PSA Test
PSA Test a Thing of the Past? MONDAY, May 10 (HealthDayNews) — The PSA test, long the gold standard for deciding who should have a biopsy for prostate cancer, may have outlived its usefulness for the most part.
Stanford University researchers say PSA (prostate specific antigen) levels bear little relationship to the severity of a cancer these days. They presented their finding May 9 at the American Urology Association’s annual meeting in San Francisco.
“”We need to recognize that PSA is no longer a marker for prostate cancer,”" said study author Dr. Thomas A. Stamey, a professor of urology at Stanford University School of Medicine. “”We urgently need to find a new marker for prostate cancer, and that marker must be proportional to how much cancer you have.”"
“”We have been so thorough and effective in screening for prostate cancer over this 20-year period that PSA no longer has a relationship to prostate cancer,”" Stamey said. “”Because we all develop the cancer, we’re now removing prostates from men whose cancer is so small that they do not need the procedure. We’re finding all these little cancers that are never going to be a danger to the patient.”"
“”In smaller cancers, the PSA test is not relevant anymore,”" Stamey explained. “”You might as well biopsy a man because he has blue eyes.”"
PSA is a protein produced by the cells of the prostate gland. Because blood levels of the antigen tend to rise as the gland enlarges, it has been used for years as a test of whether a person needs a biopsy for cancer. The test, however, is not foolproof.
“”People’s perceptions [are] that if your PSA is a certain level, you’re very likely or you do have prostate cancer, and that is incorrect,”" said Dr. Mark Soloway, chairman of the department of urology at the University of Miami School of Medicine.
“”The PSA test is a very good test. It’s not a perfect test, especially in younger men,”" added Dr. Jay Brooks, chief of hematology/oncology at the Ochsner Clinic Foundation in New Orleans.
To see how the efficacy of the PSA test might have waned, researchers in Stamey’s lab reexamined every prostate that had been removed since 1983 (1,317 of them) and compared the size of the cancer with blood PSA levels. None of the cancers had been treated with chemotherapy, radiation, or hormones before surgery.
Each cancer was rated on eight or 10 different parameters thought to indicate how aggressive the cancer was, including the size of the tumor and its grade.
Stamey then divided the samples into four five-year periods to see what had happened to the qualities of the cancers over time.
“”What we showed was that in the first five years, the cancers were related to the level of serum PSA,”" Stamey said. “”Then in the next five years, they were still bad but not as bad as the first five years. Then in the third five-year period, they were better and better. And in the last five years ending Jan. 1 of this year, the cancers were so small they had no relationship to serum PSA.”"
Twenty years ago, 80 percent of cancers were detected by digital rectal examination; only 20 percent of cancers are now detected that way, Stamey explained.
Instead, PSA levels today are driven by benign enlargement of the prostate, a condition that does not usually require surgery.
The concept that the PSA test is not foolproof is not an entirely new one. “”The point is well taken that in microscopic disease, the volume of cancer is clearly overshadowed by the volume of noncancer, so that the cancer cannot be the cause of the elevated PSA,”" said Dr. John Phillips, physician-in-charge of urologic oncology at Beth Israel Medical Center in New York City.
The question now is what can replace it. “”People are trying to find other ways of finding cancer,”" Phillips added.
As a matter of fact, University of Pittsburgh researchers who presented at the same conference reported that additional testing for a protein called early prostate cancer antigen (EPCA) might mean prostate cancer could be detected as many as five years earlier than with just the PSA test.
“”We would like a perfect test that would only find biologically significant cancers,”" Soloway said. “”Today we can’t distinguish between those with indolent cancer and those whose cancers threaten their life. We need another way. That’s going to be a difficult task.”"
