Dr. Peter C. Albertsen This is Me

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1. 1. www.indianexpress.com

   www.indianexpress.com/story/32 - [Cached]

   Published on: 6/15/2008   Last Visited: 6/15/2008

   Dr Peter Albertsen, a prostate cancer specialist at the University of Connecticut, explains: While 10 per cent of men 55 and older find out they have prostate cancer, the cancer is lethal in no more than 25 per cent of them.So if finasteride reduced the prostate cancer's incidence by 30 per cent, about 7 per cent of men would get a cancer diagnosis and approximately 1.8 per cent instead of 2.5 per cent would have a lethal cancer.
   
   "Finasteride might make a difference, but only in a very small subset of men," Albertsen said.

2. 2. www.nursesworldmag.com

   www.nursesworldmag.com/health- - [Cached]

   Published on: 1/17/2008   Last Visited: 2/15/2008

   "To me, this is a nightmare," said Dr. Peter C. Albertson, a surgery professor and prostate cancer specialist at the University of Connecticut."We are just feeding off of this cancer phobia."
   
   "We plan to offer the test now because we believe that some men and their physicians will want to take advantage of these findings -- knowing the test will be refined over time," Xu said.He said that the data used in the study focused on Swedish men, and further study is needed with different racial and ethnic groups.

3. 3. www.medicalcrossfire.com

   www.medicalcrossfire.com/monog - [Cached]

   Published on: 5/11/2008   Last Visited: 6/28/2008

   Panelists: Peter C. Albertsen, MD; Gerald E. Hanks, MD; Jerome P. Richie, MD; and Richard G. Stock, MD
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   Dr. Albertsen is Associate Professor and Chief of the Division of Urology at the University of Connecticut Health Center in Farmington, Connecticut.
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   "[I]t's the low percentage of free PSA that really tips the scale in favor of proceeding with a biopsy," agreed Peter C. Albertsen, MD, Associate Professor in and Chief of the Division of Urology at the University of Connecticut Health Center in Farmington, Connecticutt.Dr. Albertsen noted that, in a primary care setting, he would have repeated the PSA measurement after receiving the 3.6 ng/ml result in order to confirm the finding.Upon confirmation, he then would have requested a free PSA measurement."Typically, the percentage of free PSA is [only tested for] when you're troubled,[when the patient has a] PSA level between 4 and 10 ng/ml,though I think, in this case, it was appropriate to measure that."Dr. Albertsen added that the free PSA is especially helpful in situations where it is not clear whether an elevated total PSA level is attributable to other causes, such as prostatitis.In such cases, the lower the free PSA value, the more worried you need to be about prostate cancer, he said.
   
   Elaborating on Dr. Albertsen's comments regarding free PSA, Dr. Richie explained that "If the PSA level is greater than 10, there is enough likelihood of suspicion of prostate cancer that those patients should consider being biopsied, regardless of the free PSA value."
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   If the PSA is between 4 and 10 ng/ml, a free PSA value helps to predict the likelihood of prostate cancer.3,4 However, Dr. Albertsen noted, "It becomes more controversial when you have a PSA level of less than 4. . . . There's a lot of controversy [regarding biopsies] in the 2.5 to 4 range, especially for younger patients, and that really needs to be individualized," he said.
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   Dr. Albertsen emphasized that the patient's young age must be considered in formulating a treatment plan."The fact is, he has a 30- to 35-year life expectancy, and no one has data that extend out that far," he noted."He has a Gleason-5 tumor, which is a very favorable prognosis.The volume of tumor present is very small, as suggested by his low PSA level and the fact that only one core is positive.So the main question then becomes, 'How aggressive is this tumor likely to be?'" Dr. Albertsen decided that "even though his risk of progression is low over maybe five, 10, or even 15 years, [because he has a] 35-year life expectancy, I would probably recommend a more aggressive treatment than conservative management."7 He noted, "Being a surgeon, I'd probably recommend a radical prostatectomy as the most effective way of likely curing him, although I would certainly present all the other options such as radiation and seeds."He added, "I would mention conservative management, but quite frankly, that would be reserved for someone who is 76, not 46."
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   "It depends a little bit on what the comorbidities are, but it would probably be in the early to mid-seventies," particularly if the patient had heart disease, angina, or hypertension," Dr. Albertsen responded.However, he would push that age up if the patient was 75 years of age, in excellent health, and was still "running marathons.""But I think that, for anyone who has a life expectancy of maybe 10 to 12 years and up, no one really knows the answer to this,you could consider conservative management, but the risk is that the tumor progresses and you lose control of it."He noted, "In this particular case, since the PSA level is relatively low, you could argue [in favor of] having the patient come back every six months and tracking the PSA, seeing what the rate of change is, and possibly repeating the biopsy in two years, to see if there's been any additional tumor load."Dr. Albertsen emphasized that such follow-up is important when choosing conservative management."You don't want to just forget about the patient," he said.
   
   Dr. Hanks agreed with Dr. Albertsen that treatment is necessary for this case patient, given the long life expectancy.
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   "I would agree with Dr. Albertsen that, based on his young age and his overall good health, presumed sexual activity, etc., that the treatment of choice for this patient would be a nerve-sparing radical prostatectomy."He noted that this patient has a very high likelihood of having organ-confined disease and "with surgery, (a) you get accurate staging, and (b) you have an exact tumor marker to follow, because the PSA should then be zero and should stay zero, which would probably give him, I would say, a 90% to 95% likelihood of cure.
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   "I would agree with Dr. Richie," said Dr. Albertsen.
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   "The main driver here is the high Gleason score," noted Dr. Albertsen.
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   "I suspect he is not," answered Dr. Albertsen."That doesn't mean that it's 0%, but if you performed aggressive therapy, either by surgery or by radiation, I think he has a high probability of having a rising serum PSA within two years of that treatment."Dr. Albertsen explained that he would certainly treat the patient with hormonal therapy at some time."The big research question becomes: 'What is the relative value added by either surgery or by radiation?'" He said, "I would not perform a radical prostatectomy on this patient because I don't think it will alter his course."Rather, he said he would consider the relative value added by radiation and the associated morbidity in making a treatment decision."But quite frankly," he said, "I don't think he's curable, and the question becomes now how to best palliate [his disease].Since he has no symptoms at the present time, the question is: 'Do you delay hormonal therapy or do you start immediately?' and that leads into the controversy: 'Is there any additional life expectancy added from immediate versus delayed hormonal therapy?'" He noted, "There isn't good literature on that."
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   "The trial I'd love to see done would be hormone therapy alone versus the hormone-plus-radiation therapy, because you're balancing here the question of toxicity versus potential improvement in quality of life," said Dr. Albertsen.
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   Dr. Albertsen responded, "I think, with a radical prostatectomy, there's a high probability that he'll have margin-positive disease, so I'd be somewhat leery about offering him a radical prostatectomy."In addition, he said, "I think if you do nothing,in other words, watchful waiting,this patient is clearly likely to die from his disease."Furthermore, according to Dr. Albertsen, the patient is likely to die from prostate cancer within five to seven years if he is treated with hormone therapy alone.Therefore, Dr. Albertsen concluded, the patient's best option would be some type of combination therapy that includes radiation.