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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_440"
                     title="Soft Drinks Linked to Pancreatic Cancer Risk (CME/CE)"
                     score="0.012"
                     href="http://www.medpagetoday.com/HematologyOncology/OtherCancers/tb/18354?impressionId=1265748074193"
                     
      &lt;p&gt;Regular consumers of sugary soft drinks are at higher risk for pancreatic cancer than fruit juice drinkers or the general population, a new Singaporean study has found.&lt;/p&gt;
&lt;p&gt;Chinese men and women living in Singapore who drank two or more soft drinks per week were 87% more likely to contract pancreatic cancer after the researchers adjusted for factors such as smoking (95% CI 1.10 to 3.15), according to the report published Feb. 8 in &lt;em&gt;Cancer Epidemiology, Biomarkers &amp;amp; Prevention.&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;&quot;In this large prospective cohort of Chinese men and women in Singapore, those who reported regular soft drink consumption were at increased risk of pancreatic cancer when compared with those who largely abstained,&quot; Mark Pereira, PhD, of the School of Public Health at the University of Minnesota, and colleagues wrote. &quot;There was no association between consumption of juice and risk of pancreatic cancer.&quot;&lt;/p&gt;
&lt;p&gt;While pancreatic cancer is relatively rare, it is one of the most deadly cancers, with less than 5% of patients surviving five years after diagnosis. Although rates have generally plateaued in the U.S., they continue to climb in some Asian countries, including Singapore.&lt;/p&gt;
&lt;p&gt;&quot;This increase may reflect demographic and socioeconomic shifts as well as a transition towards a more westernized lifestyle and diet,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;Research has shown that insulin promotes pancreatic cancer cell growth, and some researchers think sugary foods could result in blood sugar and insulin fluctuations that expose the pancreas to high concentrations of insulin.&lt;/p&gt;
&lt;p&gt;While fruit juices contain sugar, soft drinks are the major sources of added sugar in the U.S. diet and major contributors to hyperglycemia and hyperinsulinemia.&lt;/p&gt;
&lt;p&gt;Pereira and colleagues followed 60,524 men and women who enrolled in the Singapore Chinese Health Study between April 1993 and December 1998 and were followed for 14 years.&lt;/p&gt;
&lt;p&gt;At enrollment, the participants completed a 146-question food frequency questionnaire, which contained three items related to soft drinks and juice. The questions asked the participants how much, if any, they drank of soft drinks such as Coca-Cola and 7-Up, orange juice, and other fruit and vegetable juices.&lt;/p&gt;
&lt;p&gt;The dietary data was later cross-referenced with records from the Singapore Cancer Registry and the Singapore Registry of Births and Deaths, to determine which of the participants had died of pancreatic cancer and whether it might be related to their soft drink or juice consumption.&lt;/p&gt;
&lt;p&gt;Overall, researchers found that 140 participants had contracted pancreatic cancer.&lt;/p&gt;
&lt;p&gt;The results were largely consistent with three of four previous U.S. studies on the links between pancreatic cancer and soft drinks. Three of the U.S. studies found an association between soft drinks and cancer.&lt;/p&gt;
&lt;p&gt;The author acknowledged that soft drink consumers are more likely than abstainers to participate in other unhealthy behaviors, including smoking and overeating, which makes it difficult to determine that soft drink consumption is an independent risk factor for pancreatic cancer.&lt;/p&gt;
&lt;p&gt;For instance, smokers in their study were at higher risk for pancreatic cancer. &quot;We could not rule out the possibility of residual confounding by factors associated with the habit of drinking soft drinks or other unascertained factors such as waist circumference,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;They also noted that the study was limited in statistical power because pancreatic cancer is rare, which limited the sample size of cancer cases. &quot;Also, because we were unable to collect repeated dietary measurements in this study, we were unable to account for changes in consumption of soft drinks and juices,&quot; they wrote, &quot;especially when the diagnosis of diabetes occurred after the baseline interview.&quot;&lt;/p&gt;
