Yoga Improves Back Function in Patients With Low Back Pain

From Medscape Medical News > Neurology Megan Brooks October 31, 2011 — A study released today provides more evidence that yoga can help patients who suffer from chronic low back pain. Conducted in the United Kingdom, the study found that a 12-session, 3-month yoga program led to greater improvements in back function than usual care. However, yoga did not yield greater reductions in pain or improvements in overall health compared with usual care. "Although there was no evidence of pain reduction at 12 months, confidence in performing normal activities despite pain improved more in the yoga group than usual care group at 3 and 6 months," the study team notes. In terms of yoga studies for low back pain, this study is "the largest to date, with over 300 participants, and it has the longest follow-up of any trial," investigator David J. Torgerson, PhD, from the University of York's Department of Health Sciences, United Kingdom, told Medscape Medical News. "We followed them up for 12 months (9 months after they had finished the yoga), and found that the benefit of yoga was sustained for this length of time, probably because a proportion of participants continued to practice yoga after they had completed their formal course," he said. Based on the findings in this study, "yoga could be recommended as a therapy for chronic low back pain," Dr. Torgerson said. The study was published November 1 in the Annals of Internal Medicine. Benefit "Sustained" The study involved 313 adults with chronic or recurrent low back pain. All of them received a back pain education booklet and usual care. In addition, 156 were offered Iyengar yoga classes (12 classes total, once weekly). The yoga classes were given by 12 yoga teachers who had extra training in back care. Each class lasted 75 minutes. In a statement, Iyengar yoga teacher and study investigator Alison Trewhela, DBL, said: "Yoga aims to treat the whole person — not just the physical." The yoga program offers "poses for pain-relief and mental calming; mobilizing, stretching, strengthening and relaxation; improving awareness of posture; education about how a healthy back functions; and positive mental focus," she explained. Sixty percent of patients in the yoga group attended at least 3 of the first 6 sessions and at least 3 other sessions. In the first 3 months, 82% said they practiced yoga at home on their own, 65% were practicing yoga at home at 6 months, and 60% were practicing yoga at home at 12 months. The researchers report that the yoga group had better back function at 3 months (the primary outcome) and at 6 and 12 months (secondary outcomes) than the usual care group. "Although there is no consensus, a change of 1.1 to 2.5 on the RMDQ has been recommended as clinically important," the investigators note in their report. "In this trial, we found that individuals offered yoga benefited from, on average, 2.17 fewer limited activities at 3 months and by 1.57 fewer limited activities at 12 months." They note that they were missing data for the primary outcome for 21 yoga participants and 18 usual care participants, and differential missing data were observed (more so in the yoga group) for secondary outcomes. The yoga and the usual care groups had similar back pain and general health scores at 3, 6, and 12 months, and the yoga group had higher scores on the Pain Self-Efficacy Questionnaire at 3 and 6 months, but not at 12 months. Twelve (8%) of the 156 yoga patients reported adverse events; 1 adverse event was deemed as serious and possibly or probably related to yoga (the patient had experienced severe pain but had a history of severe pain after any physical activity). The other 11 adverse events in the yoga group were nonserious and were mostly related to increased pain. Adverse events were reported in 2 (1%) of the 157 patients in the usual care group (1 accident/injury, 1 death). Yoga Comparatively Effective Other interventions for low back pain that have been evaluated in randomized controlled trials include exercise and manipulation, the Alexander technique, and cognitive behavioral therapy, Dr. Torgerson and colleagues note in their report. Comparing the findings of their study with these other techniques, they say, "suggests that group yoga may improve back function (as measured by the RMDQ) more than exercise and manipulation, cognitive behavioral treatment, and 6 sessions of 1-on-1 Alexander technique but not as much as 24 sessions." They caution, however, against "overanalyzing these results because the comparisons are indirect." Further research is needed to compare yoga directly with these other treatments, they say. Additional support for yoga in chronic back pain comes from a study published online October 24 in the Archives of Internal Medicine. As reported by Medscape Medical News, the study found that stretching, regardless of whether it is achieved via yoga classes or conventional stretching exercises, has moderate benefits in adults with moderately impairing chronic low back pain. In a comparative effectiveness study, the researchers found that yoga classes were more effective than a self-help book, but not more effective than stretching classes, in improving function and reducing symptoms resulting from chronic low back pain, with benefits lasting at least several months. The author of a comment on the article in the Archives of Internal Medicine called the results from this trial "actionable" for practice because they reinforce the evidence that exercise is safe and moderately beneficial for chronic low back pain. "Health care providers should feel comfortable referring patients to either yoga or [physical therapy–]led classes; either seems to be helpful," writes Timothy S. Carey, MD, MPH, from the Sheps Center for Health Services Research, University of North Carolina, Chapel Hill. The current study was supported by Arthritis Research UK. Disclosures can be viewed on the journal's Web site. Ann Intern Med. 2011;155:569-578. Abstract

