Fall Video Teleconferences

In the Fall, the AGEC jointly sponsored two video teleconferences (VTCs) with the GRECC at CAVHS and the DWR Institute on Aging at UAMS. Speakers for the first VTC, held on October 1 and titled "Breast and Prostate Cancer in Older Adults," were V. Suzanne Klimberg, MD and Graham F. Greene, MD, FACS. Dr. Klimberg focused her presentation on the use of radio frequency ablation (RFA) for the treatment of certain breast cancers. Benefits of RFA are minimized morbidity and side-effects as well as reduced costs. Problems encountered with it are incomplete pathology, mass effect, lack of assessment of complete ablation/imaging, loss of tumor banking tissue and limitations of the extent of ablation. Dr. Klimberg also discussed the use of RF or laser ablation after an excisional vacuum assisted biopsy to achieve negative margins in ≤T1c unicentric breast cancers, which decreases local recurrence of disease. She also reported results of a study that used percutaneous excision and RFA showing advantages of the procedure to be complete pathological data, possibility of imaging process with Doppler as well as obviating the need for open surgery. Disadvantages cited were the need for expert personnel, inability to use laser ablation and tumor size limitations. Training in excisional RFA is underway in Europe, Canada and 15 states in the USA. Other topics covered by Dr. Klimberg were the incidence of lymphedema, the use of intraoperative subareolar radioisotope injection for immediate sentinel lymph node biopsy (SLNB), arm drainage mapping (ARM) during SLNB to decrease the likelihood of disruption of arm lymphatics and subsequent lymphedema. Dr. Klimberg noted that the use of ARM "may represent a paradigm shift in the regional treatment of breast cancer."

…this may represent a paradigm shift in the regional treatment of breast cancer.

Graham F. Greene, MD, FACS reviewed the critical points of performing the digital rectal examination (DRE) properly. He reminded listeners that prostate size does not equal symptoms. Dr. Greene then spent time discussing the most common prostate condition, an enlarged prostate or benign prostatic hyperplasia (BPH). BPH can cause changes or problems with urination, including urgency, frequency, nocturia, and urge incontinence. One of the primary tests for BPH and Prostate Cancer (PCa) is Prostate Specific Antigen (PSA). Dr. Greene explained the PSA is gland specific not cancer specific and that there are several causes for an elevated PSA. The two drug treatment options for BPH are α-blocker or 5α-reductase inhibitors (5ARI). He spent the remainder of his time discussing PCa. Screening for PCa should start at age 40 with a baseline serum PSA and DRE and should be done every 5 yrs. if the PSA<0.6 ng/ml and annually after age 50, PSA >0.6 ng/ml or in African Americans or men with a family history. Dr. Greene closed with some general guidelines on when to refer to a Urologist:

  • Recurrent UTI
  • Abnormal DRE
  • Symptoms deteriorate with adequae treatment
  • Abnormal PSA
  • Rise in PSA > 0.50 ng/ml/year

The second VTC, held on November 5, was titled "Immunizations for Older Adults." The speakers were Gregory Zawada, MD and Naveen Patil, MD. Dr. Zawada and Dr. Patil presented the history and overview of the development of vaccines. The two doctors reviewed each of the vaccines and their recommendation for older adults:

  • Varicella (Chickenpox) - Only needed for adults without evidence of immunity.
  • Zoster (shingles) - All adults over 60, regardless of previous history of herpes zoster (shingles) or chickenpox.
  • Tetanus and Diphtheria (Td) – All adults should get Td booster every 10 years.
  • Influenza (flu) – All adults should receive either the Trivalent influenza vaccine (TIV) or the Live attenuated influenza vaccine (LAIV - trade name FluMist) every year.
  • Pneumococcal polysaccharide (PPSV) – Give 1 dose if unvaccinated or if previous vaccination history is unknown and give a 1-time revaccination at least 5yrs after 1st dose to persons over 65 years and older if the 1st dose was given prior to age 65 years.
  • Hepatitis A (HepA) – Only recommended for individuals with chronic liver disease.
  • Hepatitis B (HepB) – Recommended for persons with chronic liver disease or living in high-risk LTC facilities.
  • Meningococcal – Adults over age 55 should receive a single dose of polysaccharide vaccine (MPSV4).

The two vaccines discussed at length for older adults were the influenza vaccine and the Pneumococcal polysaccharide. Dr. Zawada stressed that the influenza vaccine prevents 70-90% of illness in adults. Dr. Patil reiterated the recommendation of a onetime booster vaccination after age 65.