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Showing posts from October, 2018

Prostate Radiotherapy Outcomes Better for African-Americans Than Caucasian Patients

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October 30, 2018 — While popular beliefs and population data suggest that African-American men are at higher risk of dying from prostate cancer than caucasian men, a new analysis of genetic data from a large prospective registry and clinical data from several randomized trials indicates that African-American patients may have comparatively higher cure rates when treated with radiation therapy. The study, which is the first report demonstrating improved prostate cancer outcomes for black men, was presented wat the 2018 annual meeting of the American Society for Radiation Oncology (ASTRO) . “Our findings suggest that African-American race is not independently associated with worse prostate cancer outcomes,” said lead author Daniel Spratt, M.D. , an associate professor and chief of the genitourinary radiotherapy program at the University of Michigan Rogel Cancer Center. “When we started this project, we had the commonly-held assumption that African-American men harbor more aggressive di

Prostate cancer symptoms: Needing to use the toilet more is one of the signs

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Prostate cancer is the most common cancer in men in the UK. It affects about one in eight men in the UK, particularly those over the age of 50. The cancer usually develops slowly, so there may be no signs for many years. When symptoms do appear, it’s usually when the cancer has grown large enough to put pressure on the urethra. Pressure on the urethra can increase the need to pee more frequently, often during the night. So if you notice you are needing to use the toilet more often, it could be a sign. However, an increased need to pee could also be a sign of other, less serious conditions, such as prostate enlargement. Prostate enlargement is a non-cancerous condition, common in men over the age of 50. It is a benign condition, meaning it isn’t usually a serious threat to health. An enlarged prostate can place pressure on the bladder, which can also lead to a more frequent urge to pee. There are also other similarities between the symptoms of prostate cancer and prost

Radiation Ups Survival When PCa Metastatic Burden Is Low

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October 30, 2018 Share this content: The 3-year survival rate was 81% for patients who underwent EBRT plus standard care vs 73% for those who had standard care alone. Prostate radiation therapy does not improve overall survival in men with newly diagnosed metastatic prostate cancer (PCa), except for those with a low metastatic burden, according to new findings from the STAMPEDE trial. Compared with patients who received standard care alone (controls), those who received standard of care plus external beam radiation therapy (EBRT) improved failure-free survival by 24% but not overall survival in men with metastatic disease. Among men with a low metastatic burden, however, the overall survival rate was significantly higher at 3 years among those in the EBRT group compared with controls (81% vs 73%). In adjusted analyses, EBRT was associated with a significant 32% decreased risk of death among patients with low metastatic burden, Christopher Parker, MD, of Royal Marsden Hospital in

Prostate Radiotherapy Outcomes Better for African-Americans Than Caucasian Patients

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October 30, 2018 — While popular beliefs and population data suggest that African-American men are at higher risk of dying from prostate cancer than caucasian men, a new analysis of genetic data from a large prospective registry and clinical data from several randomized trials indicates that African-American patients may have comparatively higher cure rates when treated with radiation therapy. The study, which is the first report demonstrating improved prostate cancer outcomes for black men, was presented wat the 2018 annual meeting of the American Society for Radiation Oncology (ASTRO) . “Our findings suggest that African-American race is not independently associated with worse prostate cancer outcomes,” said lead author Daniel Spratt, M.D. , an associate professor and chief of the genitourinary radiotherapy program at the University of Michigan Rogel Cancer Center. “When we started this project, we had the commonly-held assumption that African-American men harbor more aggressive di

Long-Term Benefit for Stereotactic Radiation in Prostate Cancer

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October 30, 2018 Share this content: Trials show high survival rates, freedom from recurrence for low-, intermediate-risk prostate cancer. (HealthDay News) -- For men with low- and intermediate-risk prostate cancer (PCa), stereotactic body radiation therapy (SBRT) seems safe and effective in the long term, according to a study presented at the annual meeting of the American Society for Radiation Oncology, held Oct. 21 to 24 in San Antonio, Texas. Amar U. Kishan, MD, from the University of California, Los Angeles, and colleagues conducted a study involving 2142 men with low- and intermediate-risk PCa who were enrolled in 10 institutional and 2 multi-institutional phase II trials of SBRT between 2000 and 2012. Patients were followed for a median of 6.9 years. Continue Reading Below The researchers found that 55.3, 32.3, and 12.4% of men had low-risk disease, favorable intermediate-risk disease, and unfavorable intermediate-risk disease, respectively. Overall, 6% of patients

Single-Port Robot-Assisted Radical Prostatectomy: First Clinical Experience Using The SP® Surgical System.

