Prostate Cancer Detection

“The article below was found on the medical x press blog online.  It highlights research related to DNA methylation which may play a vital role in the development of more specific biomarkers used for earlier prostate cancer detection.  In the era when the utility of the PSA test is continuously being questioned, the need for more sensitive and specific biomarkers is of paramount importance.  Miami urologists David Robbins, MD and Amery Wirtshafter, MD are experts in the field of prostate cancer detection and treatment and employ the most up to date modalities in the fight against prostate cancer.”  David Robbins , MD. 


Researchers discover biomarkers for prostate cancer detection, recurrence May 14, 2012 in Cancer Alterations to the “on-off” switches of genes occur early in the development of prostate cancer and could be used as biomarkers to detect the disease months or even years earlier than current approaches, a Mayo Clinic study has found. These biomarkers — known as DNA methylation profiles — also can predict if the cancer is going to recur and if that recurrence will remain localized to the prostate or, instead, spread to other organs. The study, published in the journal Clinical Cancer Research, is the first to capture the methylation changes that occur across the entire human genome in prostate cancer. Ads by Google Prostate Cancer Failures – Hope for treatment failures/ Rising PSA after treatment – Cancer Treatment Options – Diagnosed w/Adenocarcinoma? Learn About New Treatment Options at CTCA – The discovery could someday help physicians diagnose prostate cancer earlier and make more effective treatment decisions to improve cure rates and reduce deaths. It also points to the development of new drugs that reverse the DNA methylation changes, turning the “off” switch back “on” and returning the genetic code to its normal, noncancerous state. “Our approach is more accurate and reliable than the widely used PSA (prostate-specific antigen) test,” says senior author Krishna Donkena, Ph.D., a Mayo Clinic molecular biologist. The PSA test detects any prostate abnormality, whether inflammation, cancer, infection or enlargement, while the DNA methylation changes are specific to prostate cancer, she says. Though the instructions for all the cell’s activities lie within the genes, whether a particular gene is turned “off” or “on” is determined by the presence or absence of specific chemical tags or methyl groups — methylation — along the underlying DNA of cells. When this process of DNA methylation turns off the activity of tumor suppressor genes, cancer develops. Dr. Donkena and her colleagues analyzed the methylation status of 14,495 genes from 238 prostate cancer patients. The patients included people who remained cancer-free after treatment, those who had a localized tumor recurrence and those whose cancer spread. The researchers found that the DNA methylation changes that occurred during the earliest stages of prostate cancer development were nearly identical in all patients. Having discovered DNA methylation patterns that could distinguish between healthy and cancerous tissue, the researchers then searched for similar biomarkers that could distinguish between patients with varying levels of recurrence risk. They found distinct methylation alterations that corresponded to whether a patient had a slow-growing tumor known as an indolent tumor, or had a more aggressive one. If physicians can determine what type of tumor patients have, they can avoid exposing patients with indolent tumors to unnecessary treatment, and can treat those with aggressive tumors earlier and more effectively, Dr. Donkena says. Dr. Donkena and her colleagues are working to develop a DNA methylation test that is more cost-effective and practical for use in clinical settings. Currently, the test relies on microarray or gene “chip” technology that assesses methylation status of genes across an entire genome. The researchers are trying to generate more economical custom microarray to specifically look at only the genes that predict the development of prostate cancer or recurrence. They also hope to develop drugs that can reverse DNA methylation in prostate cancer cells. Similar drugs are already being used to treat certain forms of leukemia. Journal reference: Clinical Cancer Research Provided by Mayo Clinic

Read more at:

Radical Prostatectomy Surgery Miami

“Nerve Sparing Radical Prostatectomy in addition to providing the benefit of improved post operative erectile function for men with localized prostate cancer may improve the ability to achieve normal orgasm.   Miami urologist, David Robbins, MD is a regional expert in robotic assisted radical prostatectomy using the da Vinci surgical robot and offers patients the opportunity to have their prostate cancer treated with minimal effect on their quality of life with regard to measures such as erectile function and maintenance of continence.  This article shows evidence that nerve sparing prostatectomy may additionally result in improved ability to achieve normal orgasms.”  Miami urologist, David Robbins MD

Nerve-Sparing Prostate Surgery Helps Men Retain Sexual Function

Most men left with nerves on both sides of the gland can achieve orgasm, study shows

THURSDAY, Feb. 16 (HealthDay News) — Most men who have surgery for prostate cancer can still achieve orgasm if the nerves that surround their prostate gland are not removed, according to a new study.

