Correcting anemia, a red blood cell deficiency, can preserve kidney function in many kidney transplant recipients, according to a study appearing in an upcoming issue of the Journal of the American Society Nephrology (JASN). The results indicate that aggressively treating anemia may help save the kidneys and possibly the lives of many transplant recipients.

Anemia commonly arises in patients with kidney disease because the kidneys secrete most of the hormone erythropoietin that stimulates red blood cell production. Anemia is also a common complication of kidney transplantation, with a prevalence of 25% to 40% after the first year.

Gabriel Choukroun, MD, PhD (CHU Amiens in France) and his colleagues initiated the Correction of Anemia and PRogression of Renal Insufficiency in Transplant patients (CAPRIT) study to see if the drug epoetin beta (a synthetic form of erythropoietin) could help preserve kidney function in kidney transplant recipients with anemia. Specifically, the investigators tested whether completely correcting anemia (by normalizing levels of hemoglobin, a blood component that carries oxygen) is better than partially correcting anemia.

During the study, 63 kidney transplant recipients took epoetin beta so that their hemoglobin levels remained in the normal range of 13.0 to 15.0 g/dL, while 62 patients took epoetin beta so that their hemoglobin levels hovered at a lower concentration of 10.5 to 11.5 g/dL.

Among the major findings after patients were treated for two years:

– 4.8% of patients with completely corrected anemia developed kidney failure, compared with 21% of patients with partially corrected anemia.

– 94.6% of transplanted kidneys in patients with completely corrected anemia were functional, compared with 80% in patients with partially corrected anemia.

– Patients with completely corrected anemia experienced a significant improvement in quality of life at six and 12 months after starting therapy.

“This study shows that correction of anemia in kidney transplant recipients with anemia slows the progression of kidney failure and improves survival of transplanted kidneys,” said Dr. Choukroun. Additional studies are needed to determine whether this also prolongs patients’ lives.

Study co-authors include Nassim Kamar, Lionel Rostaing (CHU Toulouse); Bertrand Dussol (CHU Marseille); Isabelle Etienne (CHU Rouen); Elisabeth Cassuto-Viguier (CHU Nice); Olivier Toupance (CHU Reims); Fran?§ois Glowacki (CHU Lille); Bruno Moulin (CHU Strasbourg); Yvon Lebranchu (CHU Tours); Guy Touchard (CHU Poitiers); Ma??t?© Jaureguy (CHU Amiens); Nicolas Pallet, Frank Martinez (CHU Necker); and Yannick Le Meur (CHU Brest).

Disclosures: The study was funded in part by a grant from Roche. Dr. Choukroun received honorarium from Roche for lectures and a grant for clinical research.

Mass prostate cancer screenings do not lower total number of deaths from prostate cancer, researchers from Washington University School of Medicine at St. Louis reported in the Journal of the National Cancer Institute. They added that mass routine screenings do not even reduce numbers of deaths among males in their fifties and sixties, as well as patients with underlying health conditions.

The authors cited a US study involving 76,000 males that revealed that after six years of aggressive, yearly prostate cancer screening, there were more tumor diagnoses, but the number of deaths from prostate cancer did not drop.

The latest results of PLCO (Prostate, Lung, Cancer, Colorectal and Ovarian), which were published on January 6th, showed that the majority of men do not need to be screened every year for prostate cancer.

Lead author, Gerald Andriole, MD, wrote:

“The data confirm that for most men, it is not necessary to be screened annually for prostate cancer. A large majority of the cancers we found are slow-growing tumors that are unlikely to be deadly.”

In the PLCO study, males aged 55 to 74 were randomly selected to receive routine care or a PSA test once a year for six years plus a digital rectal exam for four years. Routine care means the patient only gets a PSA screening test if the doctor recommends one.

Dr. Andriole explained that this report provides updated data on an earlier report published in NEJM (New England Journal of English), 2009, when the team could not find any mortality benefit from routine prostate cancer screening.

At the time (2009), the researchers said it was too early to make any broad generalizations about PSA screening, because a very small number of males had died of any causes. They had recommended that men whose life expectancy was from seven to ten years should be screened.