To describe the first clinical experience with the novel purpose-built single-port robotic platform after FDA approval. Two male patients diagnosed with prostate cancer amenable of radical prostatectomy underwent single-port robot-assisted radical prostatectomy with bilateral pelvic lymph-nodes dissection performed by using the da Vinci SP Surgical System (Intuitive Surgical, Sunnyvale, CA, USA). The surgeries were completed through a 2.5-cm periumbilical incision through which a GelPOINT Mini advanced access platform (Applied Medical, Rancho Santa Margarita, CA, USA) and the dedicated 25-mm multichannel port accommodating a 12 × 10-mm oval articulating robotic camera, three 6-mm double-jointed articulating robotic instruments and a 6-mm accessory laparoscopic instrument were placed. One port for the assistant was placed at the level of the para-rectal line, at the planned final site for the drainage. The primary aim was to report, for the first time in the US after FDA approval of th

J&J loses patent fight over prostate cancer blockbuster

Written by Alia Paavola | October 30, 2018 | Print  | Email A federal court in New Jersey ruled that a patent on Johnson & Johnson's highly profitable prostate cancer treatment Zytiga is invalid, clearing the way for generic competition, according to STAT. The decision was a victory for generic drug companies including Teva Pharmaceutical and Mylan, two of the generic drugmakers challenging the patent in court. The ruling follows a parallel review by the Patent Trial and Appeal Board earlier this year, which also found the patent was invalid. The patent was slated to expire in 2027. Following the Oct. 26 decision, J&J immediately announced its intent to file an appeal and seek an injunction to halt any generic launches. Despite striking down the patent, generic drug companies can't launch their copies until Oct. 31 to give the court time to weigh a preliminary injunction motion from J&J to push off generic entry until the appeals process runs its course, acc

Scientists neutralize reactive nitrogen molecules to enhance cancer immunotherapy

Immunotherapy -- harnessing T-cells to attack cancer cells in the body -- has given hope to patients who endure round after round of treatment, including chemotherapy, to little effect. For all of its promise, however, immunotherapy still benefits only a minority of patients -- a reality driving research in the field for ways to improve the relatively new approach. One method for improving efficacy is the development of bio- and activity-based markers to better predict which patients will respond to immunotherapy and identify why some don't. In a new study in the Proceedings of the National Academy of Sciences , researchers at the University of Notre Dame studying tumors in prostate cancer models found that nitration of an amino acid can inhibit T-cell activation, thwarting the T-cell's ability to kill cancer cells. "People put a lot of hope on immunotherapy, and it has worked well for some patients, but overall the number is still low," said Xin Lu, John M. and Ma

Green, Gold and Growing: Packers' players shave facial hair for prostate cancer awareness

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Please enable Javascript to watch this video MILWAUKEE -- Approximately one in nine men will be diagnosed with prostate cancer during his lifetime, according to  Froedtert and the Medical College of Wisconsin . To raise awareness, officials have called upon the "Green and Gold." In the barber chair, Lane Taylor, Green Bay Packers starting guard, and Nick Collins, former safety were in it to win it Tuesday, Oct. 30 -- kicking off the " Green, Gold and Growing " campaign. "I think I can beat Nick easily," said Taylor. "Of course me! Did you see the beard I had coming in?! It's awesome," said Collins. The Froedtert and the Medical College of Wisconsin initiative asks men to put down their razor during the month of November to raise awareness of the importance of prostate cancer screenings. If found early, prostate cancer is one of the most treatable forms of cancer, but doctors say not enough men are being screened. "These gu

Concern on prostate cancer, diagnosed men seeking late medical assistance

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COLONIAL War Memorial Hospital urologist Dr Rajeev Patel says a lot of men diagnosed with prostate cancer in Fiji will only access medical assistance when their situation is at an advanced stage. Speaking at the Movember launch at Vinod Patel in Laucala Beach this morning, he said the problem was that most people regarded men’s health a taboo in their society. “We want to create awareness for men to come earlier to be checked for prostate cancer. At the moment we are getting at an advance stage rather at an early stage, this is a concern for us,” Dr Patel said. So far, he said that he had only dealt with two men that were at the early stages of prostate cancer. “Movember is a time to get our men to be aware of their health and come early for testing. Most cases men that come to us are usually between the age ranges of 50 to 75,” Dr Patel added. Movember is an annual event during the month of November to raise awareness of men’s health issues, such as prostate cancer, testicular c

The Prostate Cancer Foundation Awards $5.5 Million to PCF Challenge Award Recipients to Advance Prostate Cancer ...

