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Why Selenium Supplementation Increases Prostate Cancer Risk

March 12, 2014 Oakland, CA.  Dennis R. Hill M.D. Medical Director of the HDR Prostate Brachytherapy Center and Radiation Oncologist at the Alta Bates Summit Medical Center in Oakland, CA continues his series on prostate cancer treatment options.

March 12, 2014 Oakland, CA- A new report (1) updating the previously reported Selenium and Vitamin E Cancer Prevention Trial (SELECT), was published online February 22, 2014 in the Journal of the National Cancer Institute. This analysis included an examination of whether the baseline selenium level had any impact on the development of prostate cancer.

The SELECT trial began in 2001 as a placebo-controlled trial in which more than 35,000 men were randomized to high-dose vitamin E (400 IU/day) and/or selenium (200 µg/day) supplements. The study was funded by the National Cancer Institute.

The original report (2) concluded that men receive no preventive benefit from either selenium or vitamin E supplements; in fact, for certain men, these supplements actually increased the risk for prostate cancer. The supplements were stopped in 2008 for that reason after average of five years but the study continued.

In this new study, the investigators reviewed the previously measured concentration of selenium in the toenails of 1,739 men diagnosed with prostate cancer during the SELECT trial and compared them with 3,117 men who were not.

They found that men with high selenium levels at baseline who took selenium supplements increased their risk for high-grade cancer by 91%. In other words, the levels of selenium in these men became toxic with supplementation.

The investigators also report that vitamin E increased prostate cancer risk in men, but only in those with low selenium levels at baseline. In the men with low levels of selenium randomized to receive vitamin E alone the risk for high-grade cancer increased by 111%.

The authors write that this study “suggests that effects of supplementation are dependent upon the nutrient status of the target population, such that supplementation of populations with adequate nutrient status, leading to supra physiological exposure, has either no effect or increases cancer risk.”

Dr. Hill says “Although many people think that dietary supplements ‘can’t hurt and might help” this report is consistent with the medical literature on supplements and cancer. If you are healthy, additional supplements are of no benefit.”

If prostate cancer is proven on biopsy, treatment options are active surveillance or interventional treatment such as radical surgery, external beam radiation, permanent seed implant or High Dose Rate Brachytherapy. In low risk disease the cure rate is excellent with any of the treatment methods. However, High Dose Rate Brachytherapy has a very low complication rate compared to the other modalities. There are essentially no rectal complications, no incontinence and a low percentage of erectile dysfunction.

About Dennis R. Hill MD

Dr. Hill is a board certified radiation oncologist doing High Dose Rate brachytherapy exclusively since 2004 and has published scholarly articles on the subject. His office is located at: Dennis R. Hill MD, 3012 Summit Street, Suite 2675, Oakland, CA 94609 510-869-8875. His email is drh@dennisrhillmd.com and his website is hdrprostatebrachytherapy.com

  1. Frankel PH, Parker RS, Madsen FC, Whanger PD. Baseline selenium and prostate cancer risk: comments and open questions. J Natl Cancer Inst. Natl Cancer Inst. 2014 Feb 22. [Epub ahead of print]
  2. Lippman SM, Klein EA, Goodman PJ, et al. Effect of selenium and vitamin E on risk of prostate cancer and other cancers: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA. 2009;301:39-51.

Prostate Cancer Screening in the Elderly

It is generally recommended that elderly patients not be screened for prostate cancer, but many elderly men are quite vital and younger than their chronological age. According to an article published in the Annals of Internal Medicine November 19, 2013 physicians may be better able to tailor cancer screening for them by using a new tool that estimates co-morbidity-adjusted life expectancy.

The report from the National Cancer Institute analyzed Medicare data on 407,749 elderly persons, both male and female, to develop tables that can be used to estimate life expectancies for patients who have or do not have co-morbid conditions.