Now, Dr. Andriole writes:

“Now, based on our updated results with nearly all men followed for 10 years and more than half for 13 years, we are learning that only the youngest men – those with the longest life expectancy – are apt to benefit from screening. We need to modify our current practices and stop screening elderly men and those with a limited life expectancy.

Instead, we need to take a more targeted approach and selectively screen men who are young and healthy and particularly those at high risk for prostate cancer, including African-Americans and those with a family history of the disease.”

Andriole and team believe that adult males should receive a baseline PSA test in their early 40s. According to recent studies, men with elevated PSA levels at that age have a considerably higher risk of eventually developing prostate cancer.

Male patients in their 40s whose PSA levels are low have a very small chance of developing lethal prostate cancer, and do not really need to have further routine testing, Andriole believes.

Below are some data from the latest study:

4,250 tumors were detected in the routine PSA screening plus digital rectal examination group
3,815 tumors were detected in the routine care group
There were 158 deaths from prostate cancer in the routine PSA screening group
There were 145 deaths from prostate cancer in the routine care group

The authors said the difference in deaths from prostate cancer was not significantly different between the two groups.

Routine PSA screening every year of males in their fifties and sixties does not appear to save lives.

The authors found that patients diagnosed with prostate cancer who also had other conditions or illnesses, were far more likely to die from those other illnesses than from the prostate cancer itself. Examples of other illnesses, conditions or events include stroke, diabetes, heart attack, cancer, some respiratory diseases, and liver disease. This suggests that although screenings do detect prostate cancer tumors, most of them are not very harmful.

Andriole agrees that too many men have been over-diagnosed and over-treated for prostate cancer, many of whom subsequently suffered from impotence and incontinence.

Andriole said:

“Mass screening of all men on the basis of age alone is not the way to go, but screening can still be useful in select men. We have to take a more nuanced approach to determine which men should be screened with PSA in the first place, how frequently they should be tested, the PSA level at which they should be biopsied and whether their cancer warrants aggressive therapy.”

During the last quarter of last year, the US Preventive Services Task Force called for the end of routine PSA testing for healthy males aged over 50 years, saying that it does not save lives and frequently leads to overtreatment.

The PLCO patients will continue being monitored for a further 15 years, the authors added. The aim being to see what effects cancer screening can have on mortality over the longer term.

In an Abstract in the journal, the authors concluded:

“After 13 years of follow-up, there was no evidence of a mortality benefit for organized annual screening in the PLCO trial compared with opportunistic screening, which forms part of usual care, and there was no apparent interaction with age, baseline comorbidity, or pretrial PSA testing.”

200 million people worldwide are affected by urinary incontinence. Emeritus consultant urologist to the North Bristol NHS Trust, Professor Roger Feneley, a leading urologist, urged people to stop treating urinary incontinence as a ‘taboo’ subject and to speak more openly about it after the launch of the world’s first intelligent catheter leg bag with an electrical pump.

The award-winning leg bag called the Melio system, which has been developed by UK-based Albert Medical Devices, has received praises from leading urologists for its capability of improving overall urology care and restoring patient’s dignity and independence.

Professor Feneley highlighted the significance of talking openly about incontinence, by saying:

“Many thousands of older and disabled people rely on a catheter and bag to control their loss of bladder control yet this is a subject rarely discussed because of the embarrassment it can cause. The catheter in universal use worldwide has not fundamentally changed for over 70 years. It is invariably drained into a urine collection bag, well concealed under clothing and any attempt to empty can present a major upheaval for the user and often an even trickier maneuver for the carer.

The Melio leg bag completely transforms this routine task, enabling the urine collection bag to be emptied discreetly without an undignified struggle. So many catheter users and their carers could benefit if only they knew such a device was available.”

For over 50 years leg bags have remained largely unchanged. To empty the bag, patients have to bend down to where the bag is strapped, which is not always possible to do without assistance. In addition, the wearers of traditional bags are also unaware of when the bag is full, which can lead to reflux and infections as a simple one way valve is insufficient when the bag is overly full.

