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Anchor lead: Using chemotherapy inside the bladder may reduce recurrence, Elizabeth Tracey reports

People with early bladder cancer who had the chemotherapy drug gemcitabine placed inside the bladder following surgery to remove the tumor had fewer recurrences, a recent study found. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, explains the trial.

Nelson: They took more than 400 subjects, 384 completed the trial, randomized them to receive gemcitabine, which is a chemotherapy drug used to treat bladder cancer, they’re going to instill it into the bladder and let it sit there for an hour, versus saline or something that doesn’t have gemcitabine in it.  And then follow them every three months and they do that every three months for two years, every six months for another couple years. What they found was the recurrences were 34% less.  :29

Nelson says the goal is to keep bladder cancer in check so that it doesn’t invade the muscle wall of the organ and notes that this is a very simple intervention without significant side effects. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Targeted therapies have a role in the treatment of melanoma, Elizabeth Tracey reports

Therapies targeting a pathway known as ‘programmed cell death’ or PDL-1 have been shown to be beneficial in people with advanced melanoma, the most deadly type of skin cancer, a recent study found. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says that was true even if the tumor tested negative for this pathway.

Nelson: That’s actually a very interesting aspect of this study. There have been attempts to figure out ways to predict who is likely to respond and not likely to respond. In this particular study, the majority of the cancers had evidence of the PDL-1 expression. Having said that there was no difference in the benefit of whether that was present or not. The PDL-1 negative cancers also showed a significant benefit.  :26

Nelson says this may be because the pathway is operational in tissues other than the cancer itself. Research is underway to understand these pathways better. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: MRI helps when it comes to prostate biopsy, Elizabeth Tracey reports

Using magnetic resonance imaging or MRI, in conjunction with ultrasound guidance, improved detection of cancer in prostate biopsies, a recent study in the New England Journal of Medicine found. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, reviews the results.

Nelson: They took 500 men and randomized them to one or the other approaches. On the ones that got the magnetic resonance imaging 28% of them were felt not to have findings on magnetic resonance imaging suggestive of prostate cancer, at least of a significant prostate cancer.  And they were not subjected to biopsies. And then if you look at the clinically significant prostate cancers, these are the ones more likely to be life-threatening, they were detected a little bit more effectively, 38% versus 26% :30

Nelson says one caveat remains regarding reading MRI results, pointing to a clear need for more expert readers to interpret the findings. He predicts that use of both MRI and ultrasound will become the standard of care nationally for prostate biopsy. At Johns Hopkins, I’m Elizabeth Tracey.

 

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Anchor lead: New guidelines for prostate cancer screening have been released, Elizabeth Tracey reports

If you’re a man, should you undergo prostate specific antigen or PSA screening for prostate cancer? The United States Preventive Services Task Force, known by the acronym USPSTF, has just released its new guidelines. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes the recommendations.

Nelson: They believe that there is a possible net benefit for men aged 55 to 69 years, although they believe the trade-off is very significant and sort of mandates an individualized discussion. So they give that a grade C. for screening men above the age of 70 they believe that the risk of side effects and complications outweigh the potential benefits and they give that a grade D. I think that people considering any healthcare maneuver should have a conversation with their physician and I believe this is no exception.  :31

Nelson notes that men with a family history and African American men may be at higher risk, according to the guidelines. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: What’s the best way to have dementia diagnosed? Elizabeth Tracey reports

New screening tools for dementia are being developed, with some studies suggesting that they can be used to detect Alzheimer’s disease in a primary care setting. Constantine Lyketsos, an Alzheimer’s disease expert at Johns Hopkins, says while such a strategy may work, getting a definitive answer likely requires an expert.

Lyketsos: There clearly are primary care physicians who are very good at this. For the most part primary care physicians have other priorities and so we see errors on both sides: folks who end up on quote ‘Alzheimer drugs’ when they just have a memory complaint and then we have folks with moderate dementia who’ve been missed. My advice would be if dementia is suspected, and it usually comes from a family member, for a family member to make direct contact with a primary care physician, encourage them to do an assessment and if there’s some doubt, to request a referral to a specialist.  :32

Lyketsos is hopeful that more objective tests may soon allow dementias to be identified more easily. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Chances are good you’ll have more exposure to those with dementia, Elizabeth Tracey reports

Even though there may be fewer people being diagnosed with Alzheimer’s disease and other dementias, because people are generally healthier they are living longer with the disease, and that’s putting a huge burden on all kinds of services. Constantine Lyketsos, an Alzheimer’s disease expert at Johns Hopkins, says the impact, especially for families, is just beginning to be felt.

Lyketsos:  Every person with dementia has one or two caregivers on average through the course of the illness. Oftentimes it starts out with a spouse and then it might become a child because it can be a fairly lengthy illness from start to finish.  It’s therefore going to effect a lot of people. I don’t think it’s really hit our consciousness as to how big a problem it will be. People are terrified it will happen to them, I think that’s hit our conscience, nobody wants to get dementia. But the fact that it’s going to be all around us on a daily basis much more than it is right now hasn’t quite trickled down.  :35

At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Just how big a problem is Alzheimer’s disease? Elizabeth Tracey reports

Deaths from Alzheimer’s disease have increased by 123%, while deaths from other causes like heart disease and cancer have declined, the latest data from the Alzheimer’s Association report. Constantine Lyketsos, an Alzheimer’s expert at Johns Hopkins, says even the newest therapies won’t help in the short term.

Lyketsos: These therapies, the amyloid busting drugs, the other things that we’re seeing in the pipeline, even though they are disease targeted, even though they’ll probably bend the curve, they’re not going to stop the curve. Let’s say some of these make it out to the market. It’s going to increase the number of people alive with dementia more likely than not. So this idea that we don’t have to plan for services in the future because we’ll have fewer people with dementia isn’t true, the complete opposite is true, we’ll either have the same number or more.  :30

Lyketsos notes that costs for caring for those with dementia exceed a quarter of a trillion dollars. At Johns Hopkins, I’m Elizabeth Tracey.

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