Researchers from Cornell University say a man’s age and the number of his nerves that are spared will play a role in his ability to climax after surgery.

The study followed 408 men who underwent a procedure to remove their prostate, known as robot-assisted laparoscopic radical prostatectomy, between 2005 and 2007 for an average of three years. Men had mean age of 60 years and all were able to have an orgasm before the procedure.

Seventy-four percent of the men were able to have their nerves spared bilaterally, or on both sides. Of those men, 91 percent experienced no change in their ability to achieve orgasm following the surgery.

About 13 percent of the men had their nerves spared on only one side. Of this group, 82 percent of the men had the same ability to reach orgasm. Another 12 percent had little or no nerve sparing, with 62 percent of them were still able to achieve orgasm the same way they did before the operation.

The men’s age also played a role in their ability to orgasm. The study, published in the February issue of BJUI, showed orgasm rates were significantly higher in men younger than 60 who had their nerves spared on both sides. Orgasm rates dropped by 10 percent to 83 percent among men older than 60, even if their nerves were spared on both sides.

A questionnaire completed by 156 of the men who were able to achieve orgasm after surgery revealed 82 percent had high satisfaction rates. Another 10 percent said they had moderate satisfaction and 7 percent reported low satisfaction. Roughly 3 percent of the men said they experienced a painful orgasm.

“As far as we are aware, this is the largest analysis of orgasmic function in the robotic prostatectomy literature and will provide valuable information for surgeons talking to patients about what sort of sexual function they can expect after surgery,” study author Dr. Ashutosh Tewari, director of the Prostate Cancer Institute and the LeFrak Robotic Surgery Center at Weill Cornell Medical College, said in a journal news release.

More information

The U.S. National Institutes of Health provides more information on prostate cancer.

— Mary Elizabeth Dallas

SOURCE: Wiley-Blackwell, news release, Feb. 13, 2012

Last Updated: Feb. 16, 2012

Copyright © 2012 HealthDay. All rights reserved.

Best Robotic Prostate Cancer Surgeon Miami

David Robbins, MD is a board certified urologist in Miami and well known expert in the field of robotic prostate cancer surgery.  Dr. Robbins is currently performing robotic prostate cancer surgery out of Mount Sinai Medical Center in Miami Beach as well as Aventura Hospital and Medical Center in Aventura.  Miami urologist Dr. David Robbins received specialized training in robotic prostatectomy from experts in the field during his training at NYU Medical Center in New York.   He has an excellent track record with regard to prostate cancer cure, preservation of erectile function and maintenance of urinary continence.

PSA Screening Controversy Continues

“The PSA screening controversy continues as government agencies push their cost saving agenda at the expense of the health of every day americans.”  David Robbins, MD

(Reuters) – Dr. Ned Calonge knows firsthand how hard it is to tell Americans they’d be better off with fewer routine medical tests.

A long-time family doctor in Colorado, Calonge presided over the U.S. Preventive Services Task Force, an influential government-backed panel of health experts, when it said that most women under 50 could skip their regular mammograms.

The recommendation two years ago challenged the conviction of many breast cancer patients that they survived precisely because they were screened early. It unleashed a public fury that has weighed on the panel’s deliberations ever since.

“We blew the message,” said Calonge, now president and CEO of the Colorado Trust foundation. “The nuance was completely gone.”

Two men phoned in death threats to Calonge. Protesters showed up by the offices of the government agency that supports the panel, tucked away in a Maryland suburb. The furor slowed down work on a decision to limit prostate cancer screenings as President Barack Obama fought to pass his signature healthcare law and his Democratic party faced a mid-term election challenge in 2010.

