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 sections fills you in on the facts....
NHS fast-tracks drug docetaxel for advanced prostate cancer patients
The Guardian – 24 January 2016
This article celebrated the news that NHS England have now formally authorised the usage of docetaxel chemotherapy ‘up-front’ for new diagnoses of advanced prostate cancer. For those not following this story, it had been known for most of 2015 that the STAMPEDE trial (Systemic Therapy in Advancing or Metastatic Prostate cancer: Evaluation of Drug Efficacy) showed a survival advantage in giving docetaxel and standard care (androgen deprivation) to patients diagnosed with advanced prostate cancer. This news had come from conference presentations though and NHS England had been awaiting publication of the data in a peer-reviewed journal. The Lancet carried the publication in January 2016.
The published paper details the comparisons of arms A, B, C and E of the trial. Arm A of the trial contained 1184 men with advanced prostate cancer who were all randomised to receive standard-of-care (SOC), which is essentially just androgen deprivation therapy. Arm B was 593 men receiving SOC and zoledronic acid. Arm C was SOC and docetaxel. Arm E was SOC and zoledronic acid and docetaxel.
The median follow-up period for these men was 43 months. In the control group (SOC only) the median overall survival was 71 months. For the men receiving docetaxel and SOC the median overall survival was nearly a year better at 81 months of follow-up. There was no evidence of benefit from zoledronic acid at all. The benefits of docetaxel came at the expense of increased side-effects. Grade 3-5 adverse events were seen in 32% of patients on SOC alone, that figure rose to 52% when docetaxel was added. This led the authors to conclude that this treatment was for ‘adequately fit men’. NHS England’s Clinical Commissioning Policy Statement was finalised on 13 January to say that men with newly diagnosed prostate cancer, who are sufficiently fit, can start six cycles of docetaxel at the same time as ADT.
Revealed... 22 cancers that ARE inherited - as scientists discover your overall risk ‘increases 33% if a sibling is diagnosed’
The Daily Mail – 6 January 2016
This article refers to a research paper published in The Journal of the American Medical Association in January. At first glance, this research doesn’t sound as though it has much new to tell us, but it is in fact a huge and impressive piece of science. The ‘NorTwinCan’ study was a prospective study across Denmark, Finland, Norway and Sweden looking at a total of 203,691 twins (monozygotic and dizygotic / same-sex) and their cancer diagnoses between the years 1943 and 2010.
Looking at the diagnoses of prostate cancers in this cohort, when a monozygotic (identical) twin developed prostate cancer, the risk of his brother developing the same was 32%; that risk was 16% if the twins were dizygotic (non-identical brothers).
This information, compared to the overall cancer risk in the cohort as a whole, allowed the researchers at Harvard to calculate an estimate for which genetics contribute to the development of prostate cancer. That figure is 57%. This means that, according to their calculations, rather than diet, exercise, sex-life, toxins etc., the lion’s share of the blame for prostate cancer developing goes to the patient’s genes. Of note, this was the second highest ‘heritability risk’ of all the cancers (melanoma was 58%). The heritability risk for renal cancer was 38%.
Food for thought: The healthy breakfast spreads that can actually be GOOD for men’s prostates
The Daily Mail – 2 February 2016
You may well have noticed recently, especially if you shop at one of the fancier supermarkets, that peanut butter is utterly passé and all the cool kids now only smear butters made from the more obscure nuts on their toast. Walnut butter is actually now a thing that you can buy.
This newspaper article details some of the potential health benefits of some of these new spreads and makes special mention that pumpkin seed butter may have some finasteride-like effects (similar to Saw Palmetto). This enthusiastic review article notes that pumpkin seed butter tastes ‘grassy’ and ‘bitter’ and is ‘an acquired taste’. This would appear to be journalistic code for “it tastes deeply unpleasant”.
Erectile dysfunction ‘linked to risk of early death’
The Independent – 31 December 2015
As with the previous story, this story doesn’t come as a surprise to a urologist, but the findings detailed in the story do really illustrate the potential severity of cardiovascular disease underlying most erectile dysfunction and it serves as a useful reminder to all of us.
The story reports on a publication by Loprinzni and Nooe in The Journal of Sexual Medicine. The authors, based in Mississippi, examined a cohort of men from the National Health and Nutrition Examination Survey. These 557 men (age range 20-85; mean=45.4 years) had all reported erectile dysfunction (ED) as part of their participant questionnaire. From these 557, over a total of 93 months follow-up, 244 died. Adjusting for age and other factors, the authors calculate an estimated increase in premature all-cause mortality of 70% in men reporting ED symptoms. A good reminder that managing ED is about a lot more than just prescribing a PDE5 inhibitor.
