Journals Watch - Prostate cancer and stroke

Not had time to read the journals? Let Dr Raj Thakkar bring you up to date on the latest research.

Radiotherapy for prostate cancer: treatment for prostate cancer can cause erectile dysfunction (Photograph: SPL)
Radiotherapy for prostate cancer: treatment for prostate cancer can cause erectile dysfunction (Photograph: SPL)

Erectile function after prostate cancer
JAMA 2011; 306 (11): 1205-14

One of the major concerns men have when making decisions about treatment for prostate cancer is erectile dysfunction (ED). This study aimed to help prediction of ED up to two years post treatment, either by radical prostatectomy or radiotherapy. More than a 1,000 men were included.

After two years, 37% of the total cohort and 48% of those who had normal erectile function prior to treatment still had functional erections. Medications or devices to achieve a functional erection were used by 53% of patients without penile prostheses.

Age, pre-treatment PSA, BMI and quality of life scores all had a bearing on post-treatment ED. These data, which form the basis of prediction models, will allow specialists to predict the risk of ED with greater accuracy, and help patients decide on their treatment.

Tyrosine kinase inhibition in pulmonary fibrosis
N Engl J Med 2011; 365: 1079-87

Despite conventional treatments offering some reprieve, idiopathic pulmonary fibrosis continues to have a high mortality rate. Research has shown that tyrosine kinase signalling is involved and this study assessed whether tyrosine kinase inhibition slowed the rate of decline of forced vital capacity (FVC) in patients with idiopathic pulmonary fibrosis.

More than 400 patients were randomised to receive one of four doses of tyrosine kinase inhibitor, or placebo. At the highest dose, FVC declined at a rate of 0.06 litres per year compared with 0.19 litres in the placebo arm.

The statistical significance of this was questionable depending on the calculations used although the trial may have been underpowered. The tyrosine kinase inhibitior also resulted in significantly fewer exacerbations.

The scope of biological treatments is far reaching and novel applications including that for pulmonary fibrosis may have an untold benefits for a huge number of patients.

High residual platelet reactivity after percutaneous coronary intervention
JAMA 2011; 306 (11): 1215-23

This study looked at whether high residual platelet activity (HRPR) confers an increased long-term risk of thrombotic events in patients with acute coronary syndromes undergoing percutaneous coronary intervention (PCI) who have received anti-thrombotic drugs tailored to platelet function tests.

Nearly 1,800 patients were involved in the Italian study. All patients received 325mg of aspirin and a loading dose of clopidogrel 600mg, followed by a maintenance dose of daily aspirin 325mg and clopidogrel 75mg. Patients with HRPR were given 150-300mg clopidogrel daily or ticlopidine.

Cardiac death, MI, urgent coronary revascularisation or stroke occurred in 14.6% of patients with HRPR within two years, compared with 8.7% of patients with low residual platelet reactivity. Stent thrombosis was also more likely in patients with HRPR.

Despite increased anti-platelet medication, patients with HRPR continue to be at high risk after PCI.

Cognitive behaviour therapy for obsessive-compulsive disorder in children
JAMA 2011; 306 (11): 1224-32

Childhood obsessive-compulsive disorder (OCD) responds to SSRIs and it is considered that cognitive behaviour therapy (CBT) may offer additional benefit.

This five-year study looked at SSRI and CBT treatment in children aged between seven and 17 years. A positive result was considered if the baseline OCD score improved by more than 30% over a 12-week period.

Combined SSRI and CBT was the most effective treatment, with 68.6% of patients achieving a positive result. This compared with 34% in the 'SSRI plus instructions in CBT' group and 30% in the SSRI-only group.

Fasting plasma glucose and risk of stroke in men
Mayo Clin Proc 2011; doi: 10.4065/mcp.2011.0267

Primary prevention of stroke and identifying high-risk patients is a high priority in general practice. This study looked at the association between fasting glucose and stroke in asymptomatic men. Nearly 44,000 American men with an average age of 44.3 years and without a history of cardiovascular disease were assessed. Those with either a low fasting blood sugar or diabetes were excluded from the study.

There were 595 strokes among the cohort and 156 of these were fatal. For people with normal glucose levels there were four stroke events per 10,000 person-years and this was at least three times higher in patients with impaired fasting glucose or undiagnosed diabetes.

For people with fasting glucose concentrations 110mg/dL or greater, each 10-unit increment was associated with a 6 per cent higher risk of total stroke.

Gestational age at birth and mortality in young adulthood
JAMA 2011; 306 (11): 1233-40

This Swedish study included 674,820 people born between 1973 and 1979 who lived to at least 12 months, including 27,979 who were born before 37 weeks gestation. The cohort was followed to 29-36 years of age.

The results showed an inverse relationship between gestational age and mortality between the ages of one and five years.

Interestingly, while there was no relationship with gestational age and mortality in children aged six to 17 years, the relationship was re-established between 18 and 36 years. The excess mortality risk even included those born at 36 weeks gestation.

The cause of death among young adults tended to be from congenital disorders as well as cardiac, pulmonary and endocrine conditions. This data suggests that GPs should keep a close eye on adults and children born prematurely.

  • Dr Thakkar is a GP in Wooburn Green, Buckinghamshire and a member of our team who regularly review the journals

Reflect on this article and add notes to your CPD Organiser on MIMS Learning

CPD IMPACT: EARN MORE CREDITS

These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Develop a patient information leaflet outlining the potential side-effects of prostate cancer treatment.
  • Make a register of all of your patients born preterm and set up a clinic, ensuring their health is optimised.
  • Search all of your male patients with an impaired glucose tolerance and try to minimise their cardiovascular risk by controlling their risk factors.

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