The Melio bag deals with these problems by replacing the tap with a tiny pump that has a simple computerized level detector. The wearer remains in control through a compact computer controller that clips onto the waist belt.

According to Tom Fitzherbert, CEO of Albert Medical Devices:

“Self-management for patients is essential for them to restore dignity and give them greater control. As well as offering huge benefits to wearers, the Melio leg is an improved and cost-effective solution for hospitals and care homes.”

Petra Rattue

Thousands more American senior citizens with kidney disease are good candidates for transplants and could get them if physicians would get past outdated medical biases and put them on transplant waiting lists, according to a new study by Johns Hopkins researchers.

The Hopkins investigators estimate that between 1999 and 2006, roughly 9,000 adults over 65 would have been “excellent” transplant candidates and approximately 40,000 more older adults would have been “good” candidates for new kidneys. None, however, were given the chance.

“Doctors routinely believe and tell older people they are not good candidates for kidney transplant, but many of them are if they are carefully selected and if factors that really predict outcomes are fully accounted for,” says transplant surgeon Dorry L. Segev, M.D., Ph.D., an associate professor of surgery at the Johns Hopkins University School of Medicine and leader of the study being published in the January issue of the Journal of the American Geriatric Society. “Many older adults can enjoy excellent transplant outcomes in this day and age,” he says, and should “be given consideration for this lifesaving treatment.”

Those ages 65 and older make up over one-half of people with end-stage renal disease in the United States, and appropriately selected patients in this age group will live longer if they get new kidneys as opposed to remaining on dialysis, Segev says. The trouble is, he adds, that very few older adults are even put on transplant waiting lists. In 2007, only 10.4 percent of dialysis patients between the ages of 65 and 74 were on waiting lists, compared to 33.5 percent of 18- to 44-year-old dialysis patients and 21.9 percent of 45- to 64-year-old dialysis patients.

Segev cautions that some older kidney disease patients are indeed poor transplant prospects, because they have other age-related health problems. But he says his team’s new findings, in addition to other recent research, show that new organs can greatly improve survival even in this age group.

Segev and his team constructed a statistical model for predicting how well older adults would be expected to do after kidney transplantation by taking into account age, smoking, diabetes and 16 other health-related variables. Using those data to define an “excellent” candidate, the information was then applied to every person 65 and older on dialysis during the seven-year study period. The researchers also determined whether these candidates were already on the waiting list.

“We have this regressive attitude toward transplantation in older adults,” Segev says, “one based on historical poor outcomes in older patients, which no longer hold up. Anyone who can benefit from kidney transplantation should at least be given a chance. They should at least be put on the list.”

Segev says he knows there is a shortage of kidneys and some will question whether scarce organs would be put to better use in younger patients. But Segev’s study predicts that more than 10 percent of older patients would get kidneys from living relatives or friends, which would have little impact on the nationwide shortage of deceased donor kidneys. But finding a living donor first requires referral for transplantation.

“By not referring older adults for transplant, we’re not just denying them a chance at a kidney from a deceased donor, but we’re potentially denying them a kidney from a live donor,” he adds.

According to research by Segev and his team published last year in the Journal of the American Medical Association, live kidney donation is very safe for both donor and recipient, and more older adults are donating their kidneys to relatives. Other research done by Segev has shown that older kidney transplant recipients do well with kidneys from older donors, organs that are otherwise be rejected for use in younger patients.

“The overactive bladder syndrome has become an accepted way to simplify a complex array of symptoms and leads people to believe that an overactive bladder is an independent disease in itself. However, the truth is not as simple as this, as there are usually several factors at work explaining the symptoms. This is also one of the reasons why so called overactive bladder medications often do not bring the hoped result,” says Kari Tikkinen, MD, PhD, from the HUCS Department of Urology.

The article on overactive bladder syndrome, which was co- Tikkinen, who currently holds a senior researcher post at the McMaster University in Canada, and Anssi Auvinen, Professor of Epidemiology from the University of Tampere, was recently published in the European Urology journal. For the article, the researchers systematically reviewed the studies on overactive bladder and the channels through which these studies have been funded.

