Journals Watch - Prostate disease and hyponatraemia

Not had time to read the journals? Let Dr Simon Hunter bring you up to date with the latest research.

BPH: a study looked at the association between benign prostate disease and prostate cancer (Photograph: SPL)
BPH: a study looked at the association between benign prostate disease and prostate cancer (Photograph: SPL)

Does benign prostate disease predict prostate cancer?
Br J Gen Pract 2011; 61: e684-91

There are concerns that benign prostate disease might subsequently lead to prostate cancer. They both occur in the same age group, are hormone dependent and their incidences increase with age.

This study compared the risk of developing prostate cancer in men diagnosed with benign prostate disease against controls with no such diagnosis.

Taking 984 cases of prostate cancer, the researchers found a significant association between benign disease and cancer, but if all cancers diagnosed in the past six months were removed, the association became non-significant and if all cancers diagnosed in the past year were removed, there was no difference.

They conclude that if no diagnosis of prostate cancer is made within a year of being diagnosed with benign prostate disease, the risk of developing prostate cancer is no greater than in the general population.

Hyponatraemia and thiazides
Am J Med 2011; 124: 1064-72

Thiazides have been used for the treatment of hypertension for decades. They are also known to cause hyponatraemia. However, the actual incidence of hyponatraemia has not been determined.

This US study compared the incidence of hyponatraemia in patients attending hypertension clinics who were, and were not, taking a thiazide.

They found that approximately 30% of those taking thiazide became hyponatraemic, which was a 60% increase in risk over patients taking other antihypertensives.

The hyponatraemia could start in the first few months of treatment, but the risk of it developing could last 10 years. The median time for it to develop was 1.75 years. Fifteen patients would need to be treated with a thiazide to cause one new case of hyponatraemia.

Frequency of INR testing
Ann Intern Med 2011; 155: 653-9

In Canada, where this study was carried out, guidelines recommend that warfarin should be monitored every four weeks in stable patients - UK guidelines allow less frequent testing. Less frequent testing, if safe, has obvious organisational and patient benefits.

This study looked at 226 patients on long-term warfarin therapy whose dose had not been changed for six months. Half the group were tested every four weeks and half every 12 weeks (with a sham INR every four weeks to assist blinding). The main outcome measure was percentage of time in the therapeutic range and number of dose changes.

The 12-week regimen was not found to be inferior to the four-week testing. Patients also had fewer dose changes to manage. The team recommend testing for INR every 12 weeks in patients who are stable on warfarin therapy.

Obesity and postmenopausal fracture
Am J Med 2011; 124: 1043-50

Being obese is thought to have one advantage; it can reduce the risk of postmenopausal fractures. This is thought to be due to increased bone mineral density and better cushioning in the event of a fall.

This multinational study of more than 60,000 postmenopausal women looked into personal characteristics, fracture history, their risk of fracture and any anti-osteoporosis medication. Almost a quarter of the women were obese.

The previous fracture rate and the number of fractures that occurred during the two-year duration of the trial were the same in obese and non-obese patients. The obese patients had more ankle and upper leg fractures and fewer wrist fractures.

Of note is the different way they were treated with regard to anti-osteoporosis treatment. Of those who had a fracture, only 27% of obese patients were on bone protection therapy at the end of the study, compared with 57% of those underweight and 41% of non-obese patients.

Doctors' attitudes regarding anticoagulation in AF
Age Ageing 2011; 40: 675-83

AF incidence increases with age and it is associated with a fivefold increase in stroke. It is known that warfarin is significantly better than aspirin or placebo at preventing stroke.

This systematic review investigated why, despite all the evidence, warfarin is underused in the elderly with AF. The review found age, risk of bleeding, risk of falls, comorbidities and non-compliance were all considered to be barriers to prescribing warfarin.

The authors cite a paper about the risk of an intracranial bleed following a fall as a reason not to anticoagulate, which concluded that a patient would need to fall 300 times a year before the risk of warfarin outweighed the benefit. The paper confirms that anticoagulation is underused in elderly patients with AF.

Incentives to lose weight
Am J Med 2011; 124: 1082-5

This US study assessed whether 'reinforcements' work as a way to lose weight. Half the overweight subjects underwent the LEARN (lifestyle, exercise, attitudes, relationships and nutrition) approach, which is known to produce weight loss of around 3kg, but can have poor long-term results.

The intervention group had the LEARN approach as well as the reinforcements. Every week a participant lost a pound they got a prize costing around $2.

Those in the reinforcement group lost 6% of bodyweight compared with 3.5% in the other group. Moreover, 64% of the reinforcement group lost at least 5% of bodyweight compared with only 25% of the control group.

  • Dr Hunter is a GP in Bishop's Waltham, Hampshire 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.

  • Design a patient information leaflet on benign prostate disease and the association with cancer.
  • Search for AF patients over 75 years and re-examine the reasons for not prescribing warfarin.
  • Perform a search of patients with a recorded low-trauma fracture who are not on bone protection therapy. Assess whether your obese patients are being undertreated.

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