Report Urges More Prostate Cancer Research

September 22, 2004 08:47:40 PM PDT , HealthDay

By Steven Reinberg
HealthDay Reporter

WEDNESDAY, Sept. 22 (HealthDayNews) -- A new report calls for the urgent need to improve treatments and find a cure for prostate cancer, a disease that strikes one in six American men.

The report from the Prostate Cancer Foundation was written by 24 leading researchers into the disease and is a comprehensive review of the state of the art in prostate cancer prevention, diagnosis, treatment, and research.

"There is lots of information available about prostate cancer," said foundation senior vice president Gregg Britt. However, he added, it is difficult for laypeople and physicians to make sense of all the new data.

The goal of the report is also to set out what needs to be accomplished in treatment and research, Britt said.

"The report is a wonderful compilation of some of the most up-to-date research in prostate cancer," said Dr. Durado Brooks, director of prostate cancer at the American Cancer Society. "It also raises some very important issues in terms of where we need to be heading in diagnosis and long-term care for men with prostate cancer."

The highlights of the report include the need for specialists to coordinate care. "Outside of academic centers, that is not the norm," said Dr. Anthony V. D'Amico, a professor of radiation oncology at Brigham and Women's Hospital in Boston.

In addition, because of the recent debate on the effectiveness of prostate specific antigen (PSA) as a marker for the cancer, the report calls for new and better diagnostic methods to maximize early detection of the disease.

"We know that with PSA screening, cancers are detected early. Whether that prolongs survival is not known," D'Amico said. The value of PSA testing may be in how it changes from year to year, he added. A rapid, larger change in PSA over a year may be more significant than any single PSA level, D'Amico said.

"There is no argument that we need something that is more specific than PSA, that gives us a greater level of the prognosis of the disease," Brooks said.

The goal of the foundation's report is to find a better way of detecting cancer early while avoiding unnecessary biopsies and treating cancers that do not require therapy, the report said. Also needed are better ways of determining which cancers are fast-growing and aggressive and need aggressive treatments, as opposed to slower-growing cancers that may not affect patients during their life.

The foundation also calls for better treatment for prostate cancer patients and better data about survival rates associated with various therapies and common side effects.

Specifically, the report recommends further research on androgen-deprivation therapy, which is an accepted treatment for advanced prostate cancer. But when it should be started is still unsettled, as is its use with other therapies.

In addition, the report says that developing treatments for high-grade prostatic intraepithelial neoplasia, which is believed to be a premalignant precursor for prostate cancer, may be an approach that will prevent or delay cancer.

Moreover, for patients whose cancer has spread to the bones, zoledronic acid has been shown to reduce bone complications. But, according to the report, new practice guidelines are needed in its use.

The foundation is calling on the U.S. Food and Drug Administration to approve drugs more quickly. And it seeks more clinical trials with increased patient enrollment. "Unfortunately, only a minuscule portion of men who have advanced stage disease are ever offered the possibility of enrolling in a clinical trial," Brooks said.

D'Amico said the FDA is considering using changes in patients' PSA levels in deciding whether a new drug is beneficial to those with aggressive prostate cancer, and making the drug available early to these patients.

Brooks said there has been an improvement in the past decades in the survival of prostate cancer. "This can be attributed to improvements in therapy," he said.

"This has come about because of a wealth of information that has connected changes in PSA with outcome, particularly in poor-risk patients who have a very bad PSA profile after surgery or radiation," D'Amico said.

"We are finally getting to the point where we have effective systemic agents for prostate cancer," D'Amico said. "This message is hopeful, because in the not-too-distant future we will have answers to what the best treatment is for men with prostate cancer."

More information

Learn more about the disease from the Prostate Cancer Foundation.

New Clue to HIV Dementia Found

September 23, 2004 06:03:00 AM PDT , HealthDay

THURSDAY, Sept. 23 (HealthDayNews) -- A key mechanism in the brains of people with HIV dementia has been identified by scientists at the U.S. Department of Energy's Brookhaven National Laboratory.

The study found that people with this condition have decreased levels of the neurotransmitter dopamine. The finding may help lead to new treatments for HIV dementia, a cognitive decline that's common in the later stages of HIV infection.

"Our results offer the first evidence of dopamine terminal injury -- specifically, injury to dopamine transporters -- in HIV dementia patients," study author Dr. Gene-Jack Wang said in a prepared statement.