The authors argue that the symptoms of an ‘overactive bladder’ ought to be studied individually and not as an ambiguous constellation of symptoms. This way the underlying causes of the symptoms can be better understood and more effective treatments can be developed.

The expression ‘overactive bladder’ was coined at an industry-sponsored symposium held in 1997. The following year, the FDA approved the first drug for the treatment of ‘symptoms of overactive bladder’, after which the pharmaceutical industry launched high-profile, worldwide promotional campaigns for drugs aimed at treatment of the syndrome.

According to the current definition, overactive bladder (OAB) syndrome is defined as the presence of urinary urgency with or without urgency incontinence, usually with increased daytime frequency and nocturia in the absence of infection or other obvious pathology.

“The definition is vague and ambiguous because it includes unspecific terms, such as ‘usually’ and ‘with or without’, and the unclear expression ‘other obvious pathology’,” Tikkinen says and continues, “For the pharmaceutical industry this definition is probably quite useful, as it is partly the reason why one medicine can be prescribed to a large number of patients.”

Research into overactive bladder has increased significantly over the past ten years and the pharmaceutical industry has invested heavily in it. “It has previously been shown that research funded by commercial actors often ends up unpublished if the results don’t serve the interests of the company,” Tikkinen points out.

Tikkinen and Auvinen also bring to the fore that in many studies on prevalence of overactive bladder, very mild symptoms have been classified as abnormal.

“More independent, non-commercially funded research on the subject is needed. There are, in the end, a huge number of people who suffer from urinary urgency and increased urinary frequency, and current treatments are not bringing sufficient relief,” Tikkinen says.

Nurse Allison Batson donated one of her own kidneys to 23-year old patient, Clay Taber; somebody she barely knew, after working on the transplant department of Emory University Hospital for over two years. Allison was not even Clay’s primary nurse, but says she felt an instant connection with him.

Taber, from Columbus, Ga., became ill when he was 22, and eventually suffered from complete kidney failure. He started feeling sick and suffered occasional night sweats. At first tests came back positive for some signs of monocucleosis (infection with the Epstein-Barr virus), however, subsequent tests showed that his kidneys were in failure.
Taber’s mother says she was shopping for some groceries when the hospital telephoned, explaining that new tests had showed that her son was in complete kidney failure and that he had to be admitted to hospital straight away.

Taber was diagnosed with Goodpasture’s syndrome – a very rare disorder in which the patient’s immune system attacks the kidneys and lungs, as if they were harmful pathogens. Goodpasture’s syndrome often occurs after a viral infection, inhaling gasoline, or inhaling some other type of hydrocarbon solvent. Taber and his family wondered whether his recent vacation in the Gulf of Mexico, where he swam in water that had been affected by the oil spill, may have been a contributory factor.

Fortunately for Taber, his diagnosis was made before his lungs had been attacked by his immune system. However, he urgently needed a kidney transplant. He became a patient in the transplant unit of Emory University Hospital, Atlanta, where nurse Batson worked.

The patient’s mother and other family members did not qualify as kidney donors. Initially, his mother appeared to be a good donor match. However, the doctors found that the lining of her kidneys was not thick enough to remove one. Batson, who has four children herself, said she really related to Taber’s mother’s plight. Then, it occurred to her that perhaps she could come forward as a donor herself. She discussed her thoughts with her family, who all supported her decision to become a kidney donor.

Batson, who says her children are around the same age as Clay, was really touched; she added “We really connected.”

Batson said:

“Immediately, when Clay came onto our unit, he became a special patient that everyone just gravitated to. Here was this young man with everything in his life ahead of him, and he was fighting for his life. He quickly became friends of many of the staff, and really was just a tremendous inspiration to us all.”

Taber joined 90,000 other Americans who had been waiting for a donor kidney. Doctors informed him that it would probably take from between three to five years before a suitable organ could be found for him.
Taber, who explained that he and Batson had only known each other for six weeks, described what happened as “A blessing from God. I’ve got a piece of her in me and I will forever. She will have a special dance at my wedding” (Taber gets married this year in June).