Explaining Gender Differences in Non-fatal Suicidal Behaviour Among Adolescents

From BMC Public Health Explaining Gender Differences in Non-fatal Suicidal Behaviour Among Adolescents A Population-based Study Michael Kaess; Peter Parzer; Johann Haffner; Rainer Steen; Jeanette Roos; Martin Klett; Romuald Brunner; Franz Resch Posted: 09/27/2011; BMC Public Health. 2011;11(597) © 2011 BioMed Central, Ltd. Background While suicide is the second leading cause of death among young people in most industrial countries, non-fatal suicidal behaviour is also a very important public health concern among adolescents. The aim of this study was to investigate gender differences in prevalence and emotional and behavioural correlates of suicidal behaviour in a representative school-based sample of adolescents. Methods A cross-sectional design was used to assess suicidal behaviour and various areas of emotional and behavioural problems by using a self-report booklet including the Youth Self-Report. One hundred sixteen schools in a region of Southern Germany agreed to participate. A representative sample of 5,512 ninth-grade students was studied. Mean age was 14.8 years (SD 0.73); 49.8% were female. Results Serious suicidal thoughts were reported by 19.8% of the female students and 10.8% of the females had ever attempted suicide. In the male group, 9.3% had a history of suicidal thoughts and 4.9% had previously attempted suicide. Internalizing emotional and behavioural problems were shown to be higher in the female group (difference of the group means 4.41) while externalizing emotional and behavioural problems slightly predominated in male students (difference of the group means -0.65). However, the total rate of emotional and behavioural problems was significantly higher in the adolescent female group (difference of the group means 4.98). Using logistic regression models with suicidal thoughts or attempted suicide as dependent variables, the pseudo-R2 of gender alone was only 2.7% or 2.3%, while it was 30% or 23.2% for emotional and behavioural problems measured by the YSR syndrome scales. By adding gender to the emotional and behavioural problems only an additional 0.3% of information could be explained. Conclusions The findings suggest that gender differences in non-fatal suicidal behaviour among adolescents can to a large extent be explained by the gender differences in emotional and behavioural problems during this age. Background Suicide and non-fatal suicidal behaviour are both well-recognized public health problems in young people.Whereas the prevalence of suicide and suicidal behaviour remains relatively low before puberty, adolescent suicide is one of the leading causes of death in the teenaged group.In Europe, suicide is the second leading cause of death in male and female adolescents. In the USA, suicide is reported to be the third leading cause of death after accidents and homicides.According to the findings of a WHO multi-centre study conducted in young people 15 to 24 years of age, the increase in suicide has been shown to be associated with an increase in suicide attempts. Results of a systematic review of 128 studies on the prevalence of suicidal phenomena in adolescents revealed that, on average, 9.7% (95% CI 8.5 to 10.9) of adolescents reported to have attempted suicide while even 29.9% (95% CI 26.1 to 33.8) of these adolescents indicated having thought about suicide at some point in their life. One of the strongest predictors of completed suicide or further suicide attempt has been found to be a previous suicide attempt. Therefore, suicide attempts and also suicidal thoughts in adolescents must always be taken seriously, in spite of the fact that for every death of a young person from suicide, many suicide attempts have already been undertaken, especially by girls. In most western countries, females are more likely to engage in suicidal behaviour, but are less likely to die as a result of a suicidal act than males. This "gender paradox" is known to be extremely distinctive in adolescents; during this period of life suicide attempts are 3–9 times more common in girls while completed suicides rates are 2–4 times higher in adolescent males. Many epidemiological studies so far have reported higher rates of non-fatal suicidal behaviour in females which could indicate a gender-specific predisposition for the experience of suicidal thoughts and suicide attempts during this life-period. As regards mental illness as one of the strongest risk factors for suicidal behaviour, depression and anxiety in particular seem to function as mediators of adolescent suicidal behaviour. But drug abuse, risk behaviours and other types of externalizing psychopathological behaviours are also associated with an increased risk of suicide among adolescents. There is only little empirical research which investigated the reasons underlying the correlation of being female and showing higher rates of suicidal thoughts and suicide attempts during adolescence. One theory is that gender differences in psychopathology could play an important role in this issue, suggesting that different types and characteristics of emotional and behavioural problems may primarily lead to unequal rates of suicidal behaviour in female and male individuals. Therefore, our hypothesis was that gender differences in non-fatal suicidal behaviour among adolescents could mainly be explained by the gender differences in emotional and behavioural problems.