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[unable to retrieve full-text content] The Prostate Cancer Foundation Awards $5.5 Million to PCF Challenge Award Recipients to Advance Prostate Cancer ...    Prostate Cancer Foundation (press release) (blog) The Prostate Cancer Foundation Awards $5.5 Million To PCF Challenge Award Recipients To Advance Prostate ...    PR Newswire (press release) The 8 red flag signs of prostate cancer… from needing to pee at night to back pain    The Sun Full coverage https://ift.tt/2SxD8bu

Prostate cancer symptoms: Needing to use the toilet more is one of the signs

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Prostate cancer is the most common cancer in men in the UK. It affects about one in eight men in the UK, particularly those over the age of 50. The cancer usually develops slowly, so there may be no signs for many years. When symptoms do appear, it’s usually when the cancer has grown large enough to put pressure on the urethra. Pressure on the urethra can increase the need to pee more frequently, often during the night. So if you notice you are needing to use the toilet more often, it could be a sign. However, an increased need to pee could also be a sign of other, less serious conditions, such as prostate enlargement. Prostate enlargement is a non-cancerous condition, common in men over the age of 50. It is a benign condition, meaning it isn’t usually a serious threat to health. An enlarged prostate can place pressure on the bladder, which can also lead to a more frequent urge to pee. There are also other similarities between the symptoms of prostate cancer and prost

Saiba tudo sobre o câncer de próstata no Você e o Doutor desta quarta-feira (31)

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[unable to retrieve full-text content] Saiba tudo sobre o câncer de próstata no Você e o Doutor desta quarta-feira (31)    Record TV (liberação de imprensa) Full coverage https://ift.tt/2Q6McCB

Vergüenza, tabúes y machismo evitan detección oportuna de cáncer de próstata

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"De hecho, el 70% de los casos que se presentan son detectados en etapas tardías, cuando la enfermedad ya se extendió a los huesos", explicó el doctor. El oncólogo y expresidente de la Sociedad Mexicana de Oncología detalló que la mejor manera de detectar este padecimiento es a través del tacto rectal y la prueba del antígeno prostático. Algunos expertos estiman que de cada 100 mexicanos, solo cuatro aceptan hacerse un tacto rectal, debido en parte al machismo que permea en la sociedad aún en tiempos actuales. El cáncer de próstata representa un 13% de todas las muertes por cáncer registradas en Latinoamérica, con más de 85.000 muertes, y ocupa el primer lugar de incidencia en cánceres en varones. El problema, insistió, es que en Latinoamérica no existe una cultura de cuidado a la salud en el hombre. "Siempre son las mujeres las que deben estar pendientes de la salud de sus esposos, padres, hermanos o familiares", aseveró el doctor Rivera. Dijo que, en re

La cirugía robótica para tratar el cáncer de próstata

En las últimas décadas, los procedimientos quirúrgicos se han vuelto más fáciles gracias a los avances en la tecnología. Esto ha dado como resultado tiempos de recuperación más breves, menos complicaciones y estadía más reducida en el hospital. Un ejemplo es la cirugía de próstata laparoscópica y robótica realizada por el departamento de urología y riñones de Cleveland Clinic Florida. Este tipo de cirugía tiene como objetivo tratar a los pacientes con cáncer de próstata mediante el uso de dispositivos tecnológicos. En la cirugía abierta de próstata, este órgano se elimina mediante una incisión de tamaño más grande en la parte inferior del abdómen, mientras que en la cirugía laparoscópica las incisiones se hacen con agujeros que se utilizan para insertar un instrumento visualizador iluminado (laparoscopio) en la región pélvica. Esto le permite al médico exáminar y extirpar la próstata sin tener que realizar una incisión abdominal de tamaño mayor. Estos procedimientos se realizan a tr