The researchers found that persons with more co-morbidities such as diabetes, chronic obstructive lung disease, or congestive heart failure had shorter life expectancies when compared with an average person the same age, whereas persons with no co-morbid conditions had life expectancies beyond the average.

For example, the researchers estimate that a 75-year-old healthy person has a life expectancy of 6 years longer than a person of the same age with multiple conditions.

The study population included Medicare beneficiaries who were alive and at least 66 years old during the period 1992 and 2005. Beneficiaries who had previously had a cancer diagnosis were excluded from the study. The functional status and the severity of the co-morbidity were not available from the Medicare data reviewed.

The authors conclude that “Life expectancy varies considerably by co-morbidity status in elderly persons. Comorbidity-adjusted life expectancy may help physicians tailor recommendations cancer screening for individual patients.”

“This research confirms what I have seen in my practice, says Dr. Hill, “There are men who are biologically much younger than their stated age.”

If prostate cancer is proven on biopsy, treatment options are active surveillance or interventional treatment such as radical surgery, external beam radiation, permanent seed implant or http://HighDoseRateBrachytherapy.com [High Dose Rate Brachytherapy __title__ ]. In low risk disease the cure rate excellent with any of the treatment methods. However, High Dose Rate Brachytherapy has a very low complication rate compared to the other modalities. There are essentially no rectal complications, no incontinence and a low percentage of erectile dysfunction.

About Dennis R. Hill MD

Dr. Hill is a board certified radiation oncologist doing High Dose Rate brachytherapy exclusively since 2004 and has published scholarly articles on the subject. His office is located at: Dennis R. Hill MD, 3012 Summit Street, Suite 2675, Oakland, CA 94609 510-869-8875. His email is drh(at)dennisrhillmd(dot)com and his website is hdrprostatebrachytherapy.com

A Smarter Way to Screen for Prostate Cancer?

Oakland, CA February 5, 2014.

Herbert Lepor M.D. Chairman of the Department of Urology at New York Langone Medical Center was interviewed January 16, 2014 on CBS about the highly-debated prostate cancer screening with prostate-specific antigen (PSA) test. “Before the PSA test, being diagnosed with prostate cancer was almost a death sentence,” he said because the disease was advanced by the time it could be detected on digital rectal examination (when a doctor checks the prostate through the rectum using a gloved finger). After PSA testing became widely available, the disease was diagnosed earlier, and cure rates were much better.

“It seemed as though it would be the answer to help us identify earlier cancers,” Lepor explained. It would seem like a screening test that can catch the disease early would be a major advance in medical care. In fact, “it’s one of the most controversial areas in medicine,” said CBS News Chief Medical Correspondent Dr. Jon Lapook. The problem is that the many of the tumors are low risk and not significant enough to warrant treatment. The biopsies, radiation and surgery can cause serious side effects, including infection, impotence, incontinence and other complications which would adversely affect the man’s quality of life.

That’s why a panel that advises the U.S. government on medical treatment guidelines, the U.S. Preventative Services Task Force, recommended against healthy, symptom-free men of any age getting the PSA test in the May 2012 guidelines. However, many cancer experts believe that the PSA test should still play a role. Without using the blood test, the only method left to check for prostate cancers is a digital rectal exam and they are often discovered too late.

Lepor said that what doctors need is to “screen smarter.” He suggested still using the PSA test and if it is elevated repeating it to reconfirm. Then, Lepor said, doctors could use an advanced MRI scan to see if there is a suspicious area. The biopsy could be directed or “targeted” to the abnormal area rather that the common practice of random biopsies throughout the gland as done currently if the PSA is elevated. If the MRI scan is negative, Lepor said, a man might not need a biopsy unless their PSA scores keep increasing or they have significant family history.

“Dr. Lepor’s proposal for smarter screening makes some sense. If the MRI scan is negative, the patient could avoid a biopsy and possible infection,” says Dr. Hill.

