IN THE PUBLIC EYE
Title: IN THE PUBLIC EYE , Urology Times, 00939722, Nov2000, Vol. 28, Issue 11
What’s on your patients’ minds? Likely, it’s what’s in the news about urology. Be prepared to answer their questions by reading these summaries of articles from consumer magazine, web sites, and other news source.
Prevent prostate cancer with diet
A report in Men’s Health states that diets rich in certain foods help prevent prostate cancer. Here are the magazine’s suggestions:
Tangerines. They contain tangeretin and nobiletinand vitamin C. Researchers found that a high-C diet may cut cancer risk by 23%.
Broccoli. A study of 1,200 men showed that those who regularly ate the most broccoli and other cruciferous vegetables reduced their risk by 41%.
Sweet potatoes and carrots. These vegetables contain 4,250 mg of beta-carotene, enough to help the body absorb all of the lycopene in tomatoes while possibly reducing risk by 32%.
Chicken. One breast offers about half of your recommended daily allowance of selenium. According to one study, men taking a selenium supplement for 4 1/2 years were 63% less likely to die of prostate cancer than those who take a placebo.
Whole wheat tortilla and beans. Both contain selenium and a heavy dose of fiber. Canadian researchers found that a diet high in soluble fiber lowered levels of PSA.
Watermelon. Like tomatoes, watermelon contains lycopene, which may reduce patients’ risk by as much as 40%. A single 1-inch slice has as much lycopene as four tomatoes.
Wheat germ. A study at the Fred Hutchinson Cancer Research Center showed that men who took supplemental vitamin E had a 20% lower risk of prostate cancer while those who took zinc daily had 45% less risk. Wheat germ is high in both.
Men’s Health
November 2000
Second-round chemo increases testicular Ca cures
High-dose chemotherapy followed by stem-cell transplantation offers new hope for testicular cancer patients who experience recurrence. For these patients, such intensive therapy can achieve a durable remission in approximately 50% of patients, according to a study conducted at Indiana University Medical Center, Indianapolis.
After an average of more than 3 years follow-up, 37 of 65 patients (57%) with recurrent testicular cancer were disease-free after receiving two rounds of high-dose chemotherapy followed by stem-cell transplantation. These results are significant, according to the study’s lead author, Lawrence H. Einhorn, MD, because if testicular cancer recurs, it often develops within a year after treatment. All patients in this study had a minimum follow-up of 16 months.
Currently, 70% of patients with the disease are cured with initial chemotherapy. This study shows that for the remaining 30% of patients who did not respond to the treatment or who later relapsed, more than half can be cured with a second round of intensive chemotherapy–bringing the overall cure rate to approximately 85%.
Intelihealth Health News
September 29, 2000
Physical activity may reduce risk of impotence
Men who exercise regularly are less likely to become impotent, according to a long-term study. Compared with men who did not exercise, men who burned 200 calories or more a day in physical activity had far less risk of erectile dysfunction.
“If you do at least that, you can reduce your risk by half,” said Carol A. Derby, a researcher at New England Research Institutes, Watertown, MA. “Men who were sedentary had the highest risk.”
Derby and colleagues studied 593 men in the nearly 9-year Massachusetts Male Aging Study. The men (age range, 40 to 70 years) completed a mail-in questionnaire about their sexual health. None reported erectile dysfunction at the start of the study. At the end, 17% did.
“Even if you were sedentary at the beginning, the men who were active at the follow-up had a much lower risk, comparable to the people who were active at both time points,” Derby said. The findings make physiological sense, said Drogo K. Montague, MD, a urologist and head of the Center for Sexual Function, Cleveland Clinic Foundation. Regular aerobic exercise fights vascular disease, including fat clogs that narrow the arteries, said Dr. Montague, who is not connected to the study.
Such clogs can impede blood flow through arteries that engorge the penis, so exercise should help to keep those arteries healthy and clear, Dr. Montague said.
Associated Press
October 2, 2000
Geography impacts choice of PCa treatment
Where Americans live can determine the surgery they receive, according to a Dartmouth Atlas of Health Care series detailed in a page 1 article in USA Today. The Atlas report has sparked debates over whether patientsget full information about their options before surgery, including radical prostatectomy. These debates are likely to continue because, despite advances in health care, the geographic variations do not appear to be changing.
The article sites a recent JAMA study by researchers from the University of Massachusetts, Boston, that looked at how urologists and radiation specialists treated early-stage prostate cancer. The study found that 93% of urologists chose surgical removal of the prostate while 72% of radiation specialists chose radiation treatment. Few physicians chose watchful waiting.
“The problem probably reflects the educational background of surgeons,” said Thomas Russell, MD, of the American College of Surgeons.
Because medical training generally emphasizes decisiveness, the article says, more aggressive, young surgeons might seek out departments with aggressive reputations.
The article notes that, across 306 hospital regions studied by the Atlas researchers, radical prostatectomy showed the second highest variation in rates (after partial mastectomy). The Hattiesburg, MS, region has a radical prostatectomy rate of 4.2 per 1,000 Medicare patients, more than twice the national average, whereas too few prostatectomies took place in the nearby Oxford region for Atlas researchers to calculate a meaningful rate.
“When I sit down with patients, I can’t show them a ream of papers, but I can give them my honest opinion when discussing a radical prostatectomy,” Martin Resnick, MD, an AUA spokesman, said in the article. “The variation exists, but I think most physicians give a fair perspective.”
USA Today
September 19, 2000
Robotic device assists in laparoscopic procedures
The FDA has approved the Da Vinci Surgical System, a device to help surgeons perform certain laparoscopic procedures, Men’s Health magazine reports. Working behind a console, physicians use hand grips and foot pedals to operate the system’s three robotic arms. Experts believe that for some procedures, the robot will give physicians more dexterity than the human hand.
Men’s Health
October 2000
PCa screening at 50 valuable, despite new study
An American Cancer Society (ACS) expert says yearly prostate cancer screeming for men aged 50 years and older is valuable, despite a new study that suggests skipping the tests some years but starting them earlier may be more effective. (See also, “Earlier, less frequent PSA screens discover PCa.” page 1.)
“This study is interesting, but it really doesn’t provide the level of scientific evidence that would stimulate us to change our guidelines.” says Durado Brooks. MD. MPH. director of prostate and colorectal cancer programs for the ACS.
The new study, published in JAMA. used a computer method known as Monte Carlo simulation to estimate the number of lives that would be saved by giving the PSA test in each of seven different patterns, including the now common pattern of annual testing for men 50 and older. The researchers find the most effective testing strategy was to start at age 40, 40, repeat the test again at ages 45 and 50, and repeat it every 2 years thereafter.
“The standard strategy of annual PSA screening beginning at age 50 years appears to be less effective and more resource intensive compared with a strategy that begins earlier but screens biennially instead of annually,” noted Kevin S. Ross, MPH, of the department of epidemiology at the University of North Carolina at Chapel Hill.
ACS News Today
October 3, 2000
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Source: Urology Times, Nov2000, Vol. 28 Issue 11, p30, 1p
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