Saturday, December 10, 2011
We're moving
Wednesday, July 6, 2011
IMMUNOTHERAPY for prostate cancer
How does immunotherapy work?
Certain immune cells are collected from a patient's blood in a procedure known as leukapheresis. The immune cells are processed to combine with a protein found in most prostate cancers and another compound that stimulates the immune system to make Provenge. When given intravenously, the drug is believed to activate other immune cells to see the cancer as a threat and attack it.
Several companies are exploring this modality for the treatment of other solid tumors. More to come.
AVODART warning
Therefore, close monitoring of PSA is important in this group of patients taking Avodart as well as Proscar in those patients who require these medications for the treatment of symptomatic benign prostatic hyperplasia (BPH).
Monday, January 24, 2011
DIET, HEALTH AND FITNESS
He would famously like to say. "I can't die, it would ruin my image."
He was a true icon.
Tuesday, November 30, 2010
Vitamin D and calcium supplements
Report: Skip the Megadose of Vitamin D
"More is not necessarily better," Dr. Joann Manson of Harvard Medical School, who co-authored the report, told The Associated Press.
The report from the prestigious Institute of Medicine says most people in the U.S. and Canada from ages 1 to 70 need 600 international units of vitamin D daily. That's up from the 400 IUs under today's government-required food labels and above the 1997 guidelines from the institute that called for 200 to 600 IUs, AP noted.
Most people are getting the amount of calcium they need from their diets, the report found, and supplements are not needed, The New York Times reported. Calcium and vitamin D work together to help build strong bones.
"For most people, taking extra calcium and vitamin D supplements is not indicated," Dr. Clifford J. Rosen, a member of the panel, told The Times.
The guidelines could slow the vitamin D craze. The sale of supplements has soared as some scientists recommend 2,000 IUs a day amid studies suggesting low vitamin D levels increase the risk of cancer and heart disease, AP said. The report out today suggests an upper limit of 4,000 a day.
"This is a stunning disappointment," Dr. Cedric Garland of the University of California, San Diego, who was not part of the study, told AP. The risk of colon cancer could be cut if people got enough vitamin D, he said.
Low levels of vitamin D have also been linked to stroke, diabetes, breast cancer, auto-immune diseases, infections and depression, and studies have suggested many Americans don't get enough vitamin D because they spend time inside and wear sunscreen when they go out, according to The Wall Street Journal.
But the institute didn't find enough evidence to prove a link to those chronic diseases, the newspaper said. The new guideline was created solely to promote bone health, the Journal said.
The new guidelines will affect the recommended daily allowances listed on food packages and the makeup of school lunches and other federal nutrition programs, according to the newspaper.
Some experts were disappointed.
The recommended 600 IUs of vitamin D is "way too low," Creighton University professor of medicine Robert Heaney told USA Today. Heaney, who has studied the benefits of D, says people should consider getting about 4,000 IUs daily.
"For me, it's a no-brainer," he told the newspaper. "There is a large body of evidence for benefit at intakes above the IOM recommendations. There is no risk, and very little cost, so why not take a chance of a benefit if there's any possibility?"
The latest study to report no cancer protection from vitamin D, and the possibility of a greater risk of pancreatic cancer, came last summer from the National Cancer Institute, AP said. A megadose of more than 10,000 IUs daily is known to cause kidney problems, AP said.
"Everyone was hoping vitamin D would be kind of a panacea," Dennis Black, a University of California, San Francisco, professor of epidemiology and biostatistics, told the Times.
The guidelines may dampen enthusiasm for the vitamin, he said. "I think this will have an impact on a lot of primary care providers," he told the paper.
For calcium, the report recommended the levels that are already accepted, about 1,000 milligrams for most adults, 700 to 1,000 mg for children, and 1,300 mg for teens and menopausal women, AP said.
Tuesday, November 2, 2010
New FDA warnings about Lupron and related meds
FDA Requiring GnRH Agonists To Carry Warnings About Potential Risk For Heart Disease, Diabetes.