Losing Weight by Midlife Reduces CVD Risk

From Heartwire Harvard alumni study of early and midlife coronary disease risk Reed Miller October 26, 2011 (Cambridge, Massachusetts) — A study of Harvard alumni shows that obesity early in life does not portend a coronary disease death in people who reach a healthier weight by their mid-40s. The National Institutes of Health–sponsored Harvard Alumni Health Study has followed nearly 19 000 men who began regular medical examinations during their undergraduate years at Harvard University between 1916 and 1950. The median follow-up period was 56.4 years and the maximum was 82.5 years. The authors report their findings in the October 24, 2011 issue of the Archives of Internal Medicine. Investigators Dr Linsay Gray (Medical Research Council, Glasgow, Scotland) and colleagues found that Harvard men who were obese in early adulthood had twice the risk of dying from coronary disease as men with a normal body-mass index as young men (18.5 to 28 years). The association between obesity as young men and cardiovascular mortality later on held even after adjustment for confounding variables in early adulthood such as smoking and physical activity and after adjustment for midlife risk factors including type 2 diabetes and hypertension. However, the link seen between early obesity (18.4 years) and later coronary disease death disappeared after taking into account midlife body-mass index (46.1 years), suggesting that men who were obese when they were young can reduce their risk by reaching a normal weight by middle age. The authors caution that their results should be replicated in more studies with a broader population. Commenting on the study, Archives editor Dr Rita Redberg (University of California, San Francisco) writes that this study "brings us some reason for hope that efforts to address childhood obesity are well worth it, [and] it is never too late to adopt healthy lifestyle changes."