If prostate cancer is proven on biopsy, treatment options are active surveillance or interventional treatment such as radical surgery, external beam radiation, permanent seed implant or high dose rate brachytherapy. In low risk disease the cure rate excellent with any of the treatment methods. However, High Dose Rate Brachytherapy has a very low complication rate compared to the other modalities. There are essentially no rectal complications, no incontinence and a low percentage of erectile dysfunction.

About Dennis R. Hill MD

Dr. Hill is a board certified radiation oncologist doing High Dose Rate brachytherapy exclusively since 2004 and has published scholarly articles on the subject. His office is located at: Dennis R. Hill MD, 3012 Summit Street, Suite 2675, Oakland, CA 94609 510-869-8875. His email is drh@dennisrhillmd.com and his website is hdrprostatebrachytherapy.com

What is the Genetic Risk of Prostate Cancer?

Oakland, CA January 22, 2014.  A study was presented at the American Society of Human Genetics (ASHG) 63rd Annual Meeting in October last year which showed that prostate cancer is the most inheritable type of cancer.* Data on both identical and fraternal twins from the comprehensive birth-to-death registries in Denmark, Finland, Norway, and Sweden show that a man whose identical twin has prostate cancer has a 32% risk for the disease himself, whereas a fraternal twin whose brother has prostate cancer has only a 16% risk, said Jaakko Kaprio, MD, PhD, professor of genetic epidemiology at the University of Helsinki.

The estimated heritability of prostate cancer — the degree to which genes contribute to risk — was 58%, which is the highest for any malignancy studied, Dr. Kaprio reported. Breast cancer heritability was estimated at 28%.

Dr. Kaprio’s team looked at data on 133,689 identical and fraternal pairs as part of the Nordic Twin Registry of Cancer. They used time-to-event analysis to estimate heritability and familial cancer risk.

”This report reaffirms the notion that any man with a family history of prostate cancer should be screened with regular PSA testing and digital rectal exam,” says Dr. Hill.

If prostate cancer is proven on biopsy, treatment options are active surveillance or interventional treatment  such as radical surgery, external beam radiation, permanent seed implant or high dose rate brachytherapy. In low risk disease the cure rate is same, over 90%, with any of the treatment methods. However, High Dose Rate Brachytherapy has a very low complication rate compared to the other modalities. There are essentially no rectal complications, no incontinence and a low percentage of erectile dysfunction.

About Dennis R. Hill MD

Dr. Hill is a board certified radiation oncologist doing High Dose Rate brachytherapy exclusively since 2004 and has published scholarly articles on the subject. His office is located at: Dennis R. Hill MD, 3012 Summit Street, Suite 2675, Oakland, CA 94609 510-869-8875. His email is drh@dennisrhillmd.com and his website is hdrprostatebrachytherapy.com

*American Society of Human Genetics (ASHG) 63rd Annual Meeting: Abstract 43. Presented October 23, 2013

 

Dennis R Hill MD Receives 2013 Best of Oakland Award

Award image 12-27-13Oakland, CA December 27, 2013 — Each year, the Oakland Award Program identifies companies that we believe have achieved exceptional marketing success in their local community and business category. These are local companies that enhance the positive image of small business through service to their customers and our community. These exceptional companies help make the Oakland area a great place to live, work and play.

About Dr. Hill

Dr. Hill is president of Dennis R. Hill MD Professional Corporation which provides a unique emerging technology in cancer care called High Dose Rate Brachytherapy. In this method thin flexible treatment catheters are surgically implanted directly into tumor tissue and then under controlled conditions a miniature radiation source is inserted into the treatment catheters by a computerized robot. The tumor is treated from the inside out so normal tissue is spared. After treatment the catheters are removed. The cure rates are equal to surgery and external beam radiation with fewer side effects.

“I am honored to receive this award and happy to see that High Dose Rate Brachytherapy is being recognized as a new treatment alternative for cancer, specifically prostate cancer,” says Dr. Hill.