NOVEMBRO AZUL: Alerta para o câncer de próstata

Novembro Azul é o nome do movimento internacional que busca a conscientização a respeito do câncer de próstata e da saúde masculina. Assim como acontece no Outubro Rosa, durante todo o mês de novembro existe um esforço de mídia para informar a população sobre as principais doenças que acometem a população masculina, destacando as formas de detectá-la antecipadamente e ajudando a tirar o estigma dos exames que ajudam nas rotinas de check-up médico. Abordaremos este tema no programa Fique Bem, na TV Band, sábado, às 11h30. PÍLULAS Hiperplasia prostática e câncer de próstata A hiperplasia prostática benigna, como o próprio nome diz, é uma situação benigna, ou seja, não é câncer da próstata. Os homens com próstata aumentada, na maioria das vezes, não têm sintoma algum e tão pouco precisam de tratamento. Já o câncer de próstata, na maioria das vezes, é assintomático, e sua descoberta só pode ser feita com o exame físico do urologista associado a alguns exames adicionais, como a dosagem d

Investigators unveil metastatic prostate cancer's genomic landscape

Localized prostate cancer that is diagnosed before it has a chance to spread typically responds well to surgery or radiation. But when a tumor metastasizes and sends malignant cells elsewhere in the body, the prognosis worsens. Better treatments for men with metastatic prostate cancer are urgently needed. In 2018, scientists advanced toward that goal by sequencing the entire metastatic cancer genome. The newly revealed genomic landscape includes not just the active genes that make proteins, but also the vast stretches of DNA in between them that can also be functionally significant. Most of the genomic alterations were structural, meaning that DNA letters in the cells were mixed up, duplicated, or lost. A major finding was that the androgen receptor, which is a target for hormonal medications used when cancer returns after initial treatment, was often genetically amplified. That could explain why patients often become stubbornly resistant to hormonal therapies: if the androgen recept

Scientists neutralize reactive nitrogen molecules to enhance cancer immunotherapy

Immunotherapy -- harnessing T-cells to attack cancer cells in the body -- has given hope to patients who endure round after round of treatment, including chemotherapy, to little effect. For all of its promise, however, immunotherapy still benefits only a minority of patients -- a reality driving research in the field for ways to improve the relatively new approach. One method for improving efficacy is the development of bio- and activity-based markers to better predict which patients will respond to immunotherapy and identify why some don't. In a new study in the Proceedings of the National Academy of Sciences , researchers at the University of Notre Dame studying tumors in prostate cancer models found that nitration of an amino acid can inhibit T-cell activation, thwarting the T-cell's ability to kill cancer cells. "People put a lot of hope on immunotherapy, and it has worked well for some patients, but overall the number is still low," said Xin Lu, John M. and Ma

Dr. Kearns on Choosing Treatment for Patients With Prostate Cancer

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[embedded content] James Kearns, MD, assistant professor of urology, Levine Cancer Institute, discusses factors to consider when choosing treatment for a patient with prostate cancer. When choosing an effective therapy for prostate cancer, physicians need to choose an approach that not only will prolong survival but will also help patients maintain their quality of life (QoL), says Kearns. There are many treatments available, but a physician has to choose an approach that is individualized based on each patient’s disease characteristics. He adds that it is important to remember that every action will have side effects. For example, active surveillance for low-risk cancer can delay a patient’s risk for physical side effects, such as erectile dysfunction and urinary incontinence, but can increase the anxiety associated with having cancer that is not immediately treated. Kearns notes that there have been several recent QoL studies comparing radiation therapy with surgery for the prim

J&J loses patent fight over prostate cancer blockbuster

Written by Alia Paavola | October 30, 2018 | Print  | Email A federal court in New Jersey ruled that a patent on Johnson & Johnson's highly profitable prostate cancer treatment Zytiga is invalid, clearing the way for generic competition, according to STAT. The decision was a victory for generic drug companies including Teva Pharmaceutical and Mylan, two of the generic drugmakers challenging the patent in court. The ruling follows a parallel review by the Patent Trial and Appeal Board earlier this year, which also found the patent was invalid. The patent was slated to expire in 2027. Following the Oct. 26 decision, J&J immediately announced its intent to file an appeal and seek an injunction to halt any generic launches. Despite striking down the patent, generic drug companies can't launch their copies until Oct. 31 to give the court time to weigh a preliminary injunction motion from J&J to push off generic entry until the appeals process runs its course, acc

