, protatitis and cancer is a disease caused by metabolic disturbances and spread bacteria in the body. Bio Energy Power worked with the body's metabolism and improve the quality of antibodies in double throw bacteria. so that surgery can be avoided. if the operation must still be done, Bio Energy Power exercises will further enhance the success of the operation.

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Low Cholesterol Prevent Prostate Cancer

Men are able to keep his cholesterol low, can be protected from heart disease and prostate cancer. Recent research study found that men who are in the range of healthy cholesterol - that is under 200 - have a lower risk of getting prostate cancer than men with high cholesterol.

While other studies have also found a man with a lot of HDL, or 'good cholesterol', has no risk of prostate cancer than men with low HDL. Both studies were published by the Institute of Cancer Prevention and Epidemiology, as part of the research journal of the American Association for Cancer Research.

Both this research study is not definitive and it has some weaknesses. But researchers agree that many other disciplines that limit the fat in the blood stream can reduce the risk of cancer.

"There may be additional benefit is to maintain low cholesterol," said Elizabeth Platz of Johns Hopkins University.

Elizabeth Platz, against 5586 men aged 55 and older who are in a large placebo group. Cholesterol does not make a difference in the possibility of getting prostate cancer except for the 60 people who developed high-grade tumors, the type that grows and spreads quickly. Opportunity to develop one of these aggressive tumors have a total 59% lower among men with cholesterol under 200.

So far the researchers do not know how many men in this study using statin drugs like Lipitor, Zocor or CRESTOR. That means reducing the risk of some cancers can be derived from the cholesterol-lowering drugs, low-cholesterol rather than by itself.

Earlier reports also suggested that statins may reduce the risk of cancer, but it was too early to declare that the drug may reduce cancer risk. Statins have long been known to prevent heart disease, and no research on the new changes.

The second study involved more than 29,000 Finnish men. The men, all smokers, is testing whether the various vitamins and nutrients may reduce cancer risk.

"Those who have the highest levels of HDL as much as 11%, believed to be capable of developing prostate cancer compared with the lowest level," said study leader Dr. Demetrius Albanes of the National Cancer Institute.

Prostate cancer is the most common cancer in U.S. men. More than 192 000 new cases occurred in the U.S. this year, while the number of deaths from this disease as much as 27 360 deaths.

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Surgical Technique Still Effective For Prostate Cancer

The most effective healing for patients with prostate cancer is to perform surgery. Radical surgery is performed should be raised all the prostate. But the condition is still in early stages. Interestingly, now that the surgery can be performed by the robot and can be done in a long distance (telesurgery).

If the Europeans have done laparoscopi and endoscope for surgery for prostate cancer. But in Indonesia, especially in East Java laparoscopi and endoscopic techniques can not be done, let alone surgery by the robot, Hardjowijoto Sunaryo said Prof. Dr. Dr. Spb, SPU-K, which will be confirmed as a Professor of Unair.

It said prostate carcinoma is a cancer that originated from the prostate gland. In Western countries is a carcinoma in men and is the most widely-two cause of death due to cancer. He gave an example in the United States as many as 189 000 patients diagnosed and known in the same year there were approximately 30 200 patients died from prostate cancer. This is equivalent to 10 times the number of victims of the collapse of the WTC in New York? he said.
According to her second treatment with radiotherapy.

This technique is most much sought after and performed as a substitute for surgical treatment. Physicians and patients prefer to use the way of this radiation. Unfortunately, the radiotherapy equipment is still quite expensive and even if there were often damaged. And there is no other tool than in Dr Soetomo, he said.

He reminded, that the government should help the treatment of prostate cancer patients with radiotherapy provides the tools that are expensive enough? If not the government who else can help, he explained. Another way to prevent prostate cancer is to adopt a healthy lifestyle. Healthy lifestyles among others, with a healthy diet and consume a lot of tomatoes and broccoli. Tomato and Broccoli is known to contain substances that can prevent cancer. Can also do therapy with vitamin E and Selenium. Also recommend a diet that contains meat and animal fats such as fast food because it is known to trigger prostate cancer, he explained.

Future of Robot Technique with robotic surgery. In Asia, this technique is still performed by the two countries, namely Singapore and Malaysia. In Singapore Sunaryo said there were two hospitals that can do while in Malaysia, only one hospital. Excess using the robot, among others, more perfect skill motion, can be done in telesurgery, such operations in Singapore, but who perform in the Netherlands, as well as ergonomic.

Robot can perform surgery with the angle until it reaches 360 degrees. If that is the doctor who did so we can be sure his body would hurt all, he concluded.

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Prostate Cancer Therapy Impact on Happy Life

Various types of prostate cancer treatment - surgery, radiation, hormone therapy hinga - can affect the long term the quality of men's lives, especially about sexual function and urinary problems. The conclusion was the result of a recent study published in the Journal of Urology. This study found the fact that no treatment itu high-impact improving quality of life men, including energy level, pain, emotional level, and physical ability every day such as walking, climbing stairs, or bring load.

