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Posted 1/31/2013 6:58 PM (GMT 0)
My husband and I heard a lecture given by Dr. Ash Tewari, NYC surgeon a few weeks ago. Dr. Tewari mentioned a new trend that he is using that is being used by other local urologists. The new thing now is to give an MRI before the biopsy to determine if a biopsy is necessary and to see where the cancer is (if there is cancer). This way the urologist knows where to take the biopsy samples from. Dr. Tewari said that his patients are getting insurance approvals for the MRI's.

Dr. Tewari said that he is no longer operating on G6 cancers unless there are numerous cores of cancer, there is a high volume of cancer in the core(s) of cancer, or the patient is very young.

He is doing research on the causes of PCa, which he believes to be infection and inflammation (probably among other causes).

Dr. Tewari had some sound advice about diet (IMO).

- everything in moderation
- incorporate pomegranate and mushrooms in diet
- lots of leafy greens, lots of vegetables and fruit
- no meat, cut down on dairy
- limit sugar
- no charred foods (such as poultry)
- soy in moderation (is estrogenic so in moderation)

Post Edited (bluebird123) : 1/31/2013 1:11:40 PM (GMT-7)

Posted 1/31/2013 7:13 PM (GMT 0)
Hey bluebird-

Are Dr. Tewari's lectures open to the public? Available to view recorded online?

Is the diet advice intended to avoid getting PCa, or for the health of people already treated with surgery to maximize outcomes?

(Isn't "no meat" and "no charred meats" redundant? In what way is poultry "charred"?)

-Gedman
Posted 1/31/2013 7:23 PM (GMT 0)
(Isn't "no meat" and "no charred meats" redundant? In what way is poultry "charred"?)

meat can be charred on a grill or by broiling.  e.g., boiled meat is not charred.

ed

Posted 1/31/2013 8:17 PM (GMT 0)
My husband and I heard Dr. Tewari speak at a support group meeting at Weil-Cornell organized by USTOO. It was the first time that my husband and I attended and Dr. Tewari happened to be the speaker there.

Dr. Tewari discussed diet as an answer to a question. I edited my post to reflect what he said (I did not take notes; this is from memory). When Dr. Tewari said no meat I think that he meant no red meat. He also said no charred foods and gave poultry as an example. As F8 said, foods can be charred by over-grilling or over-broiling.

He did not specify whether these dietary recommendations were to prevent PCa or to prevent a recurrance. They probably apply to both situations.

Post Edited (bluebird123) : 1/31/2013 7:58:37 PM (GMT-7)

Posted 1/31/2013 8:34 PM (GMT 0)
Interesting. Many urologists make money from the biopsy and then from surgery.
It does sound like a personalized approach that might eliminate overtreatment in the hands of a wise doctor.
In the hands of a mercenary doctor, the MRI might be just another cost.
Posted 1/31/2013 8:42 PM (GMT 0)
Good for him!   (Dr Tewari)
Posted 1/31/2013 9:09 PM (GMT 0)
Dr. Tewari thinks that soon doing an MRI before a biopsy will be the standard protocol. My husbands friend recently went to a different urologist (not Tewari) because he had an elevated PSA. The urologist wants to do an MRI to see if he needs a biopsy.
Posted 1/31/2013 9:27 PM (GMT 0)
I think you are right; I think that the times they are a changin' .  It'll be like turning around a freighter in the ocean, but I agree with Dr Virginia Moyer, chair of USPSTF when she said that " We Can Do Better ."   The clinicians (doctors in the same role as Dr Tewari) carry some of the responsibility—and his changes are in the right direction—but it’s bigger than that.   The patient’s desire for aggressive therapy is rooted in three dimensions:   1.     The complex psychology associated with receiving a diagnosis of “cancer.”   For low-risk PC, the ball is already building up steam to eliminate the word “cancer” from many appropriate diagnosis; the final classifications to be worked out between the professional pathologists associations.   2.     The misunderstanding of the risk of progression for low-risk disease, and the misunderstanding of the survival benefits that aggressive treatments may provide.   I think that in the last several years, there have been enough well-conducted studies to shed light on this problem, too, and doctors are starting to share these results more and more with patients.   3.     The limited supportive counseling men get to consider active surveillance.   I think this is related to item 2. because many of the community doctors out in Mayberry simply don’t keep themselves up-to-date on everything.   Trickle-down will take a while.   We can do better.   We will do better.  I applaud Dr Tewari and others, and especially those within the industry who have been bold enough to be critical of their peers who have been driven by self-interests.               Post Edited (Casey59) : 1/31/2013 2:34:29 PM (GMT-7)
Posted 2/1/2013 12:00 AM (GMT 0)
I think performing a MRI before biopsy would be huge for several reasons: ·          Lessens the risk of infection from a biopsy ·          Could possibly locate cancer that a biopsy may miss ·          Avoids painful and embarrassing aspects of biopsy But how will one be prompted to get a MRI?   Because of symptoms?   Because if everyone listens to the recommendations of Dr. Moyer and the USPSTF, it won’t be via the PSA.   As the articles states, “… The panel that I chair, the U.S. Preventive Services Task Force, has just issued a recommendation against screening men of any age for prostate cancer using the prostate-specific antigen (PSA) blood test…”  I think with this recommendation, more and more men's MRI will show cancer that has already escaped the prostate because men weren't encouraged to take control of their own health.  I say that the USPSTF CAN DO BETTER and not jump to the extreme position of not screening anyone.   I agree that mass screening is not the answer, but they should change their recommendation to something similar to the experts in that field. Casey – I think there is at least one other dimension to the patient’s desire for aggressive therapy:   4.   The possibility that they have aggressive prostate cancer and are in need of aggressive therapy. Jerry   Post Edited (Jerry L.) : 1/31/2013 6:23:08 PM (GMT-7)
Posted 2/1/2013 3:35 AM (GMT 0)
JerryL., You are correct on your additional point. My earlier post (in its entirety) applies to low risk patients...I should have specified. For low risk patients, your point 4. is addressed in item 2., above in the bold text.

Post Edited (Casey59) : 1/31/2013 9:01:49 PM (GMT-7)

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