PROSTATE CANCER
A lower PSA cutoff for African-American men?
More cases of prostate cancer in African-American men younger than age 65 might be detected if the cutoff value for serum prostate-specific antigen (PSA) levels were lowered, according to a study recently published in Cancer.
PSA is a protein manufactured almost exclusively by the prostate gland; it's normally present in the blood at very low levels. Higher-than-normal serum PSA is associated with localized and metastatic prostate cancer-a PSA level of 4 ng/mL or higher is considered suspicious.
In the Cancer study, African-American men had higher prostatectomy Gleason scores (based on the microscopic appearance of prostate cells) than white men did, even though the groups had similar PSA levels and preoperative Gleason scores. Postprostatectomy Gleason scores were upgraded (raised) in 49% of African-American men, compared with 26% of white patients. This suggests pathologic differences related to race in men who have nonpalpable prostate cancer that's been detected only by an elevated serum PSA level. The study authors don't know why this might be the case, but they plan to conduct additional genetic studies of prostate tissue to determine the cause.
In the meantime, one solution may be to lower the PSA cutoff value from 4 ng/mL to 2.5 ng/mL in African-American men. Dr. Curtis Pettaway, the principal author, believes that doing so might help detect prostate cancer in earlier stages, when a patient's prognosis may be more positive.
Source
Sanchez-Ortiz RF, et al. African-American men with nonpalpable prostate cancer exhibit greater tumor volume than matched white men. Cancer. 107(1):75-82, July 2006.
STROKE
Atorvastatin may help prevent repeat strokes
If your patient recently had a stroke or transient ischemic attack (TIA), he may be able to avoid another stroke or cardiovascular event by taking atorvastatin (Lipitor), according to results of a study recently published in the New England Journal of Medicine.
The study, called the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial, tested 4,731 patients who'd had a stroke or TIA in the previous 6 months. All of them had a cholesterol level between 100 mg/dL and 190 mg/dL; none had a history of coronary heart disease. Participants were randomized to receive either 80 mg of atorvastatin or a placebo daily.
After 4 to 7 years of follow-up, 11.2% of SPARCL participants taking atorvastatin had a subsequent stroke, compared with 13.1% of the control group-a risk reduction of 16%. Treatment with the drug also reduced the risk of patients' experiencing a major cardiovascular event by 20%.
Researchers point out that atorvastatin didn't reduce the overall mortality rate of SPARCL participants, and that the drug is associated with an increased risk of nonfatal hemorrhagic stroke. According to the data, however, the benefit to patients who've had a recent stroke or TIA outweighs these drawbacks.
Source
Amarenco P, et al.: Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) investigators. High-dose atorvastatin after stroke or transient ischemic attack. New England Journal of Medicine. 355(6):549-559, August 10, 2006.
DIABETES
New first-line treatment for type 2 diabetes
The U.S. Food and Drug Administration has approved a drug that combines metformin with rosiglitazone maleate (Avandamet) for use as an initial treatment for people with type 2 diabetes. The drug, manufactured by GlaxoSmithKline, had already been approved in 2002 for secondary treatment in patients whose diabetes isn't controllable with metformin therapy alone; now it's indicated as a primary treatment for glycemic control in conjunction with eating a healthy diet and getting regular exercise. LPN
DID YOU KNOW?
*Patients may want to avoid late-afternoon surgery, according to a recent study published in Quality and Safety in Health Care. The study reviewed more than 90,000 surgeries performed at Duke University Medical Center in Durham, NC, and found that some adverse effects of surgery-particularly anesthesia-related pain and nausea-were more common when the procedure was performed after 3:00 p.m. Shift rotations, surgeons' late-day fatigue, and administrative delays were cited as reasons for these problems. The authors also hypothesize that patients may be more susceptible to pain and nausea in late afternoon because they haven't eaten all day or may feel increasing stress at having to undergo surgery.
SOURCE
Wright MC, et al. Time of day effects on the incidence of anesthetic adverse events. Quality and Safety in Health Care. 2006;15(4):258-263, August 2006.