“There was a lot of pressure from above to be more careful politically and orchestrate things better,” said Dr. Kenneth Lin, who at the time was an officer at the Agency for Healthcare Research and Quality (AHRQ), a Department of Health and Human Services entity that supports the panel. “Everything with the word ‘cancer’ got shoved back.”

Calonge rotated off the panel this past March after eight years, while Lin quit AHRQ late last year in protest over the delay to prostate cancer screening guidelines that were only released in October. A White House official noted that Calonge has attributed the delay in a final decision on prostate cancer screenings to scheduling conflicts.

Their experience shows just how difficult it will be to curb spiraling costs in the world’s most expensive healthcare system by determining what screenings work, based on a rigorous study of clinical evidence, and what can lead to unnecessary and risky procedures.

“More screening is not always better,” said Dr. Christine Laine, a general internist and editor of the Annals of Internal Medicine who is not part of the panel. “That message is lost in healthcare in general.”

The U.S. Preventive Services Task Force is right on the firing line. For much of its 27-year history, it helped convince millions of Americans to get screened early for disease.

Now the panel of primary care doctors, nurses and academics has reviewed a growing body of research that shows some early screening harms more people than it helps. But it has struggled to convince patients and doctors.

In the wake of the mammogram guidelines, the rate of such screenings for women aged 40 to 69 was barely changed in 2010 compared with 2009, according to the National Committee for Quality Assurance.

“We have a public health measure that we know is effective. Why is it continually being questioned?” said Dr. Carol Lee, breast imaging commission chairwoman at the American College of Radiology.

Graphic on mammograms:

Graphic on U.S. cancer rates:


The public at large is no less skeptical. A recent Gallup poll showed that nearly 60 percent of Americans believed that standard cancer screenings – including mammograms and prostate specific antigen (PSA) blood tests – were performed often enough. Thirty-one percent thought they should be conducted more frequently. Only 7 percent said they were done too often.

“It’s extraordinarily hard to give up the notion that there’s a way to protect yourself from dying from cancer… Our goal here is to make it a matter of evidence, not a matter of opinion,” said Virginia Moyer, a pediatrician from Baylor College of Medicine, who now chairs the 16-member panel.

“Our successes are measured in positives,” she said of the public’s growing awareness of screening in the last three decades. “We are just beginning to approach the negatives.”

Burned by the experience with mammograms, the task force is looking for a better way to deliver the message, consulting with powerful consumer interest groups, hiring public relations professionals and reworking some of the language tied to its system of letter-based recommendations.

“We’re spending more time paying attention to how we say things to make sure it’s understood well,” said long-time panel member and current co-vice chair Dr. Michael LeFevre, a professor of family medicine at the University of Missouri School of Medicine. “We have no interest in being some wizard behind the curtain.”

The panel now issues its recommendations in draft form first and solicits public comment before making them final. In about a year, the public may have a chance to chime in early on the evaluation process, including posing questions for researchers and reviewing the evidence report draft used by the panel.

Task force officials concede that the comments are unlikely to change the recommended letter grade, unless they introduce crucial new evidence. But they can point to misunderstandings and help the panel better craft its message.

In late October, the panel met with consumer interest groups, including retired persons lobby AARP and the Consumers Union, to get input on how to frame recommendations that was once reserved for patient advocates.

The public’s participation has been unprecedented. The panel is now finalizing its PSA prostate cancer recommendation and public comments on the subject have reached into the thousands, LeFevre said.


The 2009 mammogram guidance from the task force was based on the panel’s assessment of new research that showed most women over 40 face a 3 percent risk of dying from breast cancer if they have not been screened. Beginning mammogram screening at age 50 and following up every other year reduced that risk to 2.3 percent, compared with 2.2 percent risk starting at age 40.

An extra decade of screening could invite harms such as unnecessary biopsies and tests, the possible treatment of non-deadly cancers and radiation. Women in their forties are also more likely to receive false positive results.

