Physicians may soon be able to identify which men have a more deadly form of prostate cancer, U.S. researchers report.
More than one million prostate biopsies are performed each year, note a team from Oregon Health & Science University (OHSU). Of these, only 25 percent test positive for cancer, but another 25 percent have false negative findings, which means the test comes back negative even though it is later found that the patient does have cancer.
New research that is expected to be presented Feb. 22 at the Multidisciplinary Prostate Cancer Symposium in Orlando, Fla., may help identify which men need a second prostate biopsy after an initial negative biopsy, the Oregon group said.
"Until now, we've really had no clear and consistent method to recommend further follow-up or diagnostic procedures for men who have a negative biopsy. We have derived a simple marker, so urologists can identify who is at risk for high-grade prostate cancer," researcher Dr. Mark Garzotto, director of urologic oncology at the Portland Veterans Affairs Medical Center and assistant professor of surgery (urology) in the OHSU School of Medicine, said in a prepared statement.
For their study, Garzotto's team studied 511 men at the veterans' center who had been referred to urology clinics for suspicion of prostate cancer. All of the men had a prior negative biopsy.
The researchers found that a high prostate specific antigen (PSA) level adjusted for prostate size was an indicator for repeat biopsy. A Gleason score of seven or above was indicative that life-threatening prostate cancer may be present and a repeat biopsy is needed.
A Gleason score grades prostate cancer tissue on a scale of 2-10, based on how it looks under the microscope. Lower Gleason scores indicate that the cancer is less likely to spread, while higher scores suggest the tumor is more likely to spread.
"What we worry about is which men may have high-grade cancer. Now, we can prescribe a second biopsy for a few months later. We know that this is a judicious use for a biopsy," Garzotto said.
Pinpointing patients who need a second biopsy will not only help identify which men may have a deadly form of prostate cancer, but it could also reduce the rate of unnecessary biopsies. This is important, since prostate biopsies are costly and can result in anxiety, pain, bleeding and infection.
Advair Won't Lower COPD Death Risk: Study
Using Advair, an inhaled steroid combined with a long-acting bronchodilator, does not prolong the lives of patients with chronic obstructive pulmonary disease (COPD), but it could improve their quality of life by making breathing easier.
That's the conclusion from a large international trial that compared four different treatments in people with the progressive, debilitating lung disease.
The study compared the use of the long-acting bronchodilator salmeterol alone, the inhaled steroid fluticasone propionate alone, salmeterol plus fluticasone in combination (sold as Advair in the United States), or a placebo.
"There were no significant differences in mortality between the component drugs and the placebo treatment," said the study's lead author, Dr. Peter M.A. Calverley, a professor of respiratory medicine at the University of Liverpool and University Hospital Aintree. However, he did note a 25 percent decline in the total number of exacerbations for patients taking Advair compared to placebo, "and this was also statistically significant, better than either of the component drugs [alone]."
Results of the study, which was funded by drug manufacturer GlaxoSmithKline, are published in the Feb. 22 issue of the New England Journal of Medicine. GlaxoSmithKline sells combination salmeterol-plus-fluticasone therapy under the brand name Advair in the United States and as Seretide in the rest of the world.
COPD, a lethal combination of emphysema and chronic bronchitis, is responsible for 2.75 million deaths worldwide, according to background information in the study. Most cases of COPD -- between 80 percent and 90 percent -- are caused by smoking, according to the American Lung Association. There are few effective treatments for COPD, and most treatments cannot reduce the rates of mortality, according to the study.
For this study, the researchers recruited people with COPD from 444 centers in 42 different countries. The study participants were between 40 and 80 years old and were current or former smokers with at least a 10-year, pack-a-day smoking history.
More than 6,100 people were randomized into one of the four treatment groups for three years. The dose of salmeterol was 50 micrograms and the fluticasone propionate was given at a dose of 500 micrograms.
When the researchers looked at all-cause death rates, they found no statistically significant difference between the four groups. The all-cause mortality rate was 12.6 percent for the combination (Advair) group, 15.2 percent in the placebo group, 13.5 percent in the salmeterol alone group and 16 percent in the fluticasone propionate group.
