Men worried about prostate cancer have a new online resource, freely available, to help them assess their risk. The multi-step Prostate Cancer Risk Calculator, has been created by the founders of the European Randomized Study of Screening for Prostate Cancer (ERSPC). It is easy and simple for people to use. Men can use the first two calculators to assess their individual risk of developing prostate cancer without needing any medical expertise. The first starts with family history and general health information. The second is for use if you also have the results of a simple blood test to assess the level of prostate specific antigen (PSA). Prostate cancer is one of the most common cancers in men but recent improvements in treatment and diagnosis mean that more men will survive the disease. The on-line resource provides a range of helpful information about the disease, which includes the benefits and disadvantages of going for a PSA test when you do not have symptoms. PSA levels tend to increase as men age and can be a sign of prostate disease, though not always cancer. A further five risk calculators have been created for clinicians to use as part of their clinical practice. They are based on robust evidence gained from research carried out by the ERSPC, the world’s largest study into screening for prostate cancer. They calculate whether clinicians can avoid subjecting men to additional, and invasive, diagnostics tests such as biopsy, or if they can safely be monitored on a more conservative ‘active surveillance’ programme. An additional feature calculates a patient’s risk of having an aggressive form of cancer; and this further helps to decide if a biopsy is needed.

Women who go into early menopause are twice as likely to suffer from coronary heart disease and stroke, new Johns Hopkins-led research suggests. The association holds true in patients from a variety of different ethnic backgrounds, the study found, and is independent of traditional cardiovascular disease risk factors, the scientists say.
‘If physicians know a patient has entered menopause before her 46th birthday, they can be extra vigilant in making recommendations and providing treatments to help prevent heart attacks and stroke,’ says Dhananjay Vaidya, Ph.D., an assistant professor in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine, and leader of the study.
‘Our results suggest it is also important to avoid early menopause if at all possible.’
For example, he says, research has shown that smokers reach menopause, on average, two years earlier than non-smokers do, so quitting smoking may delay it.
Notably, the researchers said, their findings about the negative impact of early menopause were similar whether the women reached it naturally or surgically, via removal of reproductive organs, he says, though more research is needed. Often, Vaidya says, women who undergo hysterectomies have their ovaries removed, which precipitates rapid menopause. ‘Perhaps ovary removal can be avoided in more instances,’ he says, which might protect patients from heart disease and stroke by delaying the onset of menopause.
Cardiovascular disease is the number one killer of women in the United States, according to the Centers for Disease Control and Prevention.
Previous studies, Vaidya says, have shown a link between early menopause and heart disease and stroke among white women, but similar associations had not been demonstrated in more diverse populations. Hispanic and African-American women, he says, tend, on average, to go through menopause somewhat earlier than women of European descent.
Vaidya and his colleagues examined data from 2,509 women involved in the Multi-Ethnic Study of Atherosclerosis, a longitudinal, ethnically diverse cohort study of men and women aged 45 to 84 years, all enrolled between 2000 and 2002 and followed until 2008. Of the women, 28 percent reported early menopause, or menopause that occurs before the age of 46. Vaidya emphasizes that although the risk of heart attack and stroke was doubled in these groups, the actual number of cardiac and stroke events recorded among study participants was small. Only 50 women in the study suffered heart events, while 37 had strokes.
Menopause is a process during which a woman’s reproductive and hormonal cycles slow, her periods (menstruation) eventually stop, ovaries stop releasing eggs for fertilization and produce less estrogen and progesterone, and the possibility of pregnancy ends. A natural event that takes place in most women between the ages of 45 and 55, menopausal onsets and rates are influenced by a combination of factors including heredity, smoking, diet and exercise.
Vaidya says some women are treated with hormone replacement therapy (HRT) to control menopause symptoms such as profuse sweating and hot flashes, but its widespread long-term use has been limited after large clinical trials showed that it increased the risk of heart attacks in some women. In Vaidya’s study, no role was detected for HRT in potentially modifying the impact of early menopause.
‘Cardiovascular disease processes and risks start very early in life, even though the heart attacks and strokes happen later in life,’ he says. ‘Unfortunately, young women are often not targeted for prevention, because cardiovascular disease is thought to be only attacking women in old age. What our study reaffirms is that managing risk factors when women are young will likely prevent or postpone heart attacks and strokes when they age.’ Johns Hopkins

Vitamin D, best known for its role in calcium uptake and bone density has also been shown to have beneficial effects on the immune system, with some studies demonstrating a correlation between higher vitamin D intake and a lower incidence of cancer, and that adequate vitamin D levels may also decrease the risk of autoimmune diseases such as multiple sclerosis and rheumatoid arthritis. Now, a recent study, conducted by doctors across London hospitals and published in the Proceedings of the National Academy of Sciences, has shown that tuberculosis (TB) patients recovered more quickly when given both the vitamin and antibiotics. This idea is reminiscent of earlier times when TB patients, in the days before antibiotics, were prescribed sunbathing, which increases vitamin D production. This study found that recovery was almost two weeks faster when vitamin D was added to the treatment regime, with patients clearing the infection in 23 days on average, compared to 36 days for patients given antibiotics and a placebo. Vitamin D treatment will not replace antibiotics, but might well become a useful extra weapon, particularly with the increasing prevalence of drug-resistant TB. The vitamin seems to work by reducing the inflammatory response to the infection and helping the lungs to heal more quickly. If these lung cavities heal more quickly, patients are infectious for a shorter period of time and may also suffer less lung damage. Stronger evidence and trials to find the best dose and form of vitamin D will be needed before the treatment is put into widespread use.