Various sources of information were gathered and analyzed to choose the winners in each category. The 2013 Oakland Award Program focuses on quality, not quantity. Winners are determined based on the information gathered both internally by the Oakland Award Program and data provided by third parties.

About Oakland Award Program

The Oakland Award Program is an annual awards program honoring the achievements and accomplishments of local businesses throughout the Oakland area. Recognition is given to those companies that have shown the ability to use their best practices and implemented programs to generate competitive advantages and long-term value.

The Oakland Award Program was established to recognize the best of local businesses in our community. Our organization works exclusively with local business owners, trade groups, professional associations and other business advertising and marketing groups. Our mission is to recognize the small business community’s contributions to the U.S. economy.

SOURCE: Oakland Award Program

Contact:
Dennis R. Hill MD, 3012 Summit Street, Suite 2675, Oakland, CA 94609. Phone 510-869-8875. Fax 510-869-8882. Email drh(at)dennisrhillmd(dot)com. Website hdrprostatebrachytherapy.com.

Celebrity Prostate Exams Bring Awareness to Prostate Cancer Detection

Dennis R. Hill M.D. Medical Director of the HDR Prostate Brachytherapy Center and Radiation Oncologist at the Alta Bates Summit Medical Center in Oakland, CA discusses the recent Today Show episode which featured a story on prostate health.

Matt Lauer and Al Roker of the Today show on NBC volunteered to have prostate exams on the air Thursday November 7 in an effort to build awareness around prostate cancer. According to the Centers for Disease Control and Prevention, one in six American men will be diagnosed with prostate cancer in his lifetime.

Prostate cancer screening consists of a PSA blood test and a digital rectal exam which Lauer and Roker had behind closed doors, but on live TV, by Lauer’s urologist. “Is it the best 34 seconds of your life? Probably not,” said Lauer, who has a family history of the disease but his exam was negative. “But if in 34 seconds a guy like this can detect something that might save your life, what are we talking about?” Roker, whose prostate was deemed “a little enlarged” will require follow-up.

The weather man, soberly discussed the prevalence of prostate cancer in the African American community with Dr. Nancy Snyderman. There has been some controversy about routine prostate cancer screening since the United States Preventative Services Task Force (USPSTF) has recommended that PSA screening for prostate cancer NOT be done on any man.

Based on their study they report few men benefit out of so many tested and there could be harm with overtreatment. The American Urological Society (AUA) does not agree with that. The AUA continues to support the use of the PSA test. However, PSA-based screening without clearly targeting those who are most likely to benefit from testing does result in harms, including over diagnosis and overtreatment.

All involved professionals have to take a more targeted approach to minimize these harms. The AUA feel that men ages 55 to 70 who are in good health and have more than a 10- to 15-year life expectancy should have the choice to be tested and not discouraged from doing so. Men who are African American or have a positive family history should be screened.

There is general agreement that early detection, including PSA screening, has played a key part in decreasing prostate cancer mortality. If cancer is detected in an early stage it can be cured fairly readily. The treatment options are surgery, external beam radiation, permanent seed implant or high dose rate brachytherapy. All these methods give equal results, but high dose rate brachytherapy does the least harm.

About Dennis R. Hill MD

Dr. Hill is a board certified radiation oncologist doing High Dose Rate brachytherapy exclusively since 2004 and has published scholarly articles on the subject. His office is located at: Dennis R. Hill MD, 3012 Summit Street, Suite 2675, Oakland, CA 94609 510-869-8875. His email is drh@dennisrhillmd.com and his website is hdrprostatebrachytherapy.com

Prostate Cancer Genetic Test Not Ready for Prime Time

October 30, 2013.