There was some good news for those on combination therapy, however. Use of Advair reduced the number of annual exacerbations to 0.85 compared to 1.13 in the placebo group. Additionally, lung function and overall health status were improved in the combination therapy group compared to placebo.
Calverley said he wasn't sure why the combination therapy didn't affect the mortality rate when it seemed to improve overall health. He and the other authors suggested that the high drop-out rate -- 40 percent -- in the placebo group might have affected the mortality outcomes.
The researchers also looked for specific side effects, such as a possible increase in eye disorders such as cataracts, or a decrease in bone density, both of which are known side effects of long-term steroids taken orally rather than inhaled. They found no such problems with the inhaled form of steroids. There was, however, an increased risk of pneumonia in people taking combination therapy or in people using fluticasone alone.
"This [finding] was unanticipated and did not translate into an increase in the number of people dying from pneumonia," said Calverley.
"I am surprised, and I am worried [about the pneumonia findings]," said the author of an accompanying editorial in the same issue of the journal, Dr. Klaus Rabe, chairman of the department of pulmonology at Leiden University Medical Center in the Netherlands.
In his editorial, Rabe wrote that "caution in the use of combination therapy is urged because of the finding in [this] trial of an increased rate of pneumonia among all patients receiving treatment containing inhaled corticosteroids."
On the other hand, Dr. Bohdan Pichurko, chief of pulmonology at Providence Hospital in Southfield, Mich., said he was reassured that after three years of treatment, the study found no increased risk of eye or bone problems. Also, there have been some studies questioning the safety of salmeterol, but, in this population, the drug appears to be safe.
"With the exception of minor oral-comfort issues and this peculiar increase in pneumonia, this combination seems to be safe and to offer significant benefits. While the endpoint of all-cause mortality is interesting, what's immensely important to patients is that there's some improvement in airway function and improved overall health status," said Pichurko.
Rabe said that combination therapy is probably an acceptable choice for someone with severe COPD who has frequent exacerbations.
The study's authors felt that combination therapy did benefit patients. "The most important message for somebody with COPD is that combination treatment works, and that in addition to producing short-term symptom relief, it can prevent important complications and, in our view, is likely to reduce your chance of dying," said Calverley.
In another study, released online Monday and expected to be published in the April 17 print issue of the Annals of Internal Medicine, Canadian researchers tested another type of bronchodilator, tiotropium, in three different combinations -- with salmeterol, fluticasone-salmeterol, or a placebo. The study, which included 449 Canadians with COPD, found no statistically significant difference in the number of exacerbations for any of the treatments.
However, similar to Calverley's study, the Canadian team found that the addition of Advair improved lung function and quality of life and reduced the number of COPD-associated hospitalizations.
Health Tip: Symptoms of Staph Infection
Staphylococcus aureus bacteria are commonly found on the skin. But they can cause a serious infection if they enter the bloodstream through a cut or open sore, particularly among people with weaker immune systems.
Here are the most common symptoms of a staph infection, courtesy of the U.S. National Library of Medicine:
* A swollen, red, and sore area on the skin that may drain pus or other fluid. * A warm feeling around the infected area. * Fever, chills, headache, and muscle aches. * Pain in the chest. * Fatigue. * General feeling of sickness.
If you have these symptoms, see your doctor immediately.
Health Tip: Causes of Blindness
Blindness can be caused by a host of diseases and conditions, including diabetes, glaucoma, cataracts, vitamin A deficiency, leprosy, trachoma and river blindness (onchocerciasis).
The U.S. National Library of Medicine says these additional factors can lead to blindness:
* Injury to the eye, including from chemical burns, contact with a sharp or blunt object or fireworks. * Blocked blood vessels. * Complications from eye surgery or premature birth. * Conditions like Tay-Sachs disease, optic neuritis, retinitis pigmentosa, retinoblastoma and optic glioma. * Stroke. * Lead poisoning.