In the meantime, the American Urological Association issued a statement that, for the time being, the PSA test in combination with a digital rectal exam and a full medical history is the best way to determine when a biopsy might be necessary
Pine Bark Extract Boosts Heart Health
Pine Bark Extract Boost Diabetics’ Heart Health May 13, 2008
Supplements of extracts from French maritime pine bark reduce blood pressure and the use of blood pressure medication among diabetics, concludes results from a new study.
Blood pressure control was achieved in 58 per cent of study participants, and a halving of the use of medication, among 48 participants randomly assigned to daily supplements of pine bark extract or placebo for 12 weeks. The results of the new study, published in the May issue of the journal Nutrition Research, is of particular importance for diabetics who are reportedly two to four times more likely to suffer from heart disease than non-diabetics “”These data confirm the hypothesis that pine bark extract improves diabetes control, reduces antihypertensive medicine use, and may favour a reduction in cardiovascular disease risk in individuals with type 2 diabetes,”" wrote lead author Sherma Zibadi from the University of Arizona. Indeed, previous studies have reported potential health benefits for the extract, including hypertension, asthma, chronic venous insufficiency, osteoarthritis, deep vein thrombosis, diabetes management, and diabetic leg ulcers. The new study recruited diabetic subjects with an average age of 60 and randomly assigned them to receive daily supplements of pine bark extract (125 mg) or placebo for 12 weeks in a randomized, double-blind, placebo-controlled trial with parallel-group design. All subjects were receiving pharmaceutical anti-hypertension treatment (angiotensin- converting enzyme [ACE] inhibitors). At the end of the study, Zibadi and co-workers report that 58.3 per cent of subjects in the pine bark extract group experienced blood pressure control, defined as attaining a stable systolic blood pressure, compared to 20.8 per cent in the placebo group. Moreover, use of ACE inhibitors was reduced by 50 per cent in the group receiving the pine bark extract Improvements in measures of diabetes control were also recorded, with a 23.7 mg/dL reduction in fasting blood glucose levels in the pine bark extract group, compared to only 5.7 mg/dL in the placebo group. Improvements in LDL-cholesterol, a marker of cardiovascular health, were recorded in the pine bark extract-supplemented group. After eight and 12 weeks of supplementation, decreases of 11.6 and 12.7 mg/dL were observed, respectively, compared with placebo. Mechanism of Action In attempting to understand the benefits of the pine bark extract on cardiovascular health of the diabetics, the researchers noted that the blood pressure lowering effects may be due to a suppression of serum endothelin-1, a protein that restricts blood vessels and reported to be found in higher levels than normal in type 2 diabetics and hypertensives. On the other hand, the authors could not rule out the potential of an inhibitory effect on ACE, which could improve blood flow and subsequently blood pressure. Finally, other studies have reported a potential benefit from pine bark extract on the production of the potent vasodilator, nitric oxide (NO). Limitations About 26.5 million people are affected by diabetes in the European Union, United States, and Canada equal to four per cent of the total population. This figure is projected to increase to 40 million by 2030. In the US, there are over 20 million people with diabetes, equal to seven per cent of the population. The total costs are thought to be as much as $132 billion, with $92 billion being direct costs from medication, according to 2002 American Diabetes Association figures.
Source: Nutrition Research (Elsevier) May 2008, Volume 28, Issue 5, Pages 315-320 “”Reduction of cardiovascular risk factors in subjects with type 2 diabetes by Pycnogenol supplementation”" Authors: S. Zibadi, P.J. Rohdewald, D. Park, R.R. Watson
Resistence to Antibiotics on Rise in US
By Serena Gordon HealthScoutNews Reporter FRIDAY, April 19 (HealthScoutNews) — In the wake of a new report that the strep throat germ is now showing significant antibiotic resistance in the United States, many people are wondering if they — or their children — are at risk. They just might be, unless all of us our dependence on antibiotics, says Philip Tierno, director of clinical microbiology at New York University Medical Center and Mt. Sinai Medical Center in New York City. “”Antibiotic resistance is more prevalent than you’d think,”" Tierno adds. There are two main reasons for it: Overprescription of antibiotics by doctors and the use of antibiotics in livestock, he says.