Another view of the data showed that starting screening at age 40 led to 5,000 more mammograms, 500 false positive results and 33 biopsies for every breast cancer death prevented, according to LeFevre.

“If it was just how many deaths do you cause versus how many deaths you prevent, that would be too easy, that would be simple math,” LeFevre said. “We start with somebody who feels well, and we risk making them feel worse.”

The panel voted on a “C” recommendation, which calls for patients to decide on the screening with their doctor. But when the recommendation came out in November 2009, it started with a sentence saying the panel “recommends against” routine mammograms for most women under 50, and that language triggered the controversy.

Under pressure, the task force dropped the phrase “recommends against” a month later. Its rating on mammograms remains a “C.”

The American Cancer Society questioned the evidence, saying the panel focused on gold-standard clinical trials but weeded out newer observational studies that showed better results.

“Screening is not perfect and it’s not error-free, but the question is… do you take protective measures against the unlikely probability that you develop cancer… or do you take your chances?” said Robert Smith, director of cancer screening at the ACS.

That calculation still appears to be guiding doctors, either out of concern of missing an early sign of disease or fear of lawsuits, health experts said.

“Shared decision-making (between doctors and patients) sounds nice, but in practice usually you just end up doing the test,” said Dr. Roger Chou, an internist and researcher at the Oregon Evidence-Based Practice Center. Chou authored the report on prostate cancer behind this year’s task force recommendation.


The heat over mammograms weighed on deliberations over prostate cancer screening. In 2008, the task force gave an “I” recommendation on the PSA test in healthy men under 75, which meant it had insufficient evidence to make a call.

The panel usually updates its recommendations every five years, but new research published in 2009 warranted an earlier evaluation. One U.S. study showed a slightly higher risk of death for men with no symptoms of illness who received a PSA test, while European research showed a slightly lower risk of death.

Although the PSA blood test itself is innocuous, data reviewed by the task force also showed that 90 percent of American men who tested positive got treated, even if they may have been able to forego it, LeFevre said. Out of 1,000 men treated, five would die, 70 would have serious complications and 200 to 300 would be impotent or incontinent.

Given the possibility of false positives in the screening and the fact that prostate cancer can take many years to progress and show symptoms, the question is whether those risks are greater than the risk of doing nothing.

“It looks like your chance of being alive and well is greater if you don’t get screened than if you do get screened,” LeFevre said.

In November 2009, task force members voted on a stronger “D” rating on PSA tests, meaning they recommended against the prostate cancer screening in men under 75.

But the timing was poor as Obama struggled to win over a majority of lawmakers for his healthcare overhaul and Congressional elections loomed large. Once the law was passed in March 2010, it brought more attention to the task force by mandating insurance coverage of services it does recommend.

Republicans opposed to the bill used the mammogram example to show how government could intrude on life or death decisions. The task force’s “C” and “D” recommendations don’t dictate insurance coverage, but Congress quickly turned around legislation to make sure insurers covered mammograms for women in their forties.

“The thought that my work was being use as a fulcrum by one party to kill the most substantial part of healthcare legislation since I’ve been in practice? I’ve got to tell you, that’s something to lose sleep over,” Calonge said.

Officials working with the panel heard that more controversy could threaten the task force budget, up for Congressional approval. In 2010, Health Department funding for the panel was $4.3 million. This year, the agency overseeing the panel spent about $11 million on work related to the task force.

Calonge says the panel wanted more evidence of how the tests could harm healthy patients, and ordered further research. He canceled a new vote on PSA screenings in November 2010, citing scheduling problems, a decision that was widely criticized.

“In my heart of hearts I’d really like to believe that we’d delay it anyway,” without the surrounding politics, Calonge said. “We were trying to make the recommendations solid.”

That was too much for Lin, who believed the evidence was already enough to show the public was at risk. After talking with his pastor and his wife, he quit AHRQ.

“Even delaying it for a few months, much less a year, it was really relegating the men to the harms they were exposed to,” Lin said.

