It can be awkward when a patient asks you about a report in their favourite tabloid detailing an amazing research breakthrough or a ‘cutting-edge’ new treatment / test and you don’t know what they are talking about! So this section fills you in on the facts.
Prostate cancer prevention: Could DAIRY foods increase the risk of disease?
The Express – 16 November 2017
Whilst making no reference to it, this story seems to have sprung from the recent publication in Prostate of the original article: ‘Milk and other dairy foods in relation to prostate cancer recurrence: Data from the CaPSURE study’. The newspaper story itself is thin on data, but is bolstered by some wise words from Professor Roger Kirby. It is probably more interesting to look at the paper mentioned above though, rather than the newspaper story. The link between dairy foodstuffs and cancer risk is nothing particularly new, there have been a string of publications describing a link between populations with a high-meat, high-dairy diet and elevated cancer risk, going back as far as the 1990s. Several papers in the 2000s focused more on the prostate cancer side of things as well. This new publication from The University of California was a prospective study of 1334 men with non-metastatic prostate cancer. These men answered a food questionnaire between 2004 and 2005 (a mean of two years following diagnosis) and were then followed up until 2016 for signs of recurrence. Recurrence was defined as bone metastases, biochemical recurrence or death. The results were interesting, >4 servings of whole milk per week (as compared to 0-3 servings per month) was associated with a 73% increased risk of prostate cancer recurrence. More striking, in men with a BMI of >27, there was a three-fold increase in risk with consuming >4 servings per week, compared 0-3 per month (p-value <0.001). As Prof Kirby is quoted in The Express, dairy products (similar to chargrilled meat) exact oxidative stress on the body, leading to DNA damage. Therefore, lowering your cheeseburger intake is a good idea. As final ‘food’ for thought though, the data from the CaPSURE study also suggests that some of the risk is mitigated by consuming skimmed milk, rather than full-fat milk. That would therefore seem to be a simple bit of advice that can be given in clinic that has a better chance of being adhered to.
How a simple urine test can now help doctors spot signs of prostate cancer with 98 per cent accuracy
The Mail on Sunday – 26 November 2017
Another issue, another urine biomarker. This particular test is available for use now via the privately funded route. The website of the company which designed this test can be found at: http://mdxhealth.com/selectmdx-prostate-cancer. Costing £225 in the UK, the test is an assay on voided urine following prostatic massage, examining for levels of DLX1 and HOXc6 mRNA. Following on from trial data, totalling 905 patients, a risk stratification scoring system has been developed to determine the likelihood of disease. As with other similar products, the appeal of such a test is understandable in comparison to a TRUS biopsy, but it is clearly no replacement. It may have a role however in reassuring the worried well or further investigating disease suspected to have been undersampled on a TRUS biopsy.
Lock, block, and one very sore barrel: Man, 31, has a lock stuck in his bladder after inserting it through his URETHRA
The MailOnline – 16 November 2017
A 31-year-old man from south-east China became world-famous in November after he inserted a small padlock into his urethra, which then migrated proximally, necessitating an open cystotomy to extract it. Regular readers of this section will be familiar with the high journalistic standards within and will of course recognise that this story has not simply been included for amusement and will certainly not have the results of a lazy PubMed search shoe-horned in to justify its inclusion on educational grounds. The largest single-centre experience of urethral foreign bodies was published in Urology journal in 2016. It details 27 patients and 35 presentations with urethral foreign bodies. The most common technique for removal was manual extrinsic pressure (54%), with open cystotomy being required in only 3% of cases. Twenty percent were expelled spontaneously with the passage of urine. Whilst the sequelae of urethral foreign body insertion could be as severe as Fournier’s gangrene, there were no incidences in this cohort, although urinary tract infection and sepsis occurred following 37% of episodes. Surprisingly, there was only one documentation of stricture formation. The take home messages would seem to be though, when confronted with cases such as these; attempt extrinsic compression if safe / feasible and give some antibiotics.
Men are gearing up for a VERY happy Christmas: Sales of erectile dysfunction drugs DOUBLE in the run up to the festive period
The Mail Online – 21 November 2017
The headline suggests that day-to-day PDEi-5 sales are being closely scrutinised in real time, but what the story is actually commenting on is the fact that sales of these drugs in November in previous years have typically spiked by 40-60%. In addition to this expected ‘normal’ annual surge as the nights close in, generic tadalafil also went on sale in November 2017, for a little over £2 per pill. Pharmacists were therefore anticipating a busy Christmas period. Presumably, Obs & Gynae will be expecting a busy period in September 2018.