Chest X-Ray Screening Does Not Reduce Lung Cancer Mortality

From Medscape Medical News Laird Harrison October 26, 2011 (Honolulu, Hawaii) — The largest study yet to examine the issue shows that screening with chest radiographs does not reduce mortality from lung cancer, researchers reported here at CHEST 2011: American College of Chest Physicians Annual Meeting. The results, which were also published online October 26 in JAMA, confirmed earlier research on the issue but still came as a disappointment. "We were hopeful the chest X-rays we did would make a difference," coauthor Paul A. Kvale, MD, told Medscape Medical News. Putting these findings together with a those of study published in August in the New England Journal of Medicine, health policy groups are likely to recommend screening with low-dose computed tomography (CT), but not chest X-ray, and only for patients at high risk for lung cancer, said Dr. Kvale, a pulmonologist at Henry Ford Hospital in Detroit, Michigan. For the current study, part of the Prostate, Lung, Colorectal and Ovarian Cancer Cancer Screening Trial, researchers enrolled 154,901 participants aged 55 through 74 years. "This was the biggest study of its kind ever done," said Dr. Kvale. The investigators randomly assigned 77,445 of the patients to receive annual screenings with chest X-rays, and 77,456 to receive usual care, at 1 of 10 centers across the United States between November 1993 and July 2001. They offered participants in the screening group annual posterio-anterior view chest radiographs for 4 years. The participants in the usual care group were not offered screenings as part of the study, although 11% undertook chest X-rays independent of the study. Between 79% and 87% of the participants in the screening group got the X-rays offered each year. Researchers followed-up the patients for a maximum of 13 years until December 31, 2009. They tallied a lung cancer incidence of 20.1 per 10,000 person-years in the screening group and 19.2 per 10,000 person-years in the usual care group, for a rate ratio (RR) of 1.05 (95% confidence interval, 0.98 - 1.12). They counted 1213 deaths from lung cancer in the screening group compared with 1230 in the usual care group, for an RR of 0.99 (95% confidence interval, 0.87 - 1.22). The study avoided problems of previous studies, such as a large number of screenings in the control group, but still came up with the same bottom line, said Dr. Kvale. Another important aspect of the study was its analysis of a subgroup of patients who were at high risk for lung cancer because of their age, smoking, and other factors. Just as in the study as a whole, researchers randomly assigned 15,183 members of this subgroup to screening, and the same number to usual care. After 6 years of follow-up, 518 members of the high-risk screening group got lung cancer, and 316 died of the disease. In the high-risk usual care group, 520 got lung cancer and 334 died of it, for an RR of 0.94 (95% confidence interval, 0.81 - 1.10). The high-risk group was intentionally selected to match a high-risk group in the National Lung Screening Trial, published in the New England Journal of Medicine. In that study, researchers compared high-risk participants screened with chest X-rays with high-risk patients screened with low-dose CT. They concluded that the low-dose CT screening reduced the mortality rate of these patients by 20%. If low-dose CT screening is 20% better than X-ray screening, and X-ray screening is the same as usual care, then it would be logical to assume that CT screening is 20% better than usual care. However, more statistical analysis should be done before reaching that conclusion, writes Harold C. Sox, MD, from Dartmouth Medical School in West Lebanon, New Hampshire, in an editorial published along with the study in JAMA. New studies should directly compare usual care to low-dose CT-screening, Dr. Sox writes. Still, the findings are already being taken into consideration by a coalition of groups working on new guidelines for lung cancer screening, said Frank C. Deterrbeck, MD, chief of thoracic surgery at Yale University, New Haven, Connecticut, and cochair of the coalition. The coalition, made up of the American College of Chest Physicians, the American Cancer Society, the American Society of Clinical Oncology, the National Comprehensive Cancer Network, and to a lesser extent, the American Thoracic Society, will publish new guidelines within a few months, Dr. Deterrbeck told Medscape Medical News. However, he would not confirm that the guidelines will call for low-dose CT screening for everyone who is at high risk for lung cancer. "I think there is a potential benefit, as well as a potential harm," he said. "Selection of the appropriate population is something we have to pay careful attention to." Although low-dose CT poses a low risk from radiation, it often leads to other diagnostic procedures, some of which may not be necessary. "Low-dose CT picks up a lot of stuff that's nothing," he said. On the basis of the low-dose scans, patients may be referred for regular CT, with its higher doses of radiation, and for biopsies, which can cause complications. The cost questions are complicated, too, Dr. Deterrbeck said, as the expense of the screening must be weighed against the costs that are saved in treatment costs if cancer is caught earlier. However, the short-term implications of the study are clear, he said. "We have not employed X-rays as a screening tool for lung cancer, and I guess we won't." Dr. Kvale and Dr. Detterrbeck have disclosed no relevant financial relationships. Dr. Sox has disclosed that he is an unpaid member of advisory boards for the Southwest Oncology Group and the Fred Hutchinson University of Washington Cancer Consortium. JAMA. Published online October 26, 2011. Full text, Editorial CHEST 2011: American College of Chest Physicians Annual Meeting: Session 7225. Presented October 26, 2011.