(Editing by Michele Gershberg, Ed Tobin and Claudia Parsons)

Robotic Prostate Surgery for the Treatment of Prostate Cancer

What is da Vinci Prostate Cancer Surgery?

Prostate cancer surgery has been revolutionized with the use of the da Vinci robotic surgical system. Da Vinci Robotic Prostatectomy is a minimally invasive option for prostate cancer treatment available thanks to cutting edge breakthroughs in surgical technology. Da Vinci robotic prostate cancer surgery maintains all of the benefits of definitive surgical treatment for prostate cancer while adding the benefits decreased blood loss, less pain and more rapid return to regular activities and a shorter hospital stay.  For these reasons it is clear why da Vinci robotic prostate cancer surgery has become the preferred method for removal of the prostate after early diagnosis of prostate cancer.

About Dr. David Robbins

Miami urologist David Robbins, MD is a board certified urologist and is the director of the robotic surgical program at Urological Consultants of Florida. He has a special focus in prostate cancer having trained under the guidance of world renowned prostatectomy surgeon and pioneer in the field of nerve-sparing prostate cancer surgery Dr. Herbert Lepor. He refined his techniques of nerve-sparing prostatectomy for prostate cancer during his time at NYU and is now recognized by his colleagues and patients as one of the best prostate cancer surgeons performing da Vinci robotic prostatectomy surgery in greater Miami region. Dr. Robbins is currently performing da Vinci robotic prostate cancer surgery on a weekly basis with excellent results with respect to maintenance of erectile function, urinary continence and most importantly cancer cure. Dr. Robbins is currently perfoming da Vinci robotic prostatectomy procedures for prostate cancer at Mount Sinai Medcial Center in Miami Beach and Aventura Hospital and Medical Center in Aventura.

Why Choose Dr. David Robbins?

Miami urologist Dr. David Robbins trained at New York University and learned how to perform robotic surgery from world leaders in the field of prostate cancer surgery and da Vinci robotic surgery. This specialized training in robotic prostate cancer surgery along with Dr. Robbins’ intense drive toward improvement has helped him to develop the skills necessary to provide patients with the highest quality robotic surgery outcomes espcecially with regard to prostate cancer cure, urinary continence and maintenance of erectile function. In addition to patient satisfaction with the functional aspects of robotic prostate cancer surgery, Dr. Robbins is highly appreciated by his patients for the personal care that he delivers and his genuine compasion. For these reasons, Dr. David Robbins is considered by many to be the best urologist specializing in robotic prostatectomy surgery and prostate cancer treatment in Miami, Florida.

Why Robotic Surgery?

During open “radical” prostatectomy (removal of the prostate) for prosate cancer, the prostate is removed using a large midline incision from the umbilicus to the pubic bone. The major drawback of this approach is not only the size of the incision but also the stretching of the abdominal muscles and skin that is necessary to place a retractor to gain the appropriate visualization in order to perform an open prostatectomy. This large incision can take longer to heal and results in increased post operative pain and impaired mobility. One of the many advantages to da Vinci robotic prostatectomy for prostate cancer is that is can be performed through five tiny incisions and the prostate removed through the umbilicus at the end of the procedure. This leads to less post operative pain and scarring and a quicker return to regular activities. Additionally, the view of the surgical field afforded by the 3D stereoscopic display means that the surgeon has a much clearer view of the nerves and blood vessels surrounding the prostate which helps to minimize blood loss and reduces the risk of damaging the nerves responsible for continence and erectile function. During da Vinci robotic prostatectomy for prostate cancer, the prostate gland and seminal vesicles are separated from the bladder and urethra and then these two structures are reconnected over a foley catheter to maintain a contained urinary channel. For advanced disease the pelvic lymph nodes can be sampled to verify that the disease has not spread beyond the prostate.

What is the “robot”?

The robot itself consists of two units. The Patient-side cart has four robotic arms for carrying out the surgery; one arm holds a camera and the other three hold instruments. The surgeon sits at a console with a stereoscopic 3D view of the operating field. Unlike a conventional (2D) screen, this allows the perception of depth which makes accurate surgery much easier. Beneath the display are the master controls which translate the surgeon’s hand movements in real-time to the movement of the robotic arms and instruments. The system is designed to remove tremor and allow very precise movement.