The Wall Street Journal /Dow Jones Newswire (10/21, Dooren) reports that to shrink prostate tumors, the medical community relies on a group of products that reduce male hormone levels, but these gonadotropin-releasing hormone (GnRH) agonists may also increase the risk of diabetes and cardiovascular problems. Thus, the FDA is now requiring the drugs, marketed under generic and brand names like Zoladex (goserelin), Lupron (leuprolide), Trelstar (triptorelin), Vantas (histrelin), and Synarel (nafarelin), carry labels that highlight the potential risks.
In February, "the American Heart Association, the American Urological Association, and the American Cancer Society issued a joint advisory warning of the increased risks of diabetes, myocardial infarction, stroke, and sudden death among men who use androgen deprivation therapy (ADT) to treat prostate cancer," MedPage Today (10/20, Walker) reported. "GnRH is the most common form of ADT. However, the groups did not offer specific guidelines for clinicians on when to employ ADT therapy or when to avoid it."
Thus, the FDA stepped in May and "announced...that it was reviewing the" GnRH agonists, HealthDay (10/20, Reinberg) reported. "Speaking after the FDA's announcement earlier this spring," Dr. Nelson Neal Stone, of the Mount Sinai School of Medicine, "said studies have shown that men with advanced prostate cancer who take hormone therapy face a twofold increased risk of developing metabolic syndrome, a cluster of symptoms tied to the development of heart disease." And, "once patients understand that, Stone hopes they will be motivated to watch their diet and exercise." For the time being, however, "men should not stop taking their hormone therapy, but do everything they can to reduce their risk of developing cardiovascular disease and diabetes with lifestyle changes, he said."
Still, the "relationship between heart disease risk, diabetes, and androgen deprivation therapy has not been without controversy," Medscape (10/20, Mulcahy) pointed out. "A medical oncologist specializing in prostate cancer treatment recently defended the safety of the therapeutic approach in an interview with Medscape Medical News." Mark Scholz, MD, of the California-based Prostate Cancer Research Institute, said, "There is no convincing evidence that hormone blockade shortens life or causes excess heart attacks if weight gain is attended to and blood sugar levels are kept in check."
Nevertheless, even though "all of the drugs will stay on the market," they "will be required to carry new label warnings," WebMD (10/20, DeNoon) reported. "The risk that the drugs will trigger diabetes or heart disease/stroke appears small, the FDA says," but again, "recent studies suggest that doctors should monitor blood sugar levels and watch for signs of heart disease in men taking these drugs." Reuters (10/21, Richwine) also covers the story.
| From the AUA |
| Claim Your AUA2010 Credits Online Attendees of the 2010 AUA Annual Meeting may claim their credits and/or print a CME certificate by clicking here. All 2010 Annual Meeting credits must be claimed by December 31, 201 |
Tuesday, October 12, 2010
Testosterone replacement
Personal Health
Hormone Replacement for Men? Perhaps
By JANE E. BRODY
Published: October 11, 2010
Women are way ahead of men in knowing the benefits and risks of hormone replacement. There has yet to be a large study spanning years, comparable to the Women’s Health Initiative, of the safety and effectiveness of hormone therapy for aging men who have signs and symptoms of testosterone deficiency.
Related
Times Topic: Testosterone
More Personal Health Columns
Despite beliefs based on observational evidence that estrogen therapy enhanced the health and well-being of menopausal women, when a definitive study was finally done, clinicians and researchers were shocked to discover that the risks of long-term hormone replacement could outweigh its benefits.
Would a similar study of testosterone therapy for men experiencing “andropause” likewise reveal more hazard than help? The answer would be welcomed by an estimated four million men in the United States who have subnormal levels of this important hormone, a common result of advancing age.
But these men, as well as those already receiving testosterone therapy and the baby boomers who may soon develop symptoms of low testosterone, may never know whether adding to their bodies’ waning supply will improve or detract from the quality and length of their lives. Rather, they may have to base a decision about therapy on confusing and conflicting evidence.
Late last year, for example, a six-month federally financed study of a testosterone gel put a surprising hitch in efforts to improve the lives of aging men who experience a decline in energy, mood, vitality and sexuality as a result of low testosterone levels. The study, conducted among 209 men 65 and older who had difficulty walking, was abruptly halted when those using the hormone had an unexpectedly high rate of cardiac problems.