Scientists neutralize reactive nitrogen molecules to enhance cancer immunotherapy

Immunotherapy -- harnessing T-cells to attack cancer cells in the body -- has given hope to patients who endure round after round of treatment, including chemotherapy, to little effect. For all of its promise, however, immunotherapy still benefits only a minority of patients -- a reality driving research in the field for ways to improve the relatively new approach. One method for improving efficacy is the development of bio- and activity-based markers to better predict which patients will respond to immunotherapy and identify why some don't. In a new study in the Proceedings of the National Academy of Sciences , researchers at the University of Notre Dame studying tumors in prostate cancer models found that nitration of an amino acid can inhibit T-cell activation, thwarting the T-cell's ability to kill cancer cells. "People put a lot of hope on immunotherapy, and it has worked well for some patients, but overall the number is still low," said Xin Lu, John M. and Ma

Covenant HealthCare offers free prostate screening for uninsured/underinsured men

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Covenant HealthCare will offer free prostate screening for uninsured/underinsured men. The American Cancer Society's estimates for prostate cancer in the United States for 2018 are: • About 164,690 new cases of prostate cancer. • Prostate cancer is the most common type of cancer found in American men, other than skin cancer. Prostate cancer is the second leading cause of cancer death in men, behind only lung cancer. One man in 41 will die of this disease. • Prostate cancer can be effectively treated if found early. Ninety-eight percent of men diagnosed and treated for it are still alive after 10 years. In fact, more than 2.9 million men who have had prostate cancer at some point are still alive today. One in nine men are affected by prostate cancer. It is most common in African American men over age 50 and men with a family history. It causes 29,430 deaths a year. Early detection is the best prevention. Men who are age 50-70, uninsured, or not covered for prostate screenings

Movember and Hong Kong Cancer Fund link-up: not all about the 'mo'

Since its creation in 2004, the Movember Foundation has raised almost US$830 million (HK$6.5 billion) for men’s health initiatives around the globe. Although the charity has become synonymous with people being sponsored to grow moustaches during the month of November, it plans to encourage further participation in the local Hong Kong community by linking with the Hong Kong Cancer Fund (HKCF) – and emphasising that there is more to Movember than the “mo”. “It’s not all about the moustache, as that’s very limited: it takes off half the population in terms of male and female and, for some people, it can be a challenge,” says James Carlile, 28, a volunteer ambassador for Movember Hong Kong. “Others might have beliefs or their own reasons not to grow moustaches. Movember has diversified in recent years, which has really helped not only bring it out of the expatriate community, but also in terms of gender diversification.” The students of Chinese medicine using VR to learn acupuncture Tes

Surgical treatment of post-prostatectomy stress urinary incontinence in adult men: Report from the 6th International ...

To report the recommendations of the 6th International Consultation on Incontinence (ICI) on post-prostatectomy urinary incontinence. The 6th ICI committee on surgical treatment of urinary incontinence in men assessed and reviewed the outcomes of surgical therapy and updated the prior recommendations published in 2013. Articles from peer-reviewed journals, abstracts from scientific meetings, and literature searches by hand and electronically formed the basis of this review. The resulting guidelines were presented at the 2016 ICI meeting in Tokyo, Japan. Voiding diary and pad tests are valuable for assessing quantity of leakage. Cystoscopy and/or urodynamics may be useful in guiding therapy depending on the type of incontinence and presumed etiology. Artificial Urinary Sphincter (AUS) is the preferred treatment for men with moderate to severe stress urinary incontinence (SUI) after RP. Male slings are an acceptable approach for men with mild to moderate SUI. Much discussion centers on

A Matched and Controlled Longitudinal Cohort Study of Dehydrated Human Amniotic Membrane Allograft Sheet Used ...