Patient Testimonials

“I was diagnosed with prostate cancer in November 2010. On February 15, 2011, I registered at Mt. Sinai Hospital for robotic surgery to be performed by Dr. David Robbins and his team. Deep inside, I was expecting the worst. These were the results: 1) Pain – No pain (Percocet was prescribed. Didn’t have to use any). 2) Overall Discomfort – The same night of the surgery I walked the hallway on my hospital floor. 3) Incontinence – After the catheter was removed I used pads for a few days. Not saying that every once in a while I got a little wet, but three weeks after the surgery it was 95% under control. Today, fine and dandy. I thank the Good Lord for delivering me into the gifted hands of Dr. Robbins. An event that causes so much distress because of the obscure, turned out to be a positive, very bearable life changing experience.” DR. ROBBINS’ EXPERT ROBOTIC TEAM Please click here to download and print a copy of Dr. Robbins preoperative and postoperative instructions for da Vinci robotic prostatectomy. Please click here to link to additional information from Intuitive Surgical regarding da Vinci robotic prostatectomy.

Prostate Cancer Surgery Miami

“This is another article which highlights the debate over PSA screening for prostate cancer.  It seems that although the US Preventative Task Force has decided unilaterally to recommend against PSA screening, government officials including President Obama and Senator Wyden have chosen to ignore the recommendations and have their PSA screened.  Senator Wyden additionally underwent surgery after being diagnosed with prostate cancer.”  David Robbins

The politics of prostate cancer

  • Sen. Ron Wyden walks to the Senate floor on Capitol Hill. | AP Photo
Sen. Ron Wyden chose surgery for prostate cancer over ‘active surveillance.’ | AP PhotoClose
By DIANE WEBBER | 12/21/10 4:40 AM EST

Sen. Ron Wyden had surgery for prostate cancer Monday, putting himself — through no fault of his own — in the middle of a debate about diagnosis, treatment and bending the cost curve.

The longtime health care advocate and Oregon Democrat was operated on by Alan Partin at Johns Hopkins Hospital in Baltimore. The cancer was caught early, and Wyden, 61, has an excellent prognosis, according to his office.

The option known as “active surveillance” (formerly “watchful waiting”) allows patients to avoid or delay surgery, radiation and chemotherapy — and the side effects that come with those treatments. Active surveillance means coming back to the doctor on a regular schedule for a blood test and examination to see if the cancer is growing. But few men choose it.

Wargo discusses active surveillance with her patients, and she considers it a good option for those who fear surgery or have other serious health problems. She is on board with the new nomenclature. “Watchful waiting sounds like you can just go disappear and not come back to see me,” she said. But she understands why many men choose surgery. “There is a personality of men who can’t live with the idea that there is something inside them that could kill them.”

Bruce Quinn, M.D., health specialist with Foley Hoag and a former official in California’s Medicare program, pointed out that, over a five-year period, active surveillance doesn’t save significant funds, because the slow-growing cancers often become aggressive and require more expensive, invasive treatment.

“It’s not the difference of $100 versus $30,000 if you look at the cost comparisons over five years. Active surveillance is more costly than people think,” said Quinn. “It’s not popular, I think, because patients must find it pretty uncomfortable to be told they have a 2-to-3-centimeter tumor that could eventually blow up and kill them, and we’re just going to watch it. Men say, ‘Just get the damn thing out!’”

Wargo and Quinn both noted problems with the prostate-specific antigen test that is the screening tool used for diagnosis. A normal level in one individual might be abnormal in another, and doctors need to track changes in the level over time to approach any kind of accuracy.

“You really have to look at each patient individually,” said Wargo. “A PSA level of 4 is normal in an older patient, but it is completely unacceptable in a 47-year-old. You can have a low level and still have aggressive prostate cancer.”

