It can be awkward when a patient asks you about a report in their favourite tabloid detailing an amazing research breakthrough or a ‘cutting-edge’ new treatment / test and you don’t know what they are talking about! So this section fills you in on the facts.
Men who sleep less than 5 hours a night have 55% higher chance of prostate cancer
The Daily Mail – 4 April 2017
While interesting, this may come as unwelcome news if you are on-call tonight. The Daily Mail reports on a study that was just presented at the American Association for Cancer Research Annual Meeting in Washington DC. A team at the American Cancer Society published an analysis of data from the Cancer Prevention Study-II in 2014, which showed no definite association between sleep patterns and prostate cancer. They have now also analysed data from a total of just over 800,000 men after using another cohort study and self-reported sleep data. The research team showed that men under the age of 65 who get less than six hours of sleep per night had a 29% higher risk of death from prostate cancer than those who got seven hours or more. The researchers theorise that this may be due to impaired melatonin production. My presumption though was that it would be in the increase in cortisol from sleep deprivation and the resulting metabolic syndrome (which has a known association with prostate cancer) that brought about this effect. Either way, the next time you are unnecessarily woken at 3am by an incorrectly routed call from somebody that actually wanted a neurology opinion, you can politely ask them to stop giving you cancer.
Bladder drug taken by thousands is linked to dementia: Doctors warn pills should no longer be used because they raise the risk by 54%
The Daily Mail – 27 March 2017
This is a very important message that has been filtering through the urology community over the past few years, but is now reaching the public. The Daily Mail reports on findings that were presented at the European Association of Urology (EAU) meeting in London. The study in question was based at Henry Ford Hospital in Detroit and showed that just over a quarter of all new anti-cholinergic prescriptions in the US are oxybutynin, despite the anticholinergic burden of this drug (and its contribution to the development of dementia) now being known. This is a reminder that we should be thinking carefully about drug prescriptions for overactive bladder symptoms, especially in the elderly. I suspect we will see this advice strongly incorporated into treatment guidelines going forward.
Cutting salt intake could stop excessive toilet trips in the wee small hours
The Telegraph – 26 March 2017
This is probably my favourite story for this issue. Nocturia is a troubling symptom for many of our patients and solving it is rarely as simple as we would like. The Telegraph picks up on the findings of a study from Nagasaki University in Japan, which was also presented at the EAU meeting. Two hundred and twenty-three volunteers were asked to cut their salt intake by a quarter, down to an average of 8g per day. Their nightly voids reduced from 2.3 times to 1.4. Likewise, increasing salt intake to 11g per day increased nocturia. Even if this effect is fairly modest, this is sound advice to incorporate into your usual outpatient clinic advice, because even if it doesn’t help the nocturia, it will help their blood pressure and risk of cardiac disease.
Antidepressants can stop prostate cancer from spreading to the bones where it kills 90% of patients
The Daily Mail – 14 March 2017
The Daily Mail reports on a scientific paper published in Cancer Cell journal in March 2017. A research team, led by Dr Wu, studied the processes involved in prostate cancer metastasis in mice. They identified that monoamine oxidase A (MAOA) is a mediator of metastasis by activating sonic hedgehog (SHH) signalling. The sonic hedgehog gene has long been implicated in metastasis as a mechanism for angiogenesis and reducing cell-cell adherence. In bone, this signalling stimulates interleukin-6 release from osteoblasts in bone that stimulates osteoclasts to break down the bone. The research team therefore theorised that targeting MAOA may be a method for reducing metastasis in prostate cancer. In lab mice with induced prostate cancer, treatment with an MAOA inhibitor (e.g. the antidepressant isocarboxazid) prolonged survival. From a science viewpoint, this is a very interesting finding but it is entirely unclear at the moment if the effect would be reproducible in humans and whether it would translate to any significant improvement in overall survival or quality of life. One to watch though.