In a press release, Batson said:

“People have asked me why I would do this for a stranger, or what if I had a family member in need one day, or why would I risk my own life or health for someone I barely know. My answer is because I can. Sure, I have children who might possibly be in need one day, but here was this young man right in front of me who needs help – today, and I am in a position to help him – today. If what I do for Clay causes more awareness among others that live organ donation is a possibility, then I can only hope that other lives will be saved because of my actions.”

How does a doctor determine whether or not an emergency-room patient has acute kidney injury? Using tests currently available in the hospital, this question is often difficult to answer. In many emergency cases, however, early diagnosis of the severity of the disease picture is crucial. A large multicenter study by clinicians of the Experimental and Clinical Research Center (ECRC), a joint cooperation between the Max Delbruck Center for Molecular Medicine (MDC) Berlin-Buch and the Charite – Universitatsmedizin Berlin, the Helios Hospital Berlin, and two hospitals in the U.S. has now shown that a urine test for proteins excreted by a damaged kidney helps to swiftly identify high-risk patients (Journal of the American College of Cardiology)*.

“There are no typical symptoms for acute kidney injury,” said Professor Kai Schmidt-Ott. “Nevertheless it is very important for the doctor to rapidly determine whether or not a patient has acute kidney injury” stressed the nephrologist from the Charit?©, who leads a research group at the MDC. Jonathan Barasch, Associate Professor of Medicine and Cell Biology at Columbia University and senior author of the paper commented: “When a patient presents to the Emergency Department and a blood test identifies an abnormal creatinine value, it is difficult to know whether the patient needs to be hospitalized because of ongoing intrinsic acute kidney injury (a potentially fatal disease) or whether the patient needs to be sent home after intravenous or oral fluids and later examined at an outpatient clinic. This study, based on earlier studies by Professor Thomas L. Nickolas and Professor Schmidt-Ott, demonstrates the strength of association of the novel biomarker neutrophil gelatinase- associated lipocalin (NGAL) with intrinsic acute kidney injury and not simple volume depletion or more indolent forms of chronic kidney disease”, Prof. Barasch said. “Furthermore, the study demonstrates that NGAL and a second biomarker, kidney-injury molecule-1 (Kim1), predict poor outcomes during hospitalization, even days after the initial measurements.”

“In the initial stage of acute kidney injury, we may have most room for improvement of our current clinical practice” Professor Schmidt-Ott points out. In cases of advanced acute kidney injury, dialysis treatment is required. Many patients with severe acute kidney injury die in the hospital. Statistics illustrate how extensive the problem is. In the U.S. alone, one million patients are diagnosed every year with severe acute kidney injury. According to data of the German Society of Nephrology, there are currently around 70 000 dialysis patients in Germany; and this number is on the increase.

Currently, only the serum creatinine level is used for the diagnosis of acute kidney injury. Creatinine is a molecule that is normally excreted via the kidney, but accumulates in the blood when kidney function is impaired. “However, an elevated creatinine level is not a direct measure of kidney damage,” Professor Schmidt-Ott explained. “Thus, a prolonged slight-hypoperfused kidney can lead to a significant increase in serum creatinine, although the kidney tissue is not damaged. This functional impairment of the kidney usually responds well to treatment. The patients receive an electrolyte solution or have to stop taking the medications that damage the kidneys. In contrast, tissue damage in the kidney has a significantly worse prognosis. Nevertheless, serum creatinine values in the emergency room are of limited value because after kidney damage, 24 to 48 hours may elapse before serum creatinine values accumulate in the blood. Thus, at-risk patients remain undetected. That is why there is an urgent need for more accurate biomarkers of tissue damage in the kidney.”

Research has indicated that damaged kidneys synthesize specific proteins. In previous smaller studies, researchers investigated whether or not these proteins could serve as biomarkers to identify high-risk patients with kidney tissue damage. During the past three years, Professor Nickolas and Professor Barasch (Columbia University) and Professor Schmidt-Ott and Professor Friedrich C. Luft (both ECRC), pursued this question in a large-scale study. The researchers in Berlin and New York took a single measure of five urinary biomarkers from almost 1700 emergency room patients upon their admission to the hospital.

