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Hopkins News For You
This is a service for our