&lt;p&gt;&lt;em&gt; &lt;/em&gt;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was funded by the National Cancer Institute.&lt;/p&gt;&lt;p&gt;The authors reported no financial conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_376"
                     title="Stress of Prostate Cancer Diagnosis May Be Deadly (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/HematologyOncology/ProstateCancer/tb/18268?impressionId=1265748074193"
                     
      Men have a slightly, but statistically significant, increased risk of dying from cardiovascular disease in the year after learning they have prostate cancer, researchers found.&lt;br&gt;
&lt;br&gt;The risk was greatest in the first month after diagnosis (standardized mortality ratio 2.05, 95% CI 1.89 to 2.22), Lorelei Mucci, PhD, of Brigham and Women&apos;s Hospital in Boston, and colleagues reported online in the &lt;em&gt;Journal of the National Cancer Institute&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;The study, which covered diagnoses made from 1979 through 2004, also found an overall increased risk of suicide in the year following a prostate cancer diagnosis (SMR 1.4, 95% CI 1.2 to 1.6), although the association was not significant after screening for prostate specific antigen (PSA) became widespread.&lt;br&gt;
&lt;br&gt;The findings&lt;em&gt;&lt;/em&gt; are &quot;one additional piece in weighing the pros and cons of PSA screening,&quot; Mucci said in an interview.&lt;br&gt;
&lt;br&gt;She also said that, &quot;not only do [clinicians] need to be treating the cancer, but they need to be thinking about the social support and other support that men may need to deal with this stressful event.&quot;&lt;p&gt;&lt;/p&gt;
&lt;p&gt;A previous study by Mucci&apos;s group that looked at a Swedish population found similarly increased risks of suicide and cardiovascular death following a prostate cancer diagnosis.&lt;/p&gt;
&lt;p&gt;Because PSA testing is more extensive in the U.S., increasing the number of early-stage and indolent cancers detected, the researchers wanted to see whether the results would carry over.&lt;/p&gt;
&lt;p&gt;Using the Surveillance, Epidemiology, and End Results (SEER) Program, they looked at data from 342,497 men who were diagnosed with prostate cancer from 1979 through 2004.&lt;/p&gt;
&lt;p&gt;The number of diagnoses steadily increased throughout the study period  --  from 6,106 in 1979 to 17,688 in 2004.&lt;/p&gt;
&lt;p&gt;But the percentage of cancers that were metastatic dropped from 18.2% in the pre-PSA period (1979 to 1986) to 5% in the period of widespread testing (1993 to 2004).&lt;/p&gt;
&lt;p&gt;During the study, 148 men committed suicide within one year of learning their diagnosis, higher than the 105.2 that would be expected in the general U.S. male population.&lt;/p&gt;
&lt;p&gt;The elevated risk was only evident prior to 1993, when PSA testing became more widely used. The authors suggested that this was likely because of the potentially lower degree of stress associated with the diagnosis of indolent prostate cancer.&lt;/p&gt;
&lt;p&gt;&quot;So that&apos;s reassuring,&quot; Mucci said.&lt;/p&gt;
&lt;p&gt;However, another 6,845 men died of cardiovascular disease, which was also higher than the expected 6,282.9.&lt;/p&gt;
&lt;p&gt;Contrary to the findings regarding suicide, the risk of cardiovascular death in the first month after hearing a diagnosis was significantly increased throughout the study period.&lt;/p&gt;
&lt;p&gt;Prostate cancer patients who were not married at the time of diagnosis had higher relative risks of both suicide and cardiovascular death than married patients.The authors suggested that this may be because &quot;having someone close to confide in might alleviate the psychological stress experienced from receiving a cancer diagnosis.&quot;&lt;/p&gt;
&lt;p&gt;They also observed a clear trend between higher relative risks for suicide and cardiovascular death among patients diagnosed with a metastatic tumor, which clearly would be more stressful than diagnosis of a clinically localized tumor.&lt;/p&gt;
&lt;p&gt;&quot;This finding might further explain the decreasing excess risks that have been observed in the PSA era, in which the proportion of advanced tumors was small (i.e., 18.2% metastatic tumors in the pre-PSA era and 5.0% in the PSA era),&quot; they wrote.&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;
&lt;p&gt;Risk of cardiovascular death was magnified for patients with metastatic tumors (SMR 3.22, 95% CI 2.68 to 3.84) compared with those with local or regional tumors (SMR 1.57, 95% CI 1.42 to 1.74)(&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;Prostate cancer patients who were not married at the time of diagnosis had higher relative risks of both suicide and cardiovascular death than married patients.&lt;/p&gt;
