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Prostate Cancer: What You Should Know

When Dennis Hopper died of prostate cancer at age 74, my husband asked me: “Hey, I thought prostate cancer is slow-growing and doesn’t kill men.”

Well, he’s right about it usually being slow-growing, but prostate cancer is still the second leading cause of cancer death in men. His question made me realize that there are some facts that everyone should know about prostate cancer.

Prostate cancer is very rare in men under age 40 and the incidence increases with age. African-American men are at higher risk and Asian and Latin men are less likely that white guys to get it. We don’t know why these ethnic differences occur.

Family history is important and men with an affected brother or father are twice as likely to get prostate cancer. Although genes are undoubtedly responsible, there are no genetic tests that can predict it. Some studies show obese men and men who eat large quantities of red meat and dairy products are more at risk. A vasectomy doesn’t seem to matter, nor does exercise or prior prostatitis.

Prostate cancer grows slowly and the prostate specific antigen (PSA) test or a digital rectal exam can screen for an enlarged prostate. The PSA test can be false positive for many reasons and the only way to diagnose suspected prostate cancer is by a biopsy.

The most important marker for a cancer in the prostate is the Gleason score. This grade (on a scale of 1 to 10) tells us how advanced or aggressive the cancer is. The pathologist can see if the cells are suspicious for atypical changes or are high-grade. The extent of the tumor determines the stage.

Once a cancer has been diagnosed, graded and staged, the confusing choices of treatment come into play. Because most prostate cancer occurs in older men and it is slow growing, many men choose “watchful waiting.” By following PSA tests and ultrasounds, we can determine if the cancer is growing.

For many men nothing more needs to be done because the cancer causes them no problems. For younger men or men with high Gleason scores, treatment is usually surgical removal of the prostate or radiation of the prostate gland. Radiotherapy can also occur with seed implantation of radioactive material. Hormone therapy or cryoablation is also used less often.

The Prostate Cancer Foundation and the Mayo Clinic have  more good information if you wish to delve further.

Rest in peace, Dennis Hopper. I think I’ll take a stroll down memory lane and rent “Easy Rider” again. I haven’t seen it in 40 years!

*This blog post was originally published at EverythingHealth*


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Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

***

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