Complicating matters is the fact that no test accurately predicts who will get the aggressive, deadly form of the disease and who will get a slow-growing, non-life-threatening form. Quinn points to Medicare reimbursements as part of the problem.

In choosing surgery over what used to be called “watchful waiting,” Wyden took a path that many men take when faced with a prostate cancer diagnosis. But increasingly, that path is questioned in the era of health care reform, as cost-cutting is pitted against personal choice.

Doctors acknowledge that the cost-cutters have a point but bristle at the intrusion into the physician-patient relationship.

“It is well and good for statisticians to say, ‘This is the patient who doesn’t need to be treated,’” said Heather C. Wargo, a urologist practicing in Mount Laurel, N.J. “But when I am sitting with a patient, looking him and his spouse in the eye, it is very difficult to say, ‘I’ve been accused of overtreating, so I’m not going to treat you.’”

The U.S. Preventive Services Task Force, the body that sparked a firestorm when it said that most women do not need an annual mammogram until age 50, was set to vote on new prostate-cancer-screening recommendations last month. Instead, the panel canceled its November meeting, citing “scheduling conflicts.”

Kenneth Lin, professor and family physician, quit the task force in protest. “Politics trumped science this time, as it has in the past, and may at times in the future,” Lin wrote in his blog, where he linked to a news account of the mammogram controversy.

Rep. Debbie Wasserman Schultz (D-Fla.), who had breast cancer, told POLITICO that the task force “seems out of touch with reality.”

“I think that organization really undermines its credibility, not necessarily among the scientific community but for the general public,” Wasserman Schultz said, noting that there were no cancer experts on the panel when the breast-cancer-screening recommendations were made.

Yet statistical analysis like the task force’s research has some of the greatest potential to save money on health care spending.

Prostate cancer is ripe for study. Researchers question whether it is being overdiagnosed and whether too many surgeries are being performed on tumors that would never become dangerous.

“The Medicare fee schedule is around $20 for the PSA test, and it is just frozen there,” said Quinn. “It’s really hard for companies to do the trials that they need to do to come up with a more effective, more precise prostate cancer test with this artificially very low fee.”

Mara Aspinall is CEO of On-Q-ity, a company working on new diagnostic tests that have the potential to identify rare cancer cells circulating in the bloodstream, long before they are prevalent enough to be picked up as tumors on MRI and CT scans.

Aspinall said the Medicare fee schedule is a problem for her new technology. “In the laboratory, the more steps your process has, the more you’re paid,” she said. “This was a useful construct some time ago, but it has not kept pace with technology. We now can have one really big step to replace 10 small ones. It’s an incredible disincentive.”

While Aspinall argued that better diagnostic tests could bring more clarity and potential cost savings to prostate cancer treatment, she emphasized that tests can’t replace the doctor-patient dialogue.

“It is essential that the decision on how to proceed — even in the era of diagnostics — needs to continue to be an educated discussion between the physician and the patient,” said Aspinall. “We want to bring more information to the equation.”

Wyden will no doubt be helpful in bringing more information to the equation as he recovers from his disease. He started working on public health issues as a young lawyer when he founded a legal aid society for the elderly and Oregon’s first chapter of the Gray Panthers. During health care reform, he was the architect of the Healthy Americans Act, which would have radically changed health care from the employer-based system, and now he is co-sponsoring a bill that encourages states to innovate on reform implementation.

“If anything is taken away from my experience, I hope it is the importance of getting routine physicals,” Wyden said as he was disclosing his disease last week. “One in six men will be diagnosed with prostate cancer during their lifetimes. Early detection is critical to catching this disease when treatment is most effective.”

Mustaches and Prostate Cancer?

‘Movember’ gets hairy, for a cause


By Emily Smith, CNN
updated 9:13 AM EST, Tue November 1, 2011


Neil Van Helden, right, proudly displays his mustache at last year's Movember event at Johnny's Hideaway in Atlanta.
Neil Van Helden, right, proudly displays his mustache at last year’s Movember event at Johnny’s Hideaway in Atlanta.