&lt;p&gt;The authors acknowledged some limitations of the study, including the lack of a cancer-free group as reference and the lack of information on physical or mental health status, other prevalent disorders or comorbid illness at diagnosis, and prostate cancer treatment.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study received funding from the Swedish Council for Working Life and Social Research.&lt;/p&gt;&lt;p&gt;The authors reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_364"
                     title="ADT for Prostate Cancer Raises Heart Risks"
                     score="0.01"
                     href="http://www.medpagetoday.com/Urology/ProstateCancer/tb/18250?impressionId=1265748074193"
                     
      &lt;p&gt;Androgen deprivation therapy (ADT) for prostate cancer can exacerbate cardiac risk factors and may increase the risk of heart attack and cardiac death, according to an advisory supported by four medical organizations.&lt;/p&gt;
&lt;p&gt;However, the groups did not offer specific guidelines for clinicians on when to employ ADT therapy or avoid it.&lt;/p&gt;
&lt;p&gt;Clinical trials have shown that ADT increases body weight, decreases lean mass and increases fat mass, reduces insulin sensitivity, and triggers or worsens dyslipidemia.&lt;/p&gt;
&lt;p&gt;Several studies have demonstrated a significant increase in cardiovascular death in prostate cancer patients treated with hormonal therapy or bilateral orchiectomy, although some studies have shown no association between ADT and increased cardiovascular risk, according to a report that will appear in the Feb. 16 issue of &lt;em&gt;Circulation: Journal of the American Heart Association&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Some evidence also suggests ADT may predispose men to metabolic syndrome.&lt;/p&gt;
&lt;p&gt;&quot;Based on current data, it was appropriate to conclude that there may be a relationship between ADT therapy in patients with prostate cancer and future cardiovascular risk,&quot; Glenn N. Levine, MD, of Baylor College of Medicine in Houston and chair of the advisory writing committee, said in a statement.&lt;/p&gt;
&lt;p&gt;The writing committee comprised representatives of the American Heart Association, American Urological Association, and American Cancer Society. Additionally, the American Society for Radiation Oncology endorsed the advisory.&lt;/p&gt;
&lt;p&gt;The authors&apos; review of literature showed that ADT increased cardiovascular risk in 1% to 6% of various studies&apos; patient populations. With that in mind, &quot;the decision about whether to initiate ADT should be based on weighing the benefits of therapy with this potential modest risk,&quot; Levine said.&lt;/p&gt;
&lt;p&gt;The decision to initiate ADT should remain with the physician who has responsibility for treating a patient with prostate cancer, the authors wrote. That includes patients with known cardiac disease.&lt;/p&gt;
&lt;p&gt;&quot;It is the consensus of the writing group that there is no clear indication for patients for whom ADT is believed to be beneficial to be referred to internists, endocrinologists, or cardiologists for evaluation before initiation of ADT,&quot; the authors said.&lt;/p&gt;
&lt;p&gt;&quot;The decision as to whether or not to initiate ADT in patients with cardiac disease, in whom the benefits of therapy would be weighed against any possible risks, is most appropriately made by the physician treating the patient for prostate cancer.&quot;&lt;/p&gt;
&lt;p&gt;However, the potential adverse metabolic effects warrant periodic evaluation by a patient&apos;s primary care physician, they added.&lt;/p&gt;
&lt;p&gt;Noting a lack of clinical guidance for follow-up of patients treated with ADT, the advisory authors concluded that at least an annual assessment of blood glucose and lipids seems reasonable. They also called for prospective assessment of cardiovascular risk factors before and after ADT is begun in future clinical trials.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_336"
                     title="In Prostate CA, Sexual Decline After Radiation Has Limit (CME/CE)"
                     score="0.006"
                     href="http://www.medpagetoday.com/HematologyOncology/ProstateCancer/tb/18214?impressionId=1265748074193"
                     
      &lt;p&gt;Sexual function declines in the first two years after external beam radiation therapy for prostate cancer but stabilizes thereafter, according to data from a prospective cohort study.&lt;/p&gt;