The study involved 1269 U.S. men for four years after they get treatment early stage prostate cancer.

Most (60%) experienced a radical prostatectomy and surgical removal of the prostate gland. While the other 17% get brachytherapy, ie the internal form of radiation therapy where radioactive 'seeds planted' into the prostate gland, and the other 12% get the delivery of external radiation.

In addition, 6% of patients receiving the combination of two radiation therapy and 5% of other patients treated with drugs that block hormones cause prostate cancer to develop.

In addition, this treatment is known to cause erectile dysfunction, and it turns out surgery and radiation often cause incontinence. "But only few know that this problem affects the quality of life of men in the long term," said researchers led by Dr. George J Huang from the University of Pittsburgh School of Medicine.

This issue is important enough to remember this while prostate cancer is one of the most common cancer in men affecting approximately 160 per 100,000 people each year and kills 26 of 100,000 people. Most of these tumors grow so slowly and not causing any damage.

In this study, the researchers found that in general, men who undergo surgery or other forms of radiation, have urinary symptoms that worsen during the first year after treatment. This is based on their responses to a questionnaire of quality of life standards. Among the group, surgical patients have the most problems.

Then in the second year after treatment, surgery and radiation groups all showed a general improvement in urinary symptoms - although they did not fully return to their initial-based rating their quality of life. The extent to which people were "disturbed" by their urinary problems are also fading.

Men who undergo hormone therapy showed a different pattern: they tend to report about the gradual worsening of their urinary function over four years.

The findings of Huang and colleagues is somewhat surprising and have good reasons not yet clear. They speculate that hormone therapy may have an effect on the pelvic floor muscles and bladder from time to time so that it can have urinary problems - in a way similar to a natural process that can affect the estrogen decrease urinary detention of women after menopause.

When it came to sexual function, all groups reported a decrease in the first year after treatment - with the fall dramatically seen among surgical patients. However, surgery patients reported improvement during the second year, while the other treatment groups did not.

Moreover, while men in all treatment groups tended to say that they are more concerned with sexual problems after treatment than before, their level of satisfaction decreased when it comes to the purpose of their sexual function.

"These findings," wrote Huang and his colleagues, "provide indirect evidence that shows that while erectile dysfunction may typically look at ourselves as a means of self-adjustment of patients with various changes."

If talking about the overall quality of life ratings, there is no treatment for prostate cancer that seems to have a significant impact.

"All kinds of treatments have a negative impact about urinary and sexual function and is less impact on the overall welfare of the meaning of life," wrote the researchers.

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Vitamin Supplements for Prostate Cancer

O men, be wise in taking a multivitamin supplement. Because the pills behind it, saved a big danger, namely the risk of prostate cancer. Warning was delivered by the researchers from the National Cancer Institute in the United States (U.S.).

According to the researchers, taking a multivitamin in high doses will damage the prostate. These findings might make a scene, the article had been drinking vitamin supplements have become a lifestyle community.

The research team conducted research to determine the health benefits of multivitamins to 300 000 men. One third of respondents are accustomed to taking a multivitamin every day and five per cent consumed in high doses, approximately more than seven times a week.

Five years later, the team of researchers conducted a medical examination of the respondents. It turned out that 10 241 men diagnosed with prostate cancer. From this number 1476 of whom suffered high cancer and 179 people died.

Provisional estimates, the high doses of vitamins will nourish small tumors that cause cancer. In addition, respondents in this study were people who had prostate cancer risk because of heredity. They're just taking supplements to maintain health.

Prostate cancer is the commonest malignant disease in men in some Western countries. Although Asia has not been found, in the last ten years there is a significant increase in cases.

One way to lower prostate cancer risk is by maintaining a diet low in fat and often eat fish, especially those rich in Omega-3 fatty acids.

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Finasteride Reduces Prostate Cancer Risk, but Which Men Should Receive It?

Finasteride (Proscar) reduced the risk for prostate cancer by nearly 25% in the large Prostate Cancer Prevention Trial (PCPT), which was conducted in men 55 years and older.

But this finding begs the question of who to recommend the drug to, say the authors of a new analysis published online February 1 in the Journal of Clinical Oncology.

Despite the encouraging findings of the PCPT, the use of finasteride to prevent cancer in the community remains low and is not widely used, explained lead author Andrew Vickers, PhD, associate attending research methodologist at Memorial Sloan-Kettering Cancer Center in New York City.

"This suggests that, for the average man, the benefits of finasteride, in terms of reduced risk, do not outweigh the harms," he told Medscape Oncology.

The analysis conducted by Dr. Vickers and colleagues found that risk-group stratification for treatment with finasteride is "unlikely to be beneficial for preventing all prostate cancers detectable at biopsy." But if cancers found as a result of routine clinical care are used as an end point, then the optimal strategy would be to treat a subgroup of men at high risk rather than the whole at-risk population, they write.

