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Saturday, January 31, 2009

Blog Updates for January 2009

Jan 31. In Advice to the Newly Diagnosed we added: Also see this January 2009 study [PMID: 19054189] and Medical New Today summary which found that for patients with Gleason Score 7 or less (59.1% of the patients) that survival was not substantially worse than men without prostate cancer.

Jan 19. In the Historical Developments Dr. Donald Gleason, developer of the Gleason Score, dies Dec 28th. See LA Times

Jan 19. In PSA Screening and Early Detection. Part 3. Current Environment we added: "The American Cancer Society recommends that health care providers discuss the potential benefits and limitations of prostate cancer early detection testing with men and offer the PSA blood test and the digital rectal examination annually, beginning at age 50, to men who are at average risk of prostate cancer and who have a life expectancy of at least 10 years. Those men who indicate a preference for testing following this discussion should be tested. Men at high risk of developing prostate cancer (African Americans or men with a close relative diagnosed with prostate cancer before age 65) should have this discussion with their provider beginning at age 45. Men at even higher risk (because they have several close relatives diagnosed with prostate cancer at an early age) should have this discussion with their provider at age 40." ACS 2009

Jan 11. In Advice to the Newly Diagnosed we added: Unfortunately even papers in leading medical journals can be misleading. The abstract of a paper [PMID: 18801517] in the Journal of Urology (one of the top urology journals) indicated that the relative risk of developing bladder cancer among those with external radiation for prostate cancer was 1.42 times that of the rest of the population, i.e. 42% higher; however, the risk of bladder cancer in the population is low so the absolute risk may only be a few percentage points. By only citing relative risks a very misleading impression is given even though the data presented may be accurate. See Radiation risks associated with Prostate Cancer for a better presentation. In PC Infolink the writer point out that the authors of the study were from a urology department (where surgery, not radiation, would be done) and wonders: "if a similar study carried out by members of a department of radiation oncology might have reached a different conclusion that emphasized the occurrence of erectile dysfunction and incontinence! Caveat emptor."

Jan 5. In Testosterone Metabolism and Prostate Cancer we added: Summarizing the situation, Judy Foreman writes in the January 5, 2009 Boston Globe that: "In 2006, Morgentaler cowrote a study on 345 men with low testosterone. The study - published in the journal Urology and not industry funded - showed prostate cancer risk was higher in men with the lowest testosterone, a finding supported by a handful of other small-scale studies using human subjects. That was contrary to findings suggested by the Physicians' Health Study in 1996, a discrepancy doctors can not fully explain." On the other hand, another view expressed in the same article was: "To say that testosterone replacement therapy is safe because we have no evidence it's harmful is making an assertion on faith, not facts," said Dr. Ian Thompson, chairman of the department of urology at the University of Texas Health Science Center at San Antonio, echoing the view of other doctors who disagree with Morgentaler." Morgentaler has written a book "Testosterone for Life".

Jan 2. In Advice to the Newly Diagnosed we added: In particular, the absence of randomized trials should not be confused or equated with the absence of evidence (something that presentations which attempt to "simplify" the situation often do). As the authors of one critique write:
We are saying that a systematic review purporting to give an "evidence-based review" of the cardiovascular effects of n-3 fatty acids should not conflate an absence of well-controlled trials examining cardiovascular effects of ALA with an absence of evidence that ALA has any benefits for the cardiovascular system.[link]

Jan 2. In Can Most Studies be Wrong we add: Publication bias can be detected in meta analyses using funnel plots. See [link].

Jan 2. In Advice to the Newly Diagnosed we added: The FDA attempts to regulate health care advertising but its a very difficult task.

Jan 2. In Bradford Hill Criteria of Causation we added this reference to personalized medicine: [NY Times, Dec 29/08]

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