“”One hundred and fifty million prescriptions are written annually,”" Tierno says. “”Ninety million of those are for antibiotics, and 50 million of those are unnecessary.”" Many antibiotic prescriptions are written for sore throats, but only a small percentage of them are caused by Group A streptococci bacteria, which causes strep throat. The germ can also cause sinus, ear and skin infections. Left untreated, strep can progress into scarlet fever or the more serious rheumatic fever, with potentially fatal consequences. Young children are especially vulnerable to such complications. Strep throat is commonly treated with antibiotics, such as penicillin, or erythromycin for those who are allergic to penicillin. In yesterday’s New England Journal of Medicine report, researchers from Children’s Hospital of Pittsburgh studied a group of 100 area school children from kindergarten through eighth grade. They found that Group A streptococci was resistant to erythromycin in 48 percent of the throat cultures taken between October 2000 and May 2001. According to the researchers, this is the first time such a high level of resistance to erythromycin has been found in the United States. Similarly high levels of resistance have been reported in other countries, however, Tierno says. In Japan and Finland, he says, resistance to Group A strep has been reported at levels exceeding 50 percent. The good news, according to Tierno, is that in Japan the rate of resistance has fallen as health officials there decreased their use of erythromycin-based antibiotics. By not using these drugs, Tierno explains, the germs become vulnerable to them again. The Pittsburgh researchers followed the children for three years, and during the first two years, while they did find cases of strep, they found no signs of antibiotic resistance. It wasn’t until the third year that the antibiotic-resistant strain appeared. Tierno says this finding clearly points to overuse of antibiotics. “”What causes drug resistance is the inappropriate use of antibiotics by physicians,”" he says. But patients are partly to blame as well, he adds, because they push for inappropriate prescriptions when they’re ill. Dr. James Musser is chief of the Laboratory of Human Bacterial Pathogenesis at the National Institute of Allergy and Infectious Diseases in Hamilton, Mont. He says, “”From a national perspective, we need to be very concerned about increasing antibiotic resistance in any pathogen.”" And, he adds, we need a study that looks at a greater geographical area to assess how widespread the problem [uncovered in Pittsburgh] might be. In the meantime, he says, “”It’s important for patients to realize that not every upper-respiratory infection is of bacterial origin and to listen closely to the advice of the treating physician.”" That means patients shouldn’t badger their doctor for antibiotics unless they’re deemed necessary.
Probiotics for Health
Probiotics for Health By S.K. Dash, Ph.D.
Many health-conscious consumers today want to know when they should take probiotics. They ask whether they should wait until they are sick. If so, they ask, which illnesses respond best to probiotics? Or should they take a preventive approach and take probiotics before they get sick? What about use of probiotics with antibiotics? Today, there is no doubt that taking probiotics is as essential as a multivitamin to your health. So my reply to such questions is that a daily supplement should always be taken to maintain healthy immune and digestive function — but the supplement amount should be increased during times of stress and illness. But let’s start at the beginning.
Probiotics — What Are They?
The concept of ingesting live microorganisms for the purpose of improving one’s intestinal health and general well being can be traced back well before the beginning of the Twentieth Century to earlier eras when most foods were nonrefrigerated and instead preserved with fermentation. But the current practice of using beneficial organisms to improve and sustain health is now referred to as probiotic supplementation. Although numerous types of bacteria (and yeasts) are currently being marketed as probiotic cultures throughout the world, the two most commonly used ones are Lactobacillus and Bifidobacterium.
Probiotics — A Health Essential?