The interpretation of these results, in relation to whether finasteride should be used as chemopreventive therapy for all men or for only for those at higher risk, depends on the relative clinical significance of cancers found during the end-of-study biopsy, the authors explain.

Basically, clinicians should recommend finasteride to all men if they want to reduce the risk for any biopsy-detectable prostate cancer.

However, "clinicians who believe that it is unnecessary to prevent all cancers, but that preventing those readily detectable by screening is desirable, would be best off recommending finasteride only to a high-risk subgroup," they write.

Balancing Benefit and Harms

The primary adverse effect associated with finasteride is decreased sexual function, the authors explain. Even though this effect is generally mild, the reduction in libido can be experienced immediately. Conversely, men at higher risk have a greater potential benefit from finasteride. Therefore, note the authors, a strategy that focuses on high-risk men might tip the balance between the benefits and harms of finasteride in favor of treatment.

"Along with many other groups, we have shown that the risk of getting prostate cancer over the course of next 5 to 10 years is strongly dependent on your PSA [prostate-specific antigen] level," said Dr. Vickers. "If you have a high PSA level, you are naturally a candidate for immediate biopsy. But even among those who are not candidates for biopsy, higher PSA means higher risk."

As an example, few clinicians would consider biopsying a man with a PSA of 0.8 ng/mL or one with a PSA of 1.6 ng/mL. "However, the man with the PSA of 1.6 ng/mL has a much higher risk of being diagnosed with prostate cancer over the next 5 to 10 years," he said.

Dr. Vickers explained that, in this study, he and his colleagues demonstrate that not only is the risk higher with increasing PSA, but the effects of finasteride are larger for men with a higher PSA level. "For example, the risk of cancer goes down by about 1% for the man with a PSA of 0.8 ng/mL but nearly 3% for the man with a PSA of 1.6 ng/mL," he said.

"We go on to show, using decision analysis, that it makes the most sense to offer finasteride not to all men at risk for prostate cancer, but only to men with a PSA above 1.3 ng/mL or those with a PSA above 2 ng/mL," Dr. Vickers continued. "Whether you choose 2 or 1.3 ng/mL for your cut-point depends on your views about the relative benefits and harms of taking finasteride."

A patient who is anxious about prostate cancer might be advised to take finasteride for a PSA of 1.5 ng/mL, for example, whereas one who prefers not to take drugs unless needed might be advised to take finasteride if his PSA is above 2 ng/mL, he added.

Study Details

In the current study, Dr. Vickers and colleagues used raw data from the PCPT to model chemopreventive treatment strategies to determine whether PSA levels can identify a high-risk subgroup in which the benefits of finasteride treatment outweigh the potential harm.

For their analysis, they weighed the benefits and harms for each strategy using number-needed-to-treat (NNT) thresholds, or the maximum number of patients that a clinician would need to treat with finasteride to prevent 1 cancer.

Their analysis consisted of 9058 men, 1957 of whom were diagnosed with prostate cancer during the 7-year study period: 798 (18.3%) men were in the finasteride group and 1159 (24.7%) were in the placebo group. Demographic characteristics such as baseline PSA, age, race, and family history were similar in both groups.

The overall risk of being diagnosed with cancer was 21.6% and, in both groups, approximately half of all cancers were detected by a biopsy that followed an elevated PSA level and/or an abnormal digital rectal exam result.

The authors observed that PSA levels were significantly associated with the outcome of all cancers and for-cause cancers (P < .001 for both). The data were divided into approximate quintiles according to baseline PSA, and then the clinical net benefit of treating by each of these cut points was determined.

They note that for the outcome of detecting all cancers, it is difficult to justify stratifying the population into risk groups and treating only men who are at high risk. For an extremely conservative clinician, such as one who would treat no more than 10 men to prevent 1 cancer, the highest clinical net benefit would be obtained from treating only the highest quintile of the population. But for the other NNT threshold, they write, the optimal strategy would be to treat either all men at risk or all but the lowest-risk quintile.

If only cancers that are detected by a for-cause biopsy are considered, "there is a clear case for recommending finasteride to some, but not all, men," they write. The optimal strategy, across all NNT thresholds, is to treat either 20% or 40% of those with the highest PSA levels. If only men with a PSA of 1.3 ng/mL or greater are given finasteride, the treatment rate would be reduced by 62%, with only a small increase in the event rate (from 9.6% to 9.9%).

Restricting the use of finasteride to men with a PSA of greater than 2 ng/mL would reduce the treatment rate by 83% and result in a cancer rate only 1.1% higher than treating all men, they note.

The study was supported in part by funds from David H. Koch provided through the Prostate Cancer Foundation, the Sidney Kimmel Center for Prostate and Urologic Cancers, and a SPORE grant from the National Cancer Institute. Dr. Vickers and coauthor Hans Lilja, MD, PhD, also from Memorial Sloan-Kettering Cancer Center, report receiving honoraria from GlaxoSmithKline. Hans Lilja also reports owning stock in Arctic Partners Oy.

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