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Saturday, November 26, 2011

Blog Updates for November 2011

Nov 24, 2011. In USPSTF Draft Report so many additions and changes were made that rather than itemizing each one we ask interested readers to simply review the entire post again.

Nov 23, 2011. In Biochemical PSA Recurrence we added: Coffee. Based on a prospective analysis of 47,911 men in the Health Professionals Follow-up Study who reported intake of regular and decaffeinated coffee in 1986 and every 4 years thereafter researchers found that those who consumed coffee had a lower risk of prostate cancer and a much lower risk of lethal prostate cancer. This study was focused on first time cancer rather than recurrence although its commonly thought that the same factors affect both. Note that this is only an observational study and so is less persuasive than a randomized study with controls; nevertheless, there are a number of supporting aspects to the portion regarding the risk of prostate cancer: There was a dose-response effect for risk of prostate cancer, i.e. the more coffee that was consumed the lower the risk. The risk reduction for 3 cups or less, 4-5 cups and 6+ cups per day was 6%, 7% and 18% (fully adjusted for other risk factors). Also reductions in risk have been found for many other cancers strengthenng the conclusion, e.g. see this metanalysis of several cancers and coffee: [PMID: 21406107]. For lethal prostate cancer the risk reduction was 19%, 14% and 60% reduction for the same categories. Although the risk reduction in fatal prostate cancer was large for the heaviest coffee drinkers, there were only 12 subjects in that category (i.e. small number of observations) and strictly increasing response with dosage was not observed. See [PMID: 21586702] [Full Text] [table 2] [NY Times] [Environmental News Network]. The last link reviews the pros and cons of various levels of coffee consumption including not only prostate cancer but other diseases.

Nov 17, 2011. We added to Bradford Hill Criteria of Causation (referring to the criterion of Temporality): Nobel Prize winning biochemist Otto Warburg noted that cancer cells generate energy using glycolysis whereas normal cells use oxidative phosphorylation and it had been hypothesized that this was an adaptive response to the oxygen deprived conditions in the tumor; however, evidence since then has determined that glycolysis emerges prior to the tumor's exposure to hypoxic conditions so the adaptation hypothesis must be rejected and we must look elsewhere for an explanation. A new theory has since emerged that adpating to the uptake of nutrients rather than to energy production is the driving force. [PMID: 19460998 [Full Text] This theory is currently supported by complex computer models which show that glycolysis is implied by enzyme constraints whereas it fails to emerge in the absence of those constraints. [PMID: 21423717]

Nov 10, 2011. In Biochemical PSA Recurrence we added: One caution is that PSA doubling times from ultrasensitive assays can be substantially different from ordinary assays. For example, in [PMID: 22014796] the authors found that "Ultrasensitive prostate specific antigen doubling time was more or less rapid than traditional prostate specific antigen doubling time by more than 15 months in 244 (62%) and 35 (9%) patients, respectively." and they therefore conclude that: "Agreement between prostate specific antigen doubling time calculated using ultrasensitive vs traditional prostate specific antigen values is poor. Ultrasensitive prostate specific antigen doubling time is often significantly more rapid than traditional prostate specific antigen doubling time, potentially overestimating the risk of clinical recurrence. Until the significance of ultrasensitive prostate specific antigen doubling time is better characterized, the decision to proceed with salvage therapy should not be based on prostate specific antigen doubling time calculated using ultrasensitive prostate specific antigen values."

Nov 7, 2011. In Choosing a Surgeon - Part 2. Finding a Surgeon we added: Teaching Hospitals and High Caseload Hospitals. Patients at teaching hospitals had few complications after surgery, fewer transfusions and shorter hospital stays. Hospitals with heavy caseloads also had better results.[PMID: 21944081].

Nov 6, 2011. Patient information regarding the treatment of advanced prostate cancer can be found on here [Uptodate on Advanced Prostate Cancer] and in the references at its end most of which are also online.

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