Dennis R. Hill M.D. Radiation Oncologist at the Alta Bates Summit Medical Center in Oakland, CA reports that there is considerable interest in genetic testing for prostate cancer. He notes that at the June meeting of the American Association of Clinical Oncology a presentation about one of the relatively new tests suggested that it could predict which cancers would be aggressive and which would be indolent. If it could be accurately determined, aggressive tumors would need active treatment such as surgery, external beam radiation, permanent seed implant, or High Dose Rate brachytherapy. Indolent disease could be put under active surveillance and treated only if it progressed. The Prolaris test*, which measures the activity of cell cycle progression (CCP) genes in prostate cancer biopsy samples, was evaluated for its ability to predict either death from prostate cancer or biochemical recurrence in five published studies. All five studies were company sponsored. The presenting physician, concluded that “the CCP score predicts prostate cancer outcome in multiple cohorts and diverse clinical settings. It provides independent information beyond classic clinical pathologic variables and can help differentiate aggressive from indolent cancers.”

Dr. Hill says that there is considerable interest in genetic testing in prostate cancer because there has been success in breast cancer. Genetic breast cancer tests can be predictive of a patient’s response to breast cancer therapy but there is not an equivalent advantage with prostate cancer. “You are either at higher risk or lower risk. There are no firm cutoffs that would steer decisions toward a different treatment in prostate cancer,” he said. “If we have a new biomarker, we need to be able to demonstrate the ability to affect clinical management or treatment decisions.” However, Dr. Hill pointed out that, for the majority of patients that have had the test in his practice it did not change the risk category that was predicted by the standard parameters of PSA, gleason score, clinical stage, biopsy cores positive and perineural invasion.

Dr. Hill says that the test, which is expensive at about $3,400 and not covered by Medicare or most insurance companies does not help medical decision making beyond the standard National Comprehensive Cancer Network (NCCN) risk categories predicted by stage, gleason score and PSA. “It is not money well spent at this point in time,” says Dr. Hill.
*2013 Annual Meeting of the American Society of Clinical Oncology. Abstract 5005. Presented June 2, 2013.

About Dennis R. Hill MD
Dr. Hill is a board certified radiation oncologist doing High Dose Rate brachytherapy exclusively since 2004 and has published scholarly articles on the subject. His office is located at: Dennis R. Hill MD, 3012 Summit Street, Suite 2675, Oakland, CA 94609 510-869-8875. His email is drh@dennisrhillmd.com and his website is hdrprostatebrachytherapy.com

Dennis R. Hill, MD Slated to Present “Active Surveillance vs. High Dose Rate Brachytherapy” to the Summit Medical Staff

September 28, 2013

Dennis R. Hill, MD confirmed today that he will present “Active Surveillance vs. High Dose Rate Brachytherapy” at the Continuing Medical Education Conference for the Summit Medical Staff of the Alta Bates Summit Medical Center Thursday Oct 3. The conference is scheduled from 12:15pm to 1:15pm at the Merritt Pavilion of the Summit campus in Oakland. It will be in the Fir Conference Room. His intention is to raise awareness of active surveillance in selected patients with prostate cancer and increase the awareness of High Dose Rate brachytherapy as a safe, efficient method of treatment for prostate cancer with few side effects. Dr. Hill comments, “There is a changing paradigm in prostate cancer on several fronts, including screening, diagnosis and treatment. It can be confusing. Hopefully, I can bring the latest information out, but also some common sense on how to approach this important cancer.” Following the formal presentation there will be a question and answer session with the attending physicians. The event is sponsored by the Jordan Research and Education Institute of the Alta Bates Summit Medical Center. Physicians can obtain one Continuing Medical Education credit by attending the conference.

About Dennis R. Hill MD

Dr. Hill has been doing High Dose Rate Brachytherapy for prostate cancer treatment exclusively since 2004 and has published scholarly articles on the subject. His office is located at: Dennis R. Hill MD, 3012 Summit Street Suite 2675, Oakland, CA 94609; 510-869-8875; drh(at)dennisrhillmd(dot)com and his website is hdrprostatebrachytherapy.com, which includes a quiz to determine if a patient is a candidate for HDR Prostate Brachytherapy.