Physical Activity Cuts Risk for Invasive Breast Cancer

From Medscape Medical News > Oncology Roxanne Nelson October 26, 2011 (Boston, Massachusetts) — Data supporting the association between physical activity and a reduced risk for breast cancer are increasing. Adding to these data are the results of a large European study, presented here at the Tenth Annual American Association for Cancer Research International Conference on Frontiers in Cancer Prevention Research. When the researchers compared the highest and lowest quartiles of physical activity, the risk for invasive tumors was inversely associated with high levels of total physical activity (hazard ratio [HR], 0.85; P trend < .001), especially recreational activity (HR, 0.88; P < .001). However, no association was seen between in situ carcinoma and any of the physical activity variables. The researchers also looked at the effect of physical activity on breast cancer risk by receptor status, and note that this is the largest prospective study to do so. Previous studies investigating this issue have yielded inconsistent results, explained study author Karen Steindorf, PhD, from the German Cancer Research Center in Heidelberg. The researchers found a significant protection of physical activity only for the estrogen-receptor (ER)-positive and progesterone-receptor (PR)-positive tumor types, said Dr. Steindorf. "These findings strengthen the hypothesis that lowering breast cancer risk with physical activity is at least partly related to hormonal pathways." The association between breast cancer risk and physical activity also differed by menopausal status. "There were significant risk reductions in postmenopausal breast cancer," she said, adding that the risk reductions were a little lower in premenopausal women. Among postmenopausal women, the risk reduction was significant for both total physical activity (HR, 0.81; P = .002) and recreational activity (HR, 0.89, P = .005). These results were slightly less robust for premenopausal breast cancer for total physical activity (HR, 0.87; P = .082) and for recreational activity (HR, 0.84; P = .032). "I would say that this adds to the evidence of what we have already seen in other research — that physical activity may reduce the risk of breast cancer," said Karen T. Liby, PhD, research assistant professor of medicine at Dartmouth Medical School, Hanover, New Hampshire, who was not involved in the study. "But it seems to be effective only in receptor-positive cancers." Exercise Linked to Lower Risk As previously reported by Medscape Medical News, postmenopausal women who maintain a regular moderate to vigorous exercise program can reduce their risk for breast cancer by 20% to 40%. In addition, research has shown that physical activity can reduce the risk in premenopausal women; among the most active women, risk reduction can be as high as 23%. Other data have shown that obesity and lack of physical activity can increase the risk for triple-negative breast cancer. Protective Effects Confirmed Dr. Steindorf and colleagues used data from the European Prospective Investigation Into Cancer and Nutrition (EPIC), a large study designed to investigate the relation between diet, nutritional status, and lifestyle and environmental factors and the incidence of cancer and other chronic diseases. The trial has recruited 520,000 people from 10 European countries. Detailed information on recreational household physical activity, occupational physical activity, and other variables was assessed in a baseline examination conducted between 1992 and 2000. The cohort in this trial involved 283,680 women; within this group, at a median follow-up of 11.7 years, there were 9947 incident breast cancer cases, including 1060 cases of in situ carcinoma. Of the 8887 invasive breast cancer cases, it was possible to assess the ER status of the tumor in 6007 cases (67.6%), the PR status in 4814 cases (54.2%), and the combined status in 4798 cases (53.9%). When analyzed by hormone-receptor status, stronger effects of total physical activity were seen for ER-positive/PR-positive breast tumors than for other combinations (P = .043 for heterogeneity). A more detailed analysis revealed that it was primarily the PR status (P = .006 for heterogeneity), not the ER status (P = 0.235 for heterogeneity), that dominated this result. The protective effect of physical activity on breast cancer risk is confirmed with these results, note the researchers. "The results of this largest prospective study on physical activity and different hormone-receptor status indicate that physical activity primarily reduces the risk for PR-positive and ER-positive/PR-positive tumors," they conclude. Tenth Annual American Association for Cancer Research (AACR) International Conference on Frontiers in Cancer Prevention Research. Presented October 24, 2011.