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Approximately 29,000 men die from prostate cancer each year in the United States. When diagnosed in the early organ-confined stage, there are multiple options for treatment depending on patient characteristics and preferences, including brachytherapy, external beam radiation therapy, or surgery. Robotic-assisted laparoscopic radical prostatectomy (RALP) has become the preferred modality of surgical treatment by most practicing urologists due to improved dexterity and visualization with equivalent oncologic and functional outcomes when compared with open prostatectomy. During RALP, there are various steps that can potentially damage or traumatize the cavernosal nerves, causing compromised potency levels postoperatively. Intraoperative stretch injury, neuropraxia, thermal damage, lateral traction on nerves, etc. are all known to contribute to decreased potency postoperatively. Interestingly, sixty-eight percent of sexually active men without prostate cancer were willing to trade in 10 %

Long-Term Benefit for Stereotactic Radn in Prostate CA

Optimal Therapy for High-Risk Localized Prostate Cancer Remains Unclear

[unable to retrieve full-text content] Optimal Therapy for High-Risk Localized Prostate Cancer Remains Unclear    Oncology Learning Network Full coverage https://ift.tt/2COV5x2

Aggressive Radiation Therapy Improves Survival in Patients with Metastatic Cancer

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A high dose of precision radiation could drastically increase the survival rates of patients with metastatic cancer, and double the time patients live without cancer growth, according to study results presented at the 60th Annual Meeting of the American Society for Radiation Oncology. A high dose of precision radiation could drastically increase the survival rates of patients with metastatic cancer, and double the time patients live without cancer growth, according to study results presented at the 60th Annual Meeting of the American Society for Radiation Oncology. Usually, metastatic disease is considered incurable, but one theory suggests otherwise. “There’s a theory — called the oligometastatic theory — that if a patient only has a few spots of cancer returning, those spots could be killed with radiation or surgery to improve their survival,” lead author David Palma, M.D., Ph.D., from Lawson Health Research Institute, explained in a statement. The phase 2, open-label multi-center

Depression Negatively Impacts Survival of Patients with Metastatic Prostate Cancer - Beyond the Abstract

Prostate cancer is the most common male urologic malignancy around the world. In Taiwan, it was also growing the number of patients with prostate cancer in recent years. Androgen deprivation therapy (ADT) has been a mainstay treatment for advanced prostate cancer for decades. However, ADT has several adverse effects such as metabolic, bone, cardiovascular and erectile function. ADT is also associated with negative mood status or depression. In this retrospective study of 1101 newly diagnosed cases with prostate cancer utilizing the Taiwan National Health Insurance Research Database. 267 /1101 (24.3%) developed depression with mean follow-up period was 8.30±3.12 years. Patients with depression were associated with an increased risk of mortality (aHR: 1.37; 95% CI: 1.04–1.80). Furthermore, patients in the metastatic prostate cancer group with depression had a significantly higher mortality risk compared to the non-depression group (aHR: 1.49; 95% CI: 1.05–2.11). This result demonstrated

Prostate cancer: UK men at risk of the disease are unaware of this important fact

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Prostate cancer is the most common cancer among men in the UK. Over 46,300 cases of the disease are diagnosed annually, with around 11,600 men dying of the disease each year. According to a survey conducted by the Proton Therapy Centre in Prague, almost 15 per cent of men over the age of 50 admitted to having no idea of how common prostate cancer is. Almost 40 per cent thought prostate cancer was less common than lung cancer. The survey included 1,000 male participants in the UK. “Much has been done to improve awareness of prostate cancer among at-risk groups, including men over the age of 50,” said Proton Therapy Centre medical director Dr Jiri Kubes. “But our research shows there is still more to be done.” Around one in eight men in the UK will get prostate cancer, with men over the age of 50 most at risk. Experts say diagnosis is most common in men between the ages of 65 and 69. Symptoms can include needing to urinate more frequently, often during the night, the nee

Lung Cancer Awareness Month shines light on second most common cancer

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By Maggie Ireland, for The Gazette November is Lung Cancer Awareness Month. While not always in the spotlight, lung cancer is a serious disease that affects more people each year than you might think. “Lung cancer is the second most common cancer in females after breast cancer, and the second most common in males, second to prostate cancer,” said Dr. Eduardo Celis, director of bronchoscopy and interventional pulmonology at Mercy Medical Center in Cedar Rapids. Although it’s the second most common cancer for men and women, it is the most deadly cancer. “To have an idea of how deadly lung cancer is, people have to understand that mortality for lung cancer is higher than breast, prostate and colon cancer combined,” said Celis, who also is director of Mercy’s intensive and critical care unit. Perhaps one of the reasons lung cancer is so deadly is the fact that it is hard to detect early. “Unfortunately, the signs and symptoms of lung cancer are very unspecific, and for this reason