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| Study Shows When Second Prostate Biopsy is Needed
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Approximately 25 percent of all prostate biopsies result in false negative readings, a situation that risks the health of many patients but one that has been unavoidable without subjecting the others to unnecessary overtreatment.
A researcher at the Oregon Health & Science University's School of Medicine, however, has determined a way for physicians to identify which prostate patients who have received the all-clear should undergo a second biopsy.
"Until now we've really had no clear and consistent method to recommend further follow up or diagnostic procedures for men who have a negative biopsy," says Mark Garzotto, MD, assistant professor of surgery in the university's urology department and a member of its cancer institute, in a statement. "We have derived a simple marker so urologists can identify who is at risk for high-grade prostate cancer."
Dr. Garzotto studied the cases of 511 male patients referred to urologists between 1992 and 2006 at the Portland Veterans Affairs Medical Center, where he is director of urologic oncology. Each of the 511 had previously received a negative biopsy. He found that high levels of a prostate-specific antigen adjusted for the prostate's size — as measured by a Gleason score of seven or above — is an indicator of the presence of cancer and a recommendation to repeat the biopsy.
Gleason scores are a system of microscopically grading prostate tissue on a scale of two to 10, with 10 being a greater likelihood that a tumor will spread. Dr. Garzotto presented his findings at the recent Multidisciplinary Prostate Cancer Symposium in Orlando, Fla.
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| Office-based Colonoscopies Miss More Cancers
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The type of physician who performs a patient's colonoscopy and the location in which it's performed appear to have an influence on whether a cancer is seen or missed, Canadian researchers report.
According to a study published in the January issue of the journal Gastroenterology, the rate of new or missed colorectal cancers after colonoscopies is higher among procedures performed in office settings and by family physicians.
Investigators from the University of Western Ontario in London, Ontario, reviewed the records of 12,487 patients and found that 430 of them (3.4 percent) had a new or missed cancer, defined as a diagnosis within six months to three years of having had a colonoscopy.
Researchers found that having the procedure performed in an office setting was an independent risk factor in whether cancer was missed, with adjusted odds ratios of 3.07 higher than hospital colonoscopies for men and 1.95 for women.
When compared to colonoscopies done by gastroenterology specialists, the odds ratios for missed cancers by family physicians or internists was 1.77 higher for men and 1.85 for women.
The researchers note that office-based colonoscopy demands further study to determine why it posts higher cancer miss rates.
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| News and Notes
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Approximately 25 percent of all prostate biopsies result in false negative readings, a situation that risks the health of many patients but one that has been unavoidable without subjecting the others to unnecessary overtreatment.
A researcher at the Oregon Health & Science University's School of Medicine, however, has determined a way for physicians to identify which prostate patients who have received the all-clear should undergo a second biopsy.
"Until now we've really had no clear and consistent method to recommend further follow up or diagnostic procedures for men who have a negative biopsy," says Mark Garzotto, MD, assistant professor of surgery in the university's urology department and a member of its cancer institute, in a statement. "We have derived a simple marker so urologists can identify who is at risk for high-grade prostate cancer."
Dr. Garzotto studied the cases of 511 male patients referred to urologists between 1992 and 2006 at the Portland Veterans Affairs Medical Center, where he is director of urologic oncology. Each of the 511 had previously received a negative biopsy. He found that high levels of a prostate-specific antigen adjusted for the prostate's size — as measured by a Gleason score of seven or above — is an indicator of the presence of cancer and a recommendation to repeat the biopsy.
Gleason scores are a system of microscopically grading prostate tissue on a scale of two to 10, with 10 being a greater likelihood that a tumor will spread. Dr. Garzotto presented his findings at the recent Multidisciplinary Prostate Cancer Symposium in Orlando, Fla.
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| Are All TASS Risk Factors Being Addressed?
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Flash sterilization and low-temperature sterilization systems are important but overlooked risk factors in the development of Toxic Anterior Segment Syndrome, according to Lawrence F. Muscarella, PhD, director of research and development and chief of infection control for medical manufacturer Custom Ultrasonics, Inc., in Ivyland, Pa. TASS is a non-sterile, post-op inflammation occurring predominantly in cataract patients. Between Jan. 17 and July 11, 2006, 113 U.S. facilities reported cases of the disease, prompting the formation of an ad hoc TASS task force.
After investigating the 2006 outbreaks, the task force issued a final report in September. While unable to identify a specific cause for the outbreaks, the report suggested allowing adequate time between cases for instrument cleaning, flushing reusable cannulated instruments properly with deionized or distilled water and discarding disposable instruments after one use.
The task force's research is impressive but incomplete, argues Dr. Muscarella. He submits that TASS outbreaks may be caused by the formation of toxic substances on the surfaces of ophthalmic instruments sterilized by a low-temperature system, a possibility he says goes unmentioned in the task force's final report. Dr. Muscarella also notes that the task force did not address the potential for infection caused by instruments chipped or damaged during the rapid heating and cooling of flash sterilization.
Ultimately, Dr. Muscarella advises that facilities steam sterilize ophthalmic instruments and avoid using peracetic acid, acetic acid, hydrogen peroxide or other oxidizing agents to sterilize ophthalmic instruments. He also notes that flash sterilization should only be used in emergency situations and should not compensate for an inadequate number of instrument sets.
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