PSA Screening: USPSTF Review

From Medscape Education Clinical Briefs Draft Guidelines Recommend Against PSA Screening: USPSTF Review CME/CE News Author: Zosia Chustecka CME Author: Charles P. Vega, MD Clinical Context Few topics in the field of preventive medicine are contentious as prostate cancer screening. Widespread screening for prostate cancer has had a remarkable effect on the epidemiology of this tumor, as demonstrated in a study by Welch and Albertsen published in the October 7, 2009, issue of the Journal of the National Cancer Institute. Their study found that the introduction of routine prostate cancer screening led to approximately 1.3 million more men being diagnosed with prostate cancer in the United States alone. Men younger than 60 years accounted for most of this surge in cases. The authors estimated that more than 20 additional men would have to be diagnosed with prostate cancer through screening to result in a single case of reduced mortality risk from prostate cancer. These findings are fairly pessimistic regarding the value of prostate cancer screening. The current study commissioned by the US Agency for Healthcare Research and Quality provides a more complete review of important issues in screening for prostate cancer. Study Synopsis and Perspective The US Preventive Services Task Force issue draft recommendations against routine screening for prostate cancer using the prostate-specific antigen (PSA) test in the United States, where it is currently used more than in any other country in the world. As a result, prostate cancer is the most commonly diagnosed cancer in American men. The USPSTF draft recommendation against routine screening with the PSA test was to have been published October 11 in the Annals of Internal Medicine, but the entire draft paper was leaked and posted October 6 on the Cancer Letter Web site, in "an egregious breach of our embargo and media policies," according to the journal. The news has since been widely disseminated on the Internet; as a result, the journal published the paper early. The USPSTF already recommends against routine PSA screening in men older than 75 years. In the new draft recommendation, it extends this to all men. It now recommends against routine screening in men younger than 75 years, giving this a "D" rating, which means "there is moderate or high certainty that the service has no benefit or that the harms outweigh the benefits." The news is likely to spark a furor in medical circles, not unlike the outcry that followed the USPSTF's recommendation in 2009 against routine mammography screening for breast cancer in women younger than 50 years. This provoked outrage from some breast cancer experts, patient advocates, and professional societies, with accusations that this was a move toward the "rationing" of healthcare. Angry reactions to the latest news have already begun. The "decision of no confidence on the PSA test by the US government condemns tens of thousands of men to die," said Skip Lockwood, CEO of ZERO, the Project to End Prostate Cancer. ZERO is sponsored by many organizations with a stake in prostate cancer, such as Abbott, Beckman Coulter, Accuray, CyberKnife, Dendreon, and the American Urological Association (AUA). Based on Reviews of Trials The recommended change is based on a review of 5 randomized trials of screening and 3 trials and 23 cohort studies of treatments. Included in the review were the 2 largest trials of PSA screening, which reported conflicting results, the USPSTF notes. The European study found a reduction in mortality after 9 years of screening, but the American trial, which had high crossover and contamination rates, found no reduction in mortality after 10 years of screening, as previously reported by Medscape Medical News. The review also noted that treatment for prostate cancer, such as prostatectomy and radiation, is associated with risks for problems such as erectile dysfunction, urinary incontinence, and bowel dysfunction. The USPTSF concludes that "after about 10 years, PSA-based screening results in small or no reduction in prostate-cancer-specific mortality and is associated with harms related to subsequent evaluation and treatments, some of which may be unnecessary." Delay in Announcement This recommendation has been a long time coming, according to reports in the October 7 issue of the Cancer Letter and in the New York Times magazine. They assert that the timing of the release of this recommendation was influenced by political considerations. According to these reports, the task force first voted to recommend against routine PSA screening back in November 2009, but this "caused a violent political firestorm," and subsequent follow-up meetings were cancelled. The final vote was taken in March. After this, a paper summarizing the recommendation was submitted to the Annals of Internal Medicine, where is it expected to appear next week. PSA Test is Not Specific The main problems with the PSA test are that it is not specific for prostate cancer and it cannot differentiate between aggressive and indolent forms of the disease. "It cannot distinguish cancer that will never make a difference in a man's lifetime from cancers that will make a difference," so might prompt men to undergo aggressive treatment unnecessarily, Virginia Moyer, MD, MPH, chair of the USPTSF panel that made the recommendation, stated in an interview yesterday with Bloomberg News. "So you go from being a guy who feels fine and who is potentially one of the majority who would never have known they had this disease, to being a guy who wears adult diapers," she said. Dr. Moyer is a professor of pediatrics at Baylor College of Medicine in Houston, Texas. The PSA test is "hardly more effective than a coin toss," said Richard Ablin, PhD, research professor of pathology at the University of Arizona College of Medicine in Tucson. Dr. Ablin discovered PSA in 1970. Using this test to screen for prostate cancer in the general population has been a "hugely expensive public health disaster," he wrote in an opinion piece in the New York Times last year. "Drug companies continue peddling the tests, and advocacy groups push 'prostate cancer awareness' by encouraging men to get screened," he wrote. "The medical community must confront reality and stop the inappropriate use of PSA screening," he stated. "Doing so would save billions of dollars and rescue millions of men from unnecessary, debilitating treatment." Although PSA testing is recognized as being imperfect, it is the only test for prostate cancer that is widely available, and it does provide information that can be useful, proponents point out. One of the professional bodies that has long supported the use of the test, the AUA, emphasizes that it should not be used on its own, but needs to be combined with other information (such as family history). The AUA issued a statement in reaction to the new USPSTF recommendations: "We are concerned that the Task Force's recommendation will ultimately do more harm than good to the many men at risk for prostate cancer, both here in the United States and around the world." "The AUA's current clinical recommendations support use of the PSA test, and it is our feeling that, when interpreted appropriately, the PSA test provides important information in the diagnosis, pretreatment staging or risk assessment, and posttreatment monitoring of prostate cancer patients," according to the statement. "Not all prostate cancers require active treatment and not all prostate cancers are life-threatening," the statement points out, and the decision of whether to proceed to active treatment or whether surveillance is an option needs to be discussed in detail with the patient. The Agency for Healthcare Research and Quality supported this study. Author disclosure information is available on the Annals of Internal Medicine Web site. Ann Intern Med. Published online October 7, 2011.