&lt;p&gt;All parameters of sexual function declined significantly (&lt;em&gt;P&lt;/em&gt;&lt;0.05) in the first two years after external-beam radiation therapy (EBRT), Richard Valicenti, MD, of the University of California Davis, and colleagues found.&lt;/p&gt;
&lt;p&gt;But for years two through six of follow-up, none of the evaluated parameters of sexual function changed significantly.&lt;/p&gt;
&lt;p&gt;Pretreatment sexual function was the strongest predictor of sexual function at any time after EBRT, the investigators reported in the January issue of the &lt;em&gt;International Journal of Radiation Oncology*Biology*Physics&lt;/em&gt;&lt;em&gt;&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Their findings debunk the perception that sexual function declines continually after radiation therapy for prostate cancer.&lt;/p&gt;
&lt;p&gt;&quot;The results of this study allow patients and their partners to have a fuller understanding of the long-term sexual side effects of EBRT, and what they can expect after treatment should aid in deciding on a treatment course,&quot; Valicenti said in a statement.&lt;/p&gt;
&lt;p&gt;Reported rates of impotency after EBRT for prostate cancer have ranged from 8% to 85%, a variation the authors attributed to the different instruments used to assess sexual function. Moreover, many studies included men who received androgen deprivation therapy in addition to EBRT, possibly masking the contributions of radiation therapy to changes in sexual function.&lt;/p&gt;
&lt;p&gt;Several recent studies have suggested that rates of sexual dysfunction increase with follow-up. However, few studies included pretreatment assessment of sexual function or conducted serial assessments of sexual function after EBRT, the authors wrote.&lt;/p&gt;
&lt;p&gt;To shed more light on the question, the investigators prospectively followed 143 men who completed a sexual function questionnaire prior to EBRT for prostate cancer and at each follow-up visit. The questionnaire assessed four domains of sexual function: sexual drive, erectile function, ejaculatory function, and overall satisfaction.&lt;/p&gt;
&lt;p&gt;The mean age of the patients was 69, median Gleason score was 6, and median total radiation dose was 73.8 Gy (range of 66.6 to 79.2 Gy).&lt;/p&gt;
&lt;p&gt;During a median four-years of follow-up, the study participants completed a total of 1,187 questionnaires. Some patients were followed for as long as eight years after EBRT.&lt;/p&gt;
&lt;p&gt;Baseline scores for sexual drive and erectile function were significantly associated with patient age (&lt;em&gt;P&lt;/em&gt;=0.003 and &lt;em&gt;P&lt;/em&gt;=0.004, respectively). Ejaculatory function was significantly associated with age, race, and marital status (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05).&lt;/p&gt;
&lt;p&gt;Scores on all four domains of sexual function, as well as the total score, declined significantly in the first two years after EBRT (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05) compared with baseline values.&lt;/p&gt;
&lt;p&gt;Investigators grouped the patients according to baseline sexual function. Analysis of scores for patients above and below the median sexual function value showed that differences in sexual function persisted over time. Regression analysis showed that baseline score was the best predictor of later scores for all of the domains assessed (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;A separate analysis of scores from years two through six showed no significant changes in any of the domains: sexual drive, &lt;em&gt;P&lt;/em&gt;=0.067; erectile function, &lt;em&gt;P&lt;/em&gt;=0.5; ejaculatory function, &lt;em&gt;P&lt;/em&gt;=0.6; and overall satisfaction, &lt;em&gt;P&lt;/em&gt;=0.44.&lt;/p&gt;
&lt;p&gt;Baseline scores indicated that 74.1% of the study participants were sexually potent before EBRT. Among those who were potent before treatment, 74.4% remained potent at one year and 70.4% at two years after EBRT. The one- and two-year potency rates differed significantly from baseline, but the investigators found no statistically significant change in potency from years two through six.&lt;/p&gt;
&lt;p&gt;&quot;Our data have indicated that the widely held opinion that sexual function has a slow, progressive decline after EBRT might be incorrect,&quot; the authors wrote in conclusion. &quot;Most sexual function decline in men undergoing EBRT for prostate cancer occurred in the first two years after treatment and all domains of sexual function, including erectile dysfunction, then appeared to stabilize.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The authors reported no relevant disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_267"
