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April 21, 2014

Andrew Silow-Carroll: Passoverkill? Suggestions to make next year's seders even more culturally sensitive

Sara Israelsen Hartley: Seeking the Divine: An ancient connection in a new context

Christine M. Flowers: Priest's execution in Syria should be call to action

Courtnie Erickson: How to help kids accept the poor decisions of others

Lizette Borreli: A Glass Of Milk A Day Keeps Knee Arthritis At Bay

Lizette Borreli: 5 Health Conditions Your Breath Knows Before You Do

The Kosher Gourmet by Betty Rosbottom Coconut Walnut Bars' golden brown morsels are a beautifully balanced delectable delight

April 18, 2014

Rabbi Yonason Goldson: Clarifying one of the greatest philosophical conundrums in theology

Caroline B. Glick: The disappearance of US will

Megan Wallgren: 10 things I've learned from my teenagers

Lizette Borreli: Green Tea Boosts Brain Power, May Help Treat Dementia

John Ericson: Trying hard to be 'positive' but never succeeding? Blame Your Brain

The Kosher Gourmet by Julie Rothman Almondy, flourless torta del re (Italian king's cake), has royal roots, is simple to make, . . . but devour it because it's simply delicious

April 14, 2014

Rabbi Dr Naftali Brawer: Passover frees us from the tyranny of time

Greg Crosby: Passing Over Religion

Eric Schulzke: First degree: How America really recovered from a murder epidemic

Georgia Lee: When love is not enough: Teaching your kids about the realities of adult relationships

Cameron Huddleston: Freebies for Your Lawn and Garden

Gordon Pape: How you can tell if your financial adviser is setting you up for potential ruin

Dana Dovey: Up to 500,000 people die each year from hepatitis C-related liver disease. New Treatment Has Over 90% Success Rate

Justin Caba: Eating Watermelon Can Help Control High Blood Pressure

The Kosher Gourmet by Joshua E. London and Lou Marmon Don't dare pass over these Pesach picks for Manischewitz!

April 11, 2014

Rabbi Hillel Goldberg: Silence is much more than golden

Caroline B. Glick: Forgetting freedom at Passover

Susan Swann: How to value a child for who he is, not just what he does

Cameron Huddleston: 7 Financial Tasks You Should Tackle Right Now

Sandra Block and Lisa Gerstner: How to Profit From Your Passion

Susan Scutti: A Simple Blood Test Might Soon Diagnose Cancer

Chris Weller: Have A Slow Metabolism? Let Science Speed It Up For You

The Kosher Gourmet by Diane Rossen Worthington Whitefish Terrine: A French take on gefilte fish

April 9, 2014

Jonathan Tobin: Why Did Kerry Lie About Israeli Blame?

Samuel G. Freedman: A resolution 70 years later for a father's unsettling legacy of ashes from Dachau

Jessica Ivins: A resolution 70 years later for a father's unsettling legacy of ashes from Dachau

Kim Giles: Asking for help is not weakness

Kathy Kristof and Barbara Hoch Marcus: 7 Great Growth Israeli Stocks

Matthew Mientka: How Beans, Peas, And Chickpeas Cleanse Bad Cholesterol and Lowers Risk of Heart Disease

Sabrina Bachai: 5 At-Home Treatments For Headaches

The Kosher Gourmet by Daniel Neman Have yourself a matzo ball: The secrets bubby never told you and recipes she could have never imagined

April 8, 2014

Lori Nawyn: At Your Wit's End and Back: Finding Peace

Susan B. Garland and Rachel L. Sheedy: Strategies Married Couples Can Use to Boost Benefits

David Muhlbaum: Smart Tax Deductions Non-Itemizers Can Claim

Jill Weisenberger, M.S., R.D.N., C.D.E : Before You Lose Your Mental Edge

Dana Dovey: Coffee Drinkers Rejoice! Your Cup Of Joe Can Prevent Death From Liver Disease

Chris Weller: Electric 'Thinking Cap' Puts Your Brain Power Into High Gear

The Kosher Gourmet by Marlene Parrish A gift of hazelnuts keeps giving --- for a variety of nutty recipes: Entree, side, soup, dessert

April 4, 2014

Rabbi David Gutterman: The Word for Nothing Means Everything

Charles Krauthammer: Kerry's folly, Chapter 3

Amy Peterson: A life of love: How to build lasting relationships with your children

John Ericson: Older Women: Save Your Heart, Prevent Stroke Don't Drink Diet

John Ericson: Why 50 million Americans will still have spring allergies after taking meds

Cameron Huddleston: Best and Worst Buys of April 2014

Stacy Rapacon: Great Mutual Funds for Young Investors

Sarah Boesveld: Teacher keeps promise to mail thousands of former students letters written by their past selves

The Kosher Gourmet by Sharon Thompson Anyone can make a salad, you say. But can they make a great salad? (SECRETS, TESTED TECHNIQUES + 4 RECIPES, INCLUDING DRESSINGS)

April 2, 2014

Paul Greenberg: Death and joy in the spring

Dan Barry: Should South Carolina Jews be forced to maintain this chimney built by Germans serving the Nazis?

Mayra Bitsko: Save me! An alien took over my child's personality

Frank Clayton: Get happy: 20 scientifically proven happiness activities

Susan Scutti: It's Genetic! Obesity and the 'Carb Breakdown' Gene

Lecia Bushak: Why Hand Sanitizer May Actually Harm Your Health

Stacy Rapacon: Great Funds You Can Own for $500 or Less

Cameron Huddleston: 7 Ways to Save on Home Decor

The Kosher Gourmet by Steve Petusevsky Exploring ingredients as edible-stuffed containers (TWO RECIPES + TIPS & TECHINQUES)

Jewish World Review

Prostate cancer study questions surgery

By Rosie Mestel




JewishWorldReview.com | (MCT) Most patients diagnosed with early-stage prostate cancer will live just as long if they simply watch their cancers rather than have them surgically removed, according to the results of a landmark clinical trial that could upend the medical approach to a disease that affects 1 in 6 men.

