Radiation may deter disease progression in advanced cases.
* THE QUESTION Advances in treatment have greatly improved the odds for men whose prostate cancer is diagnosed early. But when the cancer has spread beyond the gland, might it be wise to follow prostate removal with radiation?
* THIS STUDY included 1,005 men with advanced prostate cancer who had had a radical prostatectomy and were considered at high risk for having the disease spread. They were randomly assigned to undergo radiation treatments starting within four months of their surgery or to be observed, with radiation or other follow-up treatment started later if necessary. Based on prostate-specific antigen (PSA) levels, an indicator of the cancer, 74 percent of those who had had immediate radiation were considered cancer-free after five years, compared with 53 percent of the observation group. Side effects were more frequent in the radiation group but generally moderate; severe diarrhea and greatly increased urinary frequency -- factors that may indicate cancer progression -- were not common.
* WHO MAY BE AFFECTED BY THESE FINDINGS? Men with advanced prostate cancer. More than 230,000 American men will be diagnosed with prostate cancer this year, most of them over 65 years old.
* CAVEATS Because prostate cancer progresses slowly, a longer study would be needed to determine whether radiation affected survival rates or the spread of the disease to distant parts of the body.
* FIND THIS STUDY Aug. 13 issue of The Lancet; abstract available online at www.thelancet.com.
* LEARN MORE ABOUT prostate cancer at www.cancer.org and www.cancer.gov.
Suddenly stopping routine use of aspirin could be dangerous.
* THE QUESTION Many people take aspirin not for its painkilling attributes but to thin their blood, keeping it from forming clots that can lead to a heart attack or stroke. Sometimes people stop taking aspirin before surgery, to avoid bleeding problems; sometimes they quit for no apparent reason. Is there any danger in stopping?
* THIS STUDY compared 309 aspirin-takers who had a stroke or transient ischemic attack (commonly called a mini-stroke) with 309 similar people who had not had strokes and were taking the drug as a preventative. The participants, who were mostly men, took about 200 milligrams daily. In the stroke group, 13 people had stopped taking aspirin four weeks or less before their stroke, compared with four people in the other group who had stopped taking it within four weeks or less of being interviewed for the study. The researchers calculated that a sudden stop triples one's risk of stroke compared with continuing to take aspirin regularly. The authors suggest that stopping aspirin therapy before surgery may not always be advisable in people with cardiovascular risk factors.
* WHO MAY BE AFFECTED BY THESE FINDINGS? People who take aspirin daily to stave off cardiovascular problems.
* CAVEATS The findings were based on a small number of people who stopped taking aspirin.
* FIND THIS STUDY August issue of the Archives of Neurology; abstract available online at www.archneurol.com.
* LEARN MORE ABOUT aspirin therapy for cardiovascular disease at http://patients.uptodate.com and www.americanheart.org (search for "anticoagulant and antiplatelet").
Drug treatment may be a good alternative to surgical care.
* THE QUESTION Women who have miscarried a pregnancy often undergo vacuum-aspiration surgery to clear the uterus of any tissue that was not spontaneously expelled. An increasingly common alternative to this invasive procedure is use of the ulcer-preventive drug misoprostol. How safe and effective is this option, which can be performed on an outpatient basis and even by self-administration of the drug?
* THIS STUDY involved 652 women who had experienced a first-trimester miscarriage. Eighty-four percent of those who were randomly assigned to receive misoprostol had complete expulsion of the uterine tissue, almost all of them within three days. By comparison, surgery was successful for 97 percent of those assigned to the standard treatment. Rates of complications were similar in both groups. More than three-quarters of those who tried the drug told researchers they would use it again for a subsequent miscarriage. This was true even among women who had undergone the surgical procedure after previous miscarriages.
* WHO MAY BE AFFECTED BY THESE FINDINGS? The estimated 25 percent of women who miscarry at least once in their lives.
* CAVEATS Because the drug causes uterine contractions, those who use it may need painkillers. The lowest effective dose of the drug has not been determined.
* FIND THIS STUDY Aug. 25 issue of the New England Journal of Medicine; abstract available online at www.nejm.org.
* LEARN MORE ABOUT miscarriage treatments at www.marchofdimes.com/professionals/681_1192.asp and www.facs.org/public_info/operation/brochures/dncmiss.pdf.
-- Linda Searing, Tom Graham
The research described in Quick Study comes from credible, peer-reviewed journals. Nonetheless, conclusive evidence about a treatment's effectiveness is rarely found in a single study. Anyone considering changing or beginning treatment of any kind should consult with a physician.