The investigators found that primarily the two putative biomarkers, NGAL and KIM-1, were useful in providing an early risk assessment. If both NGAL and KIM-1 levels are low, the patient’s risk of dying in the hospital or requiring dialysis treatment is likewise low. In contrast, high levels indicate the risk of acute kidney damage. If a doctor bases the diagnosis both on these biomarker readings and the serum creatinine levels, a more exact assessment of the individual risk is possible, according to Professor Schmidt-Ott, who is also adjunct assistant professor at Columbia University. This finding could quickly help emergency room doctors to devise an adequate treatment strategy for the patient.

But it is still not clear whether or not all patients admitted to an emergency room should be tested for these biomarkers. Perhaps only certain patients, for example diabetics or patients with high blood pressure, who are at high risk for acute kidney injury should be included. Furthermore, whether or not these biomarkers actually influence the individual treatment outcome is uncertain. As Professor Schmidt-Ott concluded, further studies are needed to answer these questions.

A study by investigators at the Methodist Research Institute at Indiana University confirms that an all-natural, doctor-designed formula is effective in suppressing prostate cancer tumors. The study conducted on mice, used a human prostate cancer xenograft model.

Results from the live animal study were presented by lead researcher, Dr. Daniel Sliva at the 16th World Congress on Advances in Oncology in Rhodes, Greece and at the 14th International Symposium on Molecular Medicine.

The formula showed to be considerably effective in suppressing the proliferation and metastasis of human hormone refractory (androgen independent) prostate cancer cells. Furthermore, the formula was confirmed to be non-toxic and poses no risk of adverse effects.

Dr. Sliva, explains: “Dietary supplements are used as an alternative or adjuvant therapies. However, rigorous scientific verification of their biological activity in vitro and in vivo is necessary for the acceptance of dietary supplements in conventional cancer treatment and prevention.”

The study is significant, as it is exceptionally hard to treat hormone refractory prostate cancer (androgen independent). Hormone refractory prostate cancer is the most aggressive, advanced form of the disease and usually leads to metastasis and progression of the cancer.

The ingredients of the formula, which contains botanical extracts, antioxidants, botanically enhanced medical mushrooms, and phytonutrients were chosen by the researchers based on scientific research showing their abilities to fight prostate abnormalities and provide extensive prostate support.

The researchers grafted human prostate cancer cells (tissues) onto mice using a xenograft model – where organs or tissue from an individual of one species is grafted or transplanted onto an organism of another species, genus, or family. The team found that oral administration of this natural formula produced a statistically significant suppression of tumor growth.

Study results also demonstrated that the formula worked to suppress several genes involved in cancer metastasis and proliferation. Two of the suppressed genes are associated to the metastatic potential. The genes can highlight the ability of this preparation to suppress the primary tumor growth as well as the metastatic process, a vital benefit in fighting this aggressive cancer.

Prior investigations studying this formula have been conducted at research laboratories at Columbia University, NY, NY, the Cancer Research Laboratory, Methodist Research Institute, and Indiana University health, Indianapolis, IN, using cell culture studies and gene expression analysis. These previous studies demonstrated considerable results in the formula’s ability to suppress proliferation and prostate cancer growth.

The current study is a breakthrough in the investigation of this natural formula, as it used an xenograft model on mice to test for toxicity and demonstrated to inhibit tumor growth within a living mammal.

Dr. Sliva explained: “In summary, this dietary supplement is a natural compound for the possible therapy of human hormone refractory (independent) prostate cancer.”

Current research on this formal continues to demonstrate positive results, and further investigations are to be conducted in the future.

Grace Rattue

A study published Online First in The Lancet has found that a common medication (dutasteride) used to treat enlargement of the prostate, may also reduce the need for treatments that pose risks of incontinence and impotence and delay growth of early-stage prostate cancer.

Neil Fleshner, lead researcher of the investigation from Princess Margaret Hospital, Toronto, Canada, said:

“Our trial is the first study to show the benefits of use of a 5?±-reductase inhibitor to reduce the need for aggressive treatment in men undergoing active surveillance for low-risk prostate cancer…delaying their time to pathological progression and initiation of primary therapy.”

