About one-third of men who have their prostates removed because of cancer suffer a subsequent rise in levels of the prostate-specific antigen in their blood, indicating that the cancer has metastasized to other sites in the body. But oncologists have been unsure how to treat such patients because other symptoms of the cancer may return in as little as a couple of years or not until 10 or more years have passed.
Researchers from the Johns Hopkins Medical Institutions in Baltimore have followed the course of 1,997 men who had their prostates removed between 1982 and 1997, and have produced the first guidelines for further treatment. The key points, they reported in Wednesday's Journal of the American Medical Assn., were how soon after surgery the antigen was detected, how fast it rose, and whether or not the original tumor was aggressive.
The antigen is made only by prostate tissue and should not be present in the blood after a tumor is removed.
A 75-year-old man whose original tumor was not aggressive and whose prostate-specific antigen didn't return until four years after surgery, for example, probably won't suffer a relapse for more than 10 years. Because his life expectancy, if he is healthy, is only about 10 years anyway, he probably won't choose treatment.
But men with aggressive tumors whose antigens return within two years will probably suffer a relapse within eight years and most likely will require treatment, especially if they are younger.
Steps Suggested to Treat Heart Risks in Women
Physicians are not being nearly as aggressive as they should in treating risk factors for heart disease in women, according to a new statement issued by the American Heart Assn., the American College of Cardiology and four other health organizations in the Tuesday issue of Circulation: Journal of the American Heart Assn.
Among the recommendations:
* A cholesterol-lowering drug from a family called statins should be considered instead of hormone replacement therapy as the first line of therapy for reducing high blood levels of cholesterol and triglycerides in post-menopausal women. The target level for blood triglycerides--one of the components of total cholesterol--should be reduced to 150 milligrams per deciliter.
* The target blood level of high-density lipoprotein, the so-called good cholesterol, should be raised to at least 45 milligrams per deciliter.
* Because diabetes increases a woman's risk of heart disease by three to seven times, compared with a two- to threefold increase in risk for men, physicians should step up efforts to identify women with diabetes and provide proper treatment.
Virus Test Clarifies Pap Smear Results
An ambiguous reading on a Pap smear test for cervical cancer can often propel a women into six months of agony while doctors wait to repeat the test. In as many as 80% of such cases--which doctors call atypical squamous cells of undetermined significance--the repeat test shows no problem.
Now, researchers say, a test for the human papillomavirus, which is closely associated with cervical cancer, can determine immediately whether or not those atypical cells really are cancer.
A team led by Dr. Michele Manos of Kaiser Permanente in Oakland studied 995 women with a new type of Pap smear and a test for the human papillomavirus. They reported in Tuesday's Journal of the American Medical Assn. that if a woman had an atypical Pap smear but a negative test for the virus, "we could be 99% certain that she did not have cancer," Manos said.
Antibiotics Compared in Ear Infection Study
The antibiotic Augmentin is more effective than Zithromax at eradicating the bacteria that cause pediatric ear infections, according to the first head-to-head study of the two drugs, presented Tuesday at a San Francisco meeting of the Pediatric Academic Societies. Zithromax is increasingly used because it requires fewer doses than Augmentin.
Dr. Candice Johnson and her colleagues at Children's Hospital in Denver studied 238 ear infection patients, half of whom received Zithromax and half Augmentin. Cultures of fluid from the inner ear were used to determine how well the bacteria were killed.
They found that Augmentin killed 87% of Haemophilus influenzae bacteria and 90% of Streptococcus pneumoniae. Zithromax, in contrast, killed only 39% and 68%, respectively. Incomplete eradication of the bacteria can lead to a return of the infection.
Thomas H. Maugh II can be reached at email@example.com.