Consumers rarely consider how essential healthy bacterial populations are to their health. But the fact is that a healthy ratio of beneficial to pathogenic bacteria residing within the gastrointestinal tract is essential to good health and influences not only digestive health but also immune function, detoxification, and women’s vaginal health. Unfortunately, great numbers of people today no longer have optimally balanced ratios of beneficial to pathogenic bacteria in their body, thus allowing the “”bad guys”" to gain the upper hand. This is very dangerous and one of the reasons that digestive illnesses, as well as other types of illnesses, are becoming so prevalent. Medically prescribed antibiotic use is certainly one of the most important causes of this change in our natural flora, with travel to foreign lands a close second. But beyond these detrimental impacts on our gastrointestinal health, we face many other daunting challenges to our bacterial balance. Unless one consumes organic dairy products, for example, one is almost certainly consuming traces of antibiotics and sulfa drugs, which have a disruptive effect on bowel ecology. Our highly processed food supply has also denied our bodies the opportunity to ingest beneficial bacteria as we once did through food fermentation (widely used before refrigeration). Our water also tends to be highly chlorinated which, although important from a public health perspective, has drawbacks for individual health when it comes to adversely impacting our body’s bacterial populations. When the body’s bacterial populations are upset, many kinds of illness can result. So for daily maintenance and in times of illness it just makes sense to use a quality probiotic formula.
Prevention and Treatment of Diarrhea and Constipation: Antibiotic-associated diarrhea can be attributed in part to imbalances in intestinal microflora. Bifidobacteria have been used to successfully treat intestinal disorders and in the prevention of rotaviral diarrhea in children and adults. In fact, taking a probiotic formula with antibiotics is now considered to be standard medicine in many countries. But antibiotics and probiotics must be taken a few hours apart. Constipation is a significant problem for many people, especially the elderly. Researchers have shown that enhancing Bifidobacteria in the large intestine of constipated elderly individuals provides a significant laxative effect.
Ulcer Therapy: If you’re taking antibiotics to treat your ulcer, you should be using probiotics along with your doctor’s prescribed antibiotics. That’s the message from researchers reporting in the February 2001 issue of Digestion. Frequently, nausea, bloating, diarrhea, taste disturbances and loss of appetite are side effects from use of antibiotics to eradicate Helicobacter pylori, the bacterium thought to be the causative agent in gastric ulcers. This latest study involving 120 ulcer patients shows that persons given both antibiotics and probiotics experienced markedly reduced incidence of bloating, diarrhea and taste disturbances compared to persons given only antibiotics, and most persons given the natural remedy experienced no side effects.
Enhanced Immune Function: Most of our immune cells are produced within the gastrointestinal tract and much of our protection against orally ingested pathogens (such as salmonella) is the result of a healthy gastrointestinal environment. There is perhaps no greater protection against such food-borne pathogens than the use of probiotics to sustain this healthy environment. Recent studies show that Lactobacilli and Bifidobacteria can stimulate both general immunity and also specific antibodies to certain pathogens.
Lactose Intolerance: Dairy foods are a very important part of a healthy diet, but many of us suffer from some symptoms of lactose intolerance. Studies have shown that strains of Lactobaccilli and Bifidobacteria reduce symptoms of lactose malabsorption.
Establishment of Healthy Flora: in Babies and Infants Premature infants generally take longer to establish a characteristic intestinal flora, which can render them more susceptible to certain intestinal infections. Various strains of Bifidobacterium administered to premature infants results in populations of beneficial bacteria becoming established more quickly in their intestines compared to a control group. You will also likely find that children susceptible to middle ear infections enjoy better health when they are given probiotics (DDS®-Junior Probiotic for Children).
Editor’s Note: Dr. S. K. Dash is among the world’s leading experts today in the field of probiotics. Dr. Dash is founder of America’s leading probiotic company UAS Labs.
See the full unabridged version of this article at www.freedompressonline.com.
References Armuzzi, A., et al. “”Effect of Lactobacillus GG supplementation on antibiotic-associated gastrointestinal side effects during Helicobacter pylori eradication therapy: a pilot study.”" Digestion, 2001;63:1