The study, which focused on cancers still confined to the prostate, should reassure patients who want to avoid distressing side effects of surgery — such as urinary incontinence and sexual dysfunction — but still protect their lives, cancer experts said. If embraced by patients and doctors, the new information stands to radically change prostate cancer management in the U.S., where the majority of early prostate cancers are treated aggressively with surgery or radiation therapy.

The much-anticipated results of the so-called PIVOT trial, reported in Thursday's edition of the New England Journal of Medicine, did find that surgery provided a slight benefit for patients with higher-risk early cancers. That group included men whose blood levels of prostate-specific antigen, or PSA, were above 10 nanograms per milliliter or who had larger tumors with cells that were more abnormal in appearance.

And because the average age of the 731 men who participated in the trial was 67, with only 10% under age 60, the implications for younger men who have more potential years ahead of them are less certain, experts noted.

But overall, the clinical trial — the largest of its kind and the first in the era of widespread PSA screening — should be welcome news for men diagnosed with early prostate cancer, said Dr. Mark S. Litwin, chair of urology at UCLA and a researcher at the university's Jonsson Comprehensive Cancer Center.


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"The trial gives us results that we have been waiting for in urology for quite some time," said Litwin, who was not involved in the study. "It confirms many of the recent reports that men with prostate cancer, by and large, can be safely managed with close monitoring."

The conclusions may well overstate the benefit of surgery, said study leader Dr. Timothy J. Wilt, a specialist in disease prevention and health promotion who works at the University of Minnesota and the Minneapolis Veterans Affairs Health Care System.

That's because only about half the men in the trial discovered their tumors through PSA tests, which are more common today than they were when men joined the trial, starting in 1994. In addition, doctors at the time would wait for higher PSA levels before ordering biopsies.

As a consequence, men in the past often had larger tumors by the time their prostate cancers were found.

"Men diagnosed today will likely have an even better prognosis with observation," Wilt said.

An estimated 241,740 new cases of prostate cancer will be diagnosed in the U.S. this year, and 28,170 men will die of it, according to the American Cancer Society. It is the second-leading cause of cancer death in men, after lung cancer.

Men in the trial were recruited from 44 Department of Veterans Affairs medical centers across the U.S. and eight medical centers that earned special recognition from the National Cancer Institute. Patients were randomly assigned either to receive surgery or to forego treatment and have their cancers followed with checkups every six months.

In the observation group, symptoms such as difficulty in urination or cancer that spread to the bones were treated as they arose.

About half of the men — who were tracked for a median of 10 years — died during the course of the study. But the vast majority of these deaths were not from prostate cancer, the authors noted. That finding underscores the often-repeated saying among urologists that more men die with prostate cancer than of it.

The likelihood of death from any cause was the same for patients who had surgery and those who didn't. Surgery did not affect mortality rates for any subgroups based on race, age or overall health status.

Only 7.1% of men in the study died from prostate cancer or as a result of surgery to treat it, in statistically equal numbers in both groups.

"That's a key point" that men should absorb, said Dr. Durado Brooks, director of prostate and colorectal cancers for the American Cancer Society. "When most men are told they have prostate cancer, their immediate thought is, 'Oh my God, I'm going to die,' and their immediate next step is, 'Let's do something about this.' " By then, Brooks said, "the idea of an observation approach is lost."

That is significant, because the consequences of surgery are not benign. Twenty-one percent of men in the study experienced complications such as wound infection in the 30 days after surgery, and one man died. After two years, rates of urinary incontinence and erectile dysfunction were roughly twice as high in the surgery group compared with the observation group.

Though all of the men had a diagnosis of early prostate cancer with no spread to the bones, there were differences in the seriousness of those cancers. Some of the tumors were larger, some men had higher PSA levels, and some had higher so-called Gleason scores, numbers assigned to cancers based on how abnormal the cells look under a microscope.

When higher-risk cancers were assessed separately, the authors detected a slight edge with surgery, most clearly in those men with PSA scores over 10 nanograms per milliliter of blood. Among these patients, death from any cause was 13% lower in the surgery group and death related to prostate cancer was 7% lower compared with the observation group. Men who had surgery were also half as likely to see their cancer spread to the bones, which produces pain that is hard to manage and raises the risk of fractures.

For high-risk men, "surgery clearly has been shown to be beneficial over watchful waiting," said study coauthor Dr. William Aronson, a urologist at the VA Greater Los Angeles Healthcare System.

Even so, experts noted, men in this category who are older or who have significant other health issues might consider observation or a more hands-on approach called active surveillance — in which PSA tests and biopsies are taken periodically and treatment is begun if the cancer appears to be spreading — because they are still more likely to die of something other than their prostate cancer.

Another factor to consider is a man's personality and priorities, said 73-year-old prostate cancer survivor Jim Kiefert of Olympia, Wash., a member of the prostate cancer support organization Us Too.

Some men in the support group he leads — especially younger men — will welcome the study's news because they greatly fear the side effects of surgery, he said. But it will be a hard sell to many others, he added.

"You have to be psychologically stable enough to say, 'Look, I'll let that cancer stay in me. If it starts to grow, I'll do something about it. But if not, I'll just go on with my life.' "

The trial did not compare observation to radiation therapy, another common treatment for localized prostate cancer. But scientists said the outcome is unlikely to differ.

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© 2012, Los Angeles Times Distributed by McClatchy-Tribune Information Services.