http://www.pnas.org/

Two new studies from the Johns Hopkins Bloomberg School of Public Health and the Chronic Kidney Disease Prognosis Consortium found that the presence of chronic kidney disease itself can be a strong indicator of the risk of death and end-stage renal disease (ESRD) even in patients without hypertension or diabetes. Both hypertension and diabetes are common conditions with chronic kidney disease with hypertension being the most prevalent.
Chronic kidney disease affects 10 to 16 percent of all adults in Asia, Europe, Australia and the United States. Kidney function is measured by estimating glomerular filtration rate and kidney damage is often quantified by measuring albumin, the major protein in the urine standardised for urine concentration.
In the hypertension meta-analysis, low kidney function and high urine protein was associated with all-cause and cardiovascular mortality and ESRD in both individuals with and without hypertension. The associations of kidney function and urine protein with mortality outcomes were stronger in individuals without hypertension than in those with hypertension, whereas the kidney function and urine protein associations with ESRD did not differ by hypertensive status.
In the diabetes analysis, individuals with diabetes had a higher risk of all-cause, cardiovascular mortality and ESRD compared to those without diabetes across the range of kidney function and urine protein. Despite their higher risks, the relative risks of these outcomes by kidney function and urine protein are much the same irrespective of the presence or absence of diabetes.
‘Chronic kidney disease should be regarded as at least an equally relevant risk factor for mortality and ESRD in individuals without hypertension as it is in those with hypertension,’ said Bakhtawar K. Mahmoodi, MD, PhD, lead author of the hypertension analyses.
‘These data provide support for clinical practice guidelines which stage chronic kidney disease based on kidney function and urine protein across all causes of kidney disease. The conclusions are strengthened by the findings of leading studies and the participation of investigators from 40, countries and a detailed analysis of over 1 million participants,’ said Josef Coresh, MD, PhD, MHS, the Consortium’s principal investigator and professor in the Bloomberg School’s Department of Epidemiology. EurekAlert

Researchers in the Taub Institute at Columbia University Medical Center (CUMC) have identified a mechanism that appears to underlie the common sporadic (non-familial) form of Parkinson’s disease, the progressive movement disorder. The discovery highlights potential new therapeutic targets for Parkinson’s and could lead to a blood test for the disease. The study was based mainly on analysis of human brain tissue.
Studies of rare, familial (heritable) forms of Parkinson’s show that a protein called alpha-synuclein plays a role in the development of the disease. People who have extra copies of the alpha-synuclein gene produce excess alpha-synuclein protein, which can damage neurons. The effect is most pronounced in dopamine neurons, a population of brain cells in the substantia nigra that plays a key role in controlling normal movement and is lost in Parkinson’s. Another key feature of Parkinson’s is the presence of excess alpha-synuclein aggregates in the brain.
As the vast majority of patients with Parkinson’s do not carry rare familial mutations, a key question has been why these individuals with common sporadic Parkinson’s nonetheless acquire excess alpha-synuclein protein and lose critical dopamine neurons, leading to the disease.
Using a variety of techniques, including gene-expression analysis and gene-network mapping, the CUMC researchers discovered how common forms of alpha-synuclein contribute to sporadic Parkinson’s. ‘It turns out multiple different alpha-synuclein transcript forms are generated during the initial step in making the disease protein; our study implicates the longer transcript forms as the major culprits,’ said study leader Asa Abeliovich, MD, PhD, associate professor of pathology and cell biology and neurology at CUMC. ‘Some very common genetic variants in the alpha-synuclein gene, present in many people, are known to impact the likelihood that an individual will suffer from sporadic Parkinson’s. In our study, we show that people with ‘bad’ variants of the gene make more of the elongated alpha-synuclein transcript forms. This ultimately means that more of the disease protein is made and may accumulate in the brain.’
‘An unusual aspect of our study is that it is based largely on detailed analysis of actual patient tissue, rather than solely on animal models,’ said Dr. Abeliovich. ‘In fact, the longer forms of alpha-synuclein are human-specific, as are the disease-associated genetic variants. Animal models don’t really get Parkinson’s, which underscores the importance of including the analysis of human brain tissue.’
‘Furthermore, we found that exposure to toxins associated with Parkinson’s can increase the abundance of this longer transcript form of alpha-synuclein. Thus, this mechanism may represent a common pathway by which environmental and genetic factors impact the disease,’ said Dr. Abeliovich.
The findings suggest that drugs that reduce the accumulation of elongated alpha-synuclein transcripts in the brain might have therapeutic value in the treatment of Parkinson’s. The CUMC team is currently searching for drug candidates and has identified several possibilities.
The study also found elevated levels of the alpha-synuclein elongated transcripts in the blood of a group of patients with sporadic Parkinson’s, compared with unaffected controls. This would suggest that a test for alpha-synuclein may serve as a biomarker for the disease. ‘There is a tremendous need for a biomarker for Parkinson’s, which now can be diagnosed only on the basis of clinical symptoms. The finding is particularly intriguing, but needs to be validated in additional patient groups,’ said Dr. Abeliovich. A biomarker could also speed clinical trials by giving researchers a more timely measure of a drug’s effectiveness. Columbia University Medical Center