In the United States about 20% of males will be diagnosed with the disease, although the majority will have low-risk (low-grade, low-volume) prostate cancer. For them, it can be appropriate to stay under conservatively managed active surveillance, meaning they do not have to undergo immediate therapy in favor of regular assessment and biopsies to monitor the disease.

Dutasteride is a 5?±-reductase inhibitor that works by preventing testosterone from converting to dihydrotestosterone (the male sex hormone involved in the development of prostate cancer). The drug has been approved for treating benign prostatic hyperplasia, a non-cancerous enlargement of the prostate, and has shown to decrease the volume of some prostate cancers.

302 men aged between 48 to 82 years old undergoing active surveillance for low-risk localized prostate cancer were enrolled to participate in the Reduction by Dutasteride of Clinical Progression Events in Expectant Management (REDEEM). The researchers randomly assigned the participants to two groups; one group received 0.5 mg dutasteride once daily for 3 years, while the other group received placebo for the same duration.

In order to measure time to disease progression, participants received biopsies at 18 months and 3 years. In addition, the researchers gave participants a questionnaire in order to examine anxiety associated to the disease.

The researchers found that dutasteride considerably delayed disease progression in comparison with placebo – 48% of men given placebo experienced disease progression compared with 38% of participants receiving dutasteride.

Furthermore, cancer was less likely to be detected at final biopsy for participants in the dutasteride group (36% [50 men]) compared with 23% (31) men in the placebo group. Throughout the duration of the study, those who received dutasteride also reported considerably lower cancer-related anxiety compared with men in the placebo group.

Similar side effects were observed between both groups. Drug-related adverse effects, consisting mainly of adverse sexual events or breast enlargement or tenderness, were experienced by more participants in the dutasteride group (24%) than those given placebo (15%). There were no cases of disease spread or deaths related to prostate cancer during the duration of the study.

In an associated comment, Chris Parker from the Royal Marsden National Health Service Foundation Trust, Sutton, UK warns:

“These data are consistent with the hypothesis that dutasteride reduces the volume of low-grade prostate cancers but has no effect, or even an adverse effect, on the progression of high-grade disease. Thus, although reducing overall prostate cancer detection, dutasteride could plausibly have no effect (or possibly a deleterious one) on prostate cancer mortality.”

The researchers conclude:

“The benefit of dutasteride is to reduce the amount of low-grade cancer, not to reduce the risk of being diagnosed with higher-grade cancer. This reduction leads to fewer men with biopsy-detectable prostate cancer, and therefore fewer treatment interventions. Dutasteride…provides a treatment option for men with low-risk, localized disease.”

Grace Rattue

View drug information on dutasteride.

Texas Democratic gubernatorial hopeful Chris Bell on Wednesday said Democrats and Republicans need to work together to improve health care for low-income women and to develop a comprehensive sex education curriculum for public schools to reduce the number of abortions in the state, the San Antonio Express-News reports. At a Democratic Women’s Club event in New Braunfels, Texas, Bell criticized Gov. Rick Perry (R), who is running for reelection, for promoting abstinence-only education programs in schools and for vetoing legislation in 2001 that would have provided family planning services $131 million in federal matching funds. “We have the second-highest teen pregnancy rate in the country,” Bell said, adding that Perry’s “policies have failed to reduce the number of abortions in Texas.” According to Bell, about 80,000 abortions occur in the state annually. Perry’s campaign spokesperson, Robert Black, said the governor’s policies have helped lower the number of abortions among minors “by making sure that parents are involved in their minor daughter’s life-altering decision.” Bell’s proposals include “more sex education in elementary schools and free condoms in high schools,” Black said, adding, “The bottom line here is that Rick Perry is pro-life, and Chris Bell is simply trying to blur the fact that he’s very pro-abortion.” Bell reiterated his support for abortion rights, adding that he does not know anyone “who is pro-abortion,” the Express-News reports. He said, “[Democrats] should not be shy about saying just how rare we think abortion should be” (Croteau/Scharrer, San Antonio Express-News, 12/15).

“Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.