Prostate Cancer Stage vs. Gleason Score

August 28, 2013

Dennis R. Hill M.D. Radiation Oncologist at the Alta Bates Summit Medical Center in Oakland, CA reports that a recently published study confirms his experience that PSA screening has detected prostate cancer at a much earlier stage or tumor size. The journal Cancer Research published August 14, 2013 Abstract looked at 1,207 men who were diagnosed with prostate cancer from 1982 to 2004 and subsequently treated with surgery as their treatment for prostate cancer. They found that the proportion of advanced-stage tumors (≥T3) dropped from 19.9% during the earliest period of the study (1982–1993, when PSA screening was not well established) to 3% during the latest period of the study (2000–2004). In other words, the proportion of advanced stage tumors dropped more than six-fold from the pre PSA screening era to the PSA screening era.

On the other hand, they report the proportion of high Gleason scores or the appearance of the cancer cells when viewed under a microscope decreased substantially less. Gleason grade 4 + 4 prostate cancer or greater dropped from 25.3% to 17.6% across the pre-PSA and PSA screening eras. It is unknown whether prostate cancers arise well differentiated and then progress to less differentiated forms. However, this study says that Gleason grade is an early and largely unchanging feature because the expectation is that Gleason grade and clinical stage would progress together. Prostate cancer treatment options take into account both stage and Gleason score.

They conclude, “This has implications for the understanding of tumor progression and prognosis, and may help patients diagnosed with lower grade disease feel more comfortable choosing active surveillance.”

Dr. Hill says, “I know that we have a higher cure rate with a lower stage of disease but this report suggests that there is a group of men with low grade disease that can be safely followed since Gleason grade progression is relatively uncommon.”

About Dennis R. Hill MD

Dr. Hill has been doing High Dose Rate Brachytherapy exclusively since 2004 and has published scholarly articles on the subject. His office is located at: Dennis R. Hill MD 3012 Summit Street Suite 2675 Oakland, CA | 94609 510-869-8875 | drh(at)dennisrhillmd(dot)com and his website is hdrprostatebrachytherapy.com, which includes a quiz to determine if a patient is a candidate for HDR Prostate Brachytherapy.

Dennis R. Hill, MD to Speak at the American Cancer Society Man-to-Man Support Group

Oakland, CA August 16, 2013.  Dennis R. Hill, MD has confirmed today that he will be speaking to the American Cancer Society Man-to-Man support group on High Dose Rate Brachytherapy Tuesday, September 24, from 6:30 to 8:00pm at the Summit Campus of Alta Bates Summit Medical Center in Oakland, CA.

The Man to Man program helps men cope with prostate cancer by offering community-based education and support for patients and their family members. Part of this volunteer organization is outreach and collaboration with health care professionals. Dr. Hill has volunteered to speak for the second time in three years. His previous High Dose Rate Brachytherapy presentation was “a big hit” according to William H. Spurgeon the facilitator of the group. He also said, “We appreciate (Dr. Hill’s) time and energies to help educate our men.”

Dr. Hill explains that High Dose Rate Brachytherapy is an advanced form of treatment for prostate cancer which treats the prostate with radiation from the inside out with temporary implanted catheters. It is less rigorous than surgery, less time consuming than external beam radiation, and more precise than permanent seed implant. The success rate is the same as surgery, external beam radiation and permanent seeds and there are fewer side effects according to Dr. Hill.

Dr. Hill has been doing High Dose Rate Brachytherapy exclusively since 2004. He has done over five hundred High Dose Rate Prostate Brachytherapy implants and has published scholarly articles on the subject.

His office is located at: Dennis R. Hill MD 3012 Summit Street Suite 2675 Oakland, CA 94609 510-869-8875 drh(at)dennisrhillmd(dot)com and his website is hdrprostatebrachytherapy.com, which includes a quiz to determine if a patient is a candidate for HDR Prostate Brachytherapy.