Testosterone May Not Treat ED

From WebMD Health News Study: Testosterone May Not Treat ED Denise Mann October 24, 2011 — Many men may be taking supplements of the male sex hormone testosterone to boost their sex drive, but it may not be that helpful after all. A new study of men 60 and older who had low or borderline low levels of testosterone showed that testosterone replacement therapy did not improve erectile dysfunction (ED) or their ability to achieve and maintain an erection, compared to a placebo gel. Men who used either a low dose or a conventional dose of testosterone gel showed no improvements in their sexual function during the course of the year-long study, compared with men who used placebo gel. The findings were presented at the annual meeting of the American Society for Reproductive Medicine in Orlando, Fla. "It appears that testosterone supplementation will not improve ED, though it may have other benefits on sexual function that were not evaluated with this data," says study researcher Lauren W. Roth, MD, an obstetrician/gynecologist at the University of Colorado in Denver, in an email. Sexual function is one of many reasons that many men are turning to testosterone therapy. With a laundry list of promises from a boost in sex drive and more energy to an increase in muscle mass and mental acuity, testosterone therapy can be tempting for many men who want to feel and look younger than they do. But, according to some experts, the hormone may be more harmful than helpful for some men. "I am quite concerned about the rampant use of testosterone replacement therapy for very soft indications," says Rebecca Sokol, MD. She is a professor of medicine and obstetrics and gynecology and the director of the andrology program at the Keck School of Medicine of the University of Southern California in Los Angeles. "It is very much a buyer beware situation." "We have to be very cautious about who we do and do not start on testosterone," Sokol says. Risks of Testosterone Supplements There are risks attached to the use of testosterone, Sokol says. "This hormone may cause the prostate gland to increase in size, and there is also the theoretic risk that we can stimulate the growth of cancer cells in the prostate. We have been looking carefully to see if testosterone initiates prostate cancer and there is no data to indicate that it does at this point." Testosterone may also increase levels of LDL "bad" cholesterol while decreasing levels of HDL "good" cholesterol, she says. Men who are considering taking testosterone need to weigh the pros and cons carefully with their doctor. "The patient really needs to be evaluated by a physician who is an expert in hormones and male reproduction," Sokol says. "The indication for treatment needs to be very clear and verified by evaluation and physical exam." Checking for Low Levels of Testosterone Part of the problem is that men are getting their testosterone from non-expert sources, including their buddies in the gym and online, says Joseph P. Alukal, MD. He is an assistant professor of urology and the director of male reproductive health at New York University's Langone Medical Center in New York City. Testosterone replacement does have a role in treating some men with erectile dysfunction who also have low levels of the hormone, he says. "Testosterone is one of the treatments we have, but it's not the only one." The first step is to measure a man's testosterone levels to see if they are low. This needs to be done on more than one occasion to make sure the results are accurate, he says. If levels are low, and there are no other health problems that may be causing the problems with sexual functioning, testosterone replacement therapy is an option, Alukal tells WebMD. In some men, ED can be a red flag for heart problems. In these cases, men will likely need to see a cardiologist, he says. "Hormones are powerful," Alukal says. "They have tremendous benefits and significant risks, so to go on them requires proper monitoring by a physician who understands their risks and benefits and knows how to monitor men." Doctors who prescribe testosterone should monitor the prostate gland closely, he says. "We know that there is some relationship between testosterone and the growth of the prostate and the development of prostate cancer, but we don't fully understand the relationship," Alukal tells WebMD. SOURCES: Lauren W. Roth, MD, ob-gyn, University of Colorado, Denver. Joseph P. Alukal, MD, assistant professor of urology; director of male reproductive health, New York University Langone Medical Center. Annual Meeting of American Society for Reproductive Medicine, Orlando, Fla. Oct. 15-19, 2011. Rebecca Sokol, MD, professor of medicine and obstetrics and gynecology; director of andrology program, Keck School of Medicine, University of Southern California, Los Angeles.