  • During November men grow mustaches to raise money for men’s health issues
  • Movember, a nonprofit group, lays out specific rules on how to maintain your mustache
  • Chicago, America’s most mustache-friendly city, will hold the 5th annual ‘Stache Bash

(CNN) — A word of warning: You might notice a few more unshaved upper lips proudly displayed by men in the next few weeks.

Don’t worry, it’s not males the world over being lazy. They’re actually growing that Fu Manchu for a good cause.

During Movember (the month formerly known as November), men around the globe grow mustaches (hence the name) while raising money for men’s health issues. Movember started in Australia in 2003. It has spread from down under to South Africa and Europe, and five years ago it reached American shores.

This will be the fifth year Sydney native Neil Van Helden has participated in the global charity event. Van Helden came to the United States two years ago for work and said he is just like any other guy.

Submit your Movember photos to iReport!

His reasons for joining the Movember movement are simple: “I had family members deal with prostate cancer and friends with depression issues. … There’s not a whole lot out there in terms of support for men with charities. It’s not talked about that much.”

He said men in general aren’t good at committing to regular health screenings. “We’re pretty terrible at it.”

But before you sign up and start growing a ‘mo all willy-nilly, there are rules for this sort of thing, as laid out by the nonprofit group.

First and foremost, the registered participant must start November 1 clean-shaven.

Second, you need to maintain your mustache: Grooming is key.

There are also rules pertaining to gentlemanly behavior, as well as rules preventing the mustache from touching one’s sideburns (as this is a beard) or joining the mustache’s handlebars to your chin (as this is a goatee).

The goal is to get your friends to donate money to your Movember cause, which is then donated to the Prostate Cancer Foundation, LiveStrong and other men’s health research and awareness programs.

So far Americans have raised $7.5 million for Movember. Worldwide, participants have raised $174 million, which, according to Movember, makes the group the largest nongovernment funder of prostate cancer research in the world.

According to the American Cancer Society, one in every six men will get prostate cancer during his lifetime, and one in every 36 will die from the disease. Behind lung cancer, prostate cancer is the second leading cause of cancer death in men.

Van Helden got some interesting looks when he started growing his stateside ‘stache.

“It’s a lot bigger thing in Australia. Every second guy has a mustache. Everyone applauds it,” he said.

With a chuckle, he added: “Back home, the ladies like it when you have a mustache growing in Movember. Here, not so much.”

First-time mustache grower Michael Erickson is excited about his friends’ reaction to his new facial hair. He has never grown a mustache and was prompted to join Movember by some Twitter buddies. The “marriage of social media and Movember is perfect,” said Erickson, who is actively involved in social media in his job as director of marketing for a popular restaurant group in Atlanta.

For Erickson, Movember kills two birds with one stone. “I wanted to help bring attention to men’s health issues, which is something, I believe, that doesn’t get the attention it deserves. Plus, I always wanted to try to grow a mustache.”

Like most men, he recognizes that he doesn’t go for health screenings as often as he should. “That’s another reason I’m doing this: to make a commitment to myself to take better care of my own health.”

At the end of the month, parties are held around the globe to celebrate those “who sacrificed their upper lip for the month.”

Men dress up as famous mustache-sporting characters, such as the Village People. Van Helden went as Sherlock Holmes last year– complete with tweed and his pants tucked into his socks. He likes that “everyone (there) has something in common. You’re all there for a good cause.”

‘Stache soirees have grown in popularity, prompting the fifth annual “Stache Bash,” put on by the American Mustache Institute. This year the bash will be held in Chicago, which was deemed to be America’s most mustache-friendly city.

The event also benefits LiveStrong and the Prostate Cancer Foundation. The facial hair advocacy group has been around since 1965 and touts itself as “committed to battling a demonstrated discriminatory culture against people of mustached American heritage” by “promoting the growth, care and culture of the lower nose forest.”

All jokes aside, the American Mustache Institute and Movember hope to raise awareness about an often less thought about issue, men’s health.

So, if you happen to see more mustaches in November, don’t give that person a funny look. Instead, think about donating to their hairy cause or at least be inspired to get a health screening.