                     title="Public-Private Divide Found in Prostate Cancer Treatment (CME/CE)"
                     score="0.002"
                     href="http://www.medpagetoday.com/HematologyOncology/ProstateCancer/tb/18118?impressionId=1265748074193"
                     
      &lt;p&gt;Treatment that men receive for prostate cancer may depend less on their condition and more on where they are treated, a new study found.&lt;/p&gt;
&lt;p&gt;Moreover, men treated by private hospitals were nearly two and a half times more likely to receive radiation therapy (OR 2.36; 95% CI 1.37 to 4.07) and more than four and a half times more likely to receive primary androgen deprivation therapy (OR 4.71; 95% CI 2.15 to 10.36) than surgery, which was the predominant treatment at county hospitals, according to findings published Jan. 25 in &lt;em&gt;Cancer&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Patients in private hospitals were also more likely to be white.&lt;/p&gt;
&lt;p&gt;&quot;This is the first study to compare prostate cancer treatments between private and public institutions, and it reveals a novel variable influencing treatment choice: healthcare venue,&quot; J. Kellogg Parsons, MD, MHS, of the University of California San Diego, and colleagues wrote.&lt;/p&gt;
&lt;p&gt;&quot;Men treated at county hospitals were significantly more likely to undergo surgery, whereas those treated by private providers were more likely to undergo radiotherapy or primary androgen deprivation, irrespective of age, race, comorbidity status, clinical tumor stage, Gleason sum, and D&apos;Amico risk stratification.&quot;&lt;/p&gt;
&lt;p&gt;&quot;A likely explanation for this imparity is that the initial provider in the county hospitals was always a urologist, whereas at the private venues the initial providers were a mix of urologists, radiation oncologists, and medical oncologists,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;In the U.S. in 2009, more than 190,000 men were diagnosed with prostate cancer and more than 27,000 men died from the disease, according to the National Cancer Institute. Although life expectancy, other illnesses, cancer severity, and patient preference may play a role in treatment choice, the common treatments for localized prostate cancer  --  surgery, radiation, and hormone therapy  --  all have pros and cons, and experts differ on which option is more effective.&lt;/p&gt;
&lt;p&gt;Parsons and colleagues explored whether treatment location might play a role in determining what therapy a patient receives. They analyzed the records of 559 men enrolled in a state-funded public assistance program for low-income patients, known as Improving Access, Counseling and Treatment for Californians with Prostate Cancer (IMPACT), who received prostate cancer treatment between 2001 and 2006.&lt;/p&gt;
&lt;p&gt;The researchers noted that a limitation of the study was the population included in the IMPACT database -- generally patients with more severe cancer than in the general U.S. population; thus the findings may not reflect patients from other regions and socioeconomic groups.&lt;/p&gt;
&lt;p&gt;Of the participants, 315 received treatment from county hospitals and 244 received care from private facilities. No significant difference existed between the two groups in terms of age and tumor characteristics, yet the patients received varying therapies.&lt;/p&gt;
&lt;p&gt;&quot;In this economically disadvantaged cohort, prostate cancer treatments differed significantly between county hospitals and private providers,&quot; the authors wrote. &quot;These data reveal substantial variations in treatment patterns between different types of healthcare institutions that  --  given the implications for health policy and quality of care  --  merit further scrutiny.&quot;&lt;/p&gt;
&lt;p&gt;To help patients make informed decisions, develop appropriate expectations, and avoid making decisions they will regret, the authors proposed that patients with localized prostate cancer be provided access to multiple care providers so that they will be exposed to a variety of opinions and information about their disease.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The researchers did not report specific support for this analysis but the IMPACT program is supported by the state of California.&lt;/p&gt;&lt;p&gt;The reseachers reported no financial conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
</recommendedContent>