The researchers, who published their findings in The New England Journal of Medicine, noted that the deck might have been stacked in favor of a hazardous outcome because study participants, especially the group that received testosterone, had high rates of high blood pressure, diabetes, obesity and elevated blood lipids. Then again, this may be a realistic population to study, given that many candidates for hormone therapy are likely to have such health issues.
Advisement ‘in Limbo’
A $45 million study financed by the National Institute on Aging is under way at 12 medical centers to see if a year of treatment with testosterone will help 800 men aged 65 and older with low levels of the hormone and problems with physical functioning, fatigue and sexual or cognitive performance. The study, in which the men are being randomly assigned to receive the hormone or a look-alike placebo, will also evaluate the hormone’s effects on cardiac risk factors.
Still, this study will not answer the question of whether it is safe to use the hormone for years, even decades, which would be necessary to maintain any benefits. A major concern is whether long-term use would promote the growth of prostate cancer, which is present but hidden in as many as half of older men.
“There are not many good studies of testosterone in older men,” Dr. William J. Bremner, a urologist at the University of Washington in Seattle, said in an interview. “The studies are small and the longest of them lasted only three years. We need the same kind of study for testosterone as the Women’s Health Initiative — several thousand men followed for maybe 10 years. Currently, we’re in limbo as to how to advise patients.”
He acknowledged that the need for such a study for men is “less compelling” because, in contrast to women, who experience an abrupt drop in estrogen at menopause, often with disruptive symptoms, hormone decline in aging men is far more gradual, and symptoms, when they occur, are commonly viewed as normal signs of aging, not hormone deficiency.
A large European study published in the same issue of the journal sought to better determine who, among middle-aged and elderly men, might be candidates for testosterone replacement. Among a sample of 3,369 men aged 40 to 79, researchers at eight European medical centers found that “limited physical vigor” and three sexual symptoms — diminished sexual thoughts and morning erections and erectile dysfunction — were most closely linked to low levels of testosterone.
Although low hormone levels are widely thought to increase a man’s risk of depression, the researchers found that “psychological symptoms had little or no association with the testosterone level.”
There are four main approaches to testosterone therapy available in this country: intramuscular injections every one to three weeks; skin applications through a patch or gel; and pellets implanted under the skin that last for months. The patch can cause skin irritation, and the gel can be transferred to others through skin contact unless care is taken to cover the area where it is applied. But oral administration is rarely used because of toxic effects on the liver.
Weighing Help vs. Harm
The most common reason men seek testosterone therapy is waning sexual desire or performance, although the ability of the hormone to relieve sexual symptoms is unpredictable. More than one-quarter of men with normal testosterone levels have such symptoms, and many men with subnormal levels do not. Dr. Bremner said he typically suggests a trial of therapy for up to a year to see if sexual function or other symptoms improve.
Citing the results of many small studies, Dr. Bremner said, “There is good evidence that testosterone administration can improve muscle mass and strength and increase bone density” in men with subnormal levels. Dr. Abraham Morgentaler, a urologist at Harvard Medical School and author of “Testosterone for Life” (McGraw-Hill, 2009), said in an interview that other noted benefits include a decrease in body fat and total cholesterol and improved blood sugar metabolism.
In a report on the risks of testosterone therapy, written with Dr. Ernani Luis Rhoden and published in 2004 in The New England Journal of Medicine, Dr. Morgentaler noted that testosterone has widespread effects throughout the body, but he and Dr. Rhoden concluded that with proper monitoring, any looming hazards can be readily detected.
Before the most recent study, at doses considered normal, the testosterone gel showed little or no effect on cardiovascular risk, the two doctors reported. Injections could result in harmful thickening of the blood, however, especially if above-normal blood levels of the hormone result.
Although testosterone can cause overgrowth of the prostate, studies have not shown harm to urinary function, Dr. Morgentaler said. The risk of prostate cancer is of greater concern, given that suppressing the body’s natural production of testosterone can cause this cancer to regress. Men considering treatment should first undergo a full prostate exam and PSA