"This suggests that a decrease in transporters may contribute to the disease process. We believe our findings also indicate a new direction for treatment," Wang said.

He and his colleagues used positron emission tomography (PET) to scan the brains of 15 people with HIV, including some with symptoms of HIV dementia.

The study appears in the September issue of Brain.

More information

The American Academy of Family Physicians has more about dementia.

Health Tip: Oral Piercing

September 23, 2004 06:03:00 AM PDT , HealthDay

(HealthDayNews) -- Piercing may be a popular form of body art and self-expression, but oral piercings can be dangerous, the American Dental Association says.

Common symptoms after oral piercing include pain, swelling, infection and increased salivary flow. Potential complications include damage to teeth, interference with speech, and scarring.

Oral piercing can also cause prolonged bleeding of the tongue, airway obstruction from pronounced swelling, or accidental swallowing of jewelry.

Mild Kidney Woes Tied to Heart Disease

September 22, 2004 02:02:31 PM PDT , HealthDay

By Ed Edelson
HealthDay Reporter

WEDNESDAY, Sept. 22 (HealthDayNews) -- Kidney disease so mild that a person might not notice it can still increase the risk of heart disease, stroke, and even death, two studies find.

The link between kidney failure and cardiovascular disease has long been known. The two large-scale studies, published in the Sept. 23 issue of the New England Journal of Medicine, show a direct relationship between kidney function that is below normal but not severe enough to cause kidney failure and the risk of major cardiovascular problems and death.

Kidney function is described by the glomerular filtration rate (GFR), which measures the kidney's ability to remove impurities from the blood. Most people have a GFR of 100 or more, said Dr. Alan S. Go, a research scientist at Kaiser Permanente of Northern California, who led one of the studies.

That study included more than 1.1 million Kaiser Permanente adult members, calculating the rate of cardiovascular problems, hospitalizations and death associated with lower-than-normal GFR levels in a follow-up period of nearly three years.

"There appears to be a cutoff at a filtering rate below 60," Go said. "The risk really takes off below 45."

The incidence of cardiovascular problems increased steadily as GFR readings decreased, the study found. Compared to those with a reading of 60 or more, the cardiovascular risk was 40 percent higher for persons with a GFR between 45 and 59. It doubled for readings between 30 to 44 and was 3.4 times higher for readings between 15 and 29.

The death rate followed the same pattern. It was 20 percent higher for GFRs from 45 to 59, 80 percent higher for readings from 30 to 44 and more than three times higher for persons with GFRs between 15 to 29.

The second report looked at a completely different population, more than 14,000 patients who survived heart attacks. It found the same relationship, starting at higher GFR levels. The risk of death or cardiovascular events such as heart attack and stroke went up 10 percent for every 10-point drop in GFR, the study found.

The link between kidney disease and cardiovascular disease have long been established, Go said. The two most common causes of kidney disease are diabetes and high blood pressure, which are also known to be major risk factors for cardiovascular disease.

Kidney disease has its own adverse effects on the arteries, Go explained. "It leads to higher levels of inflammation," he said. "With reduced kidney function, there is a higher likelihood of blood clots. Also, blood vessels get stiffer and less flexible."

Other mechanisms are at work, said Dr. Nick D. Vaziri, a professor of medicine and physiology at the University of California at Irvine, who has done animal studies on the effects of reduced kidney function.

Vaziri has studied the effects of proteinuria, the leakage of protein into the urine that occurs when the kidney does not function normally. He found the same inflammation noted by Go, but also alterations in the way the body manages cholesterol.

"In proteinuria, the level of bad cholesterol rises and the metabolism of good cholesterol is altered," he said.

"Bad" cholesterol is the LDL form, which can accumulate in artery walls. "Good" cholesterol is the HDL form, which escorts fats away from artery walls. When kidney function declines, the altered metabolism of HDL cholesterol means that "cholesterol keeps going into cardiovascular cells but cannot get out, so the cholesterol content of the cell rises," Vaziri explained.

The lesson for people in general and doctors in particular is that "persons with risk factors such as high blood pressure or a family history of cardiovascular disease need to be screened for reduced kidney function," Go said. "If they do have reduced function, there should be more aggressive efforts to control known risk factors for cardiovascular disease, such as blood pressure, cholesterol and diabetes."

Kidney function can be measured by a readily available test for blood levels of creatinine, a muscle-derived protein that is filtered out by the kidneys, he said.

More information

An overview of the relationship between kidney trouble and heart disease can be found at the American Heart Association.