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Patients Avoid Impotence After Prostate Removal

April 30, 2001|THOMAS H. MAUGH II | TIMES MEDICAL WRITER

More than half of men who have their prostates removed as treatment for prostate cancer lose the ability to have an erection; now researchers say that problem can often be prevented.

When the cavernous nerves that control erections are accidentally cut during surgery, that damage cannot normally be repaired, leaving the men impotent. But researchers from the Memorial Sloan-Kettering Cancer Center in New York City say the problem can be avoided in some men by implanting a nerve harvested from the ankle to patch the severed nerve.

Dr. Joseph J. Disa said Wednesday at an American Cancer Society meeting in Dana Point that the procedure has been performed in approximately 300 men and that about a third of the patients have been able to have sex without injections or drugs to produce an erection. Another third can achieve erections with drugs.

Because the cavernous nerves are extremely small, surgeons are able to perform the repair only during the original prostate operation. Later, it is too difficult to locate the ends of the nerves.

Prostate cancer is the most common cancer among American men and the second leading killer after lung cancer. This year, 185,000 new cases are expected and 32,000 men will die from it.

Mammogram Benefits May Be Underestimated

Another study presented at the same meeting suggests that routine mammography is twice as effective at preventing breast cancer deaths as researchers currently believe.

Mammography is thought to reduce breast cancer deaths by about 30%, based on seven large studies conducted in North America and Europe during the 1970s and 1980s. But epidemiologist Robert A. Smith, of the American Cancer Society, said that the early studies underestimated potential benefits because some women in the mammogram group refused to be screened, while some in the control group sought out mammograms on their own.

The new study examined 6,807 women in Sweden, where 85% of women now get mammograms. In the United States, in contrast, only 50% to 60% of women do. The team examined mortality rates during three periods: from 1968 to 1977, before mammography was introduced; from 1978 to 1987, when about half the women received mammograms; and from 1988 to 1996. They concluded that routine mammograms reduced the risk of death by 63%, about double what had been found in previous studies.

The American Cancer Society estimates that about 192,200 new cases of invasive breast cancer will be diagnosed this year, with about 40,600 deaths.

Testing White Spots in the Mouth for Cancer

Norwegian researchers have developed a new genetic test to help physicians determine whether white patches in the mouth--called oral leukoplakia--are likely to turn into cancer.

More than 300,000 people around the world, including 30,000 in the United States, are diagnosed with oral cancer each year. About half of them die within five years, largely because it is hard to diagnose the cancers early.

Dr. Jon Sudbo and his colleagues at the University of Oslo counted the number of chromosomes in cells in the white patches, then monitored the patients for periods averaging 8.5 years. They reported in the April 26 New England Journal of Medicine that, if the cells contained the normal 46 chromosomes--23 from each parent--cancer was unlikely to develop. If the number of chromosomes was some other multiple of 23, cancer was more likely. And if the number could not be evenly divided by 23, cancer was very likely.

Out of 103 patients with leukoplakia made up of cells containing 46 chromosomes, for example, only three developed cancer. Twelve of 20 patients with 92 chromosomes per cell developed tumors, while 21 of 27 with odd numbers of chromosomes did so.

"There is a message to consumers and patients here," Sudbo said. "Be aware of white patches and get them investigated."

Antidepressant May Ease Kids' Anxiety

The antidepressant fluvoxamine can provide significant benefit to children and adolescents who suffer severe anxiety about life situations that are handled readily by their peers, according to a new study.

Symptoms can include severe shyness, inability to interact with others of their own age and excessive worrying about going to school, taking tests or performing in sports. Those symptoms are often accompanied by physical symptoms such as palpitations, sweating, trembling, stomachache and headache.

Some experts estimate that as many as 13% of children and adolescents suffer from such symptoms during any six-month period, making them the most common class of psychiatric disorders in that age group. Most do not seek treatment. But an estimated 575,000 children were formally diagnosed with anxiety disorders in the last 12 months, including 136,000 under the age of 10. Physicians recommended that 390,000 of them be put on medicines such as Zoloft, Paxil, and Prozac, according to IMS Health, which tracks the pharmaceutical industry.

In the new study, a team led by Dr. Daniel Pine of the National Institute of Mental Health studied 128 children and adolescents over a period of eight weeks. They reported in the April 26 New England Journal of Medicine that symptoms improved in 76% of those receiving fluvoxamine, compared to only 29% of those who received a placebo. Few side effects were observed.

The study was funded by NIMH and Solvay Pharmaceuticals, which sells fluvoxamine under the trade name Luvox.

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Medical writer Thomas H. Maugh II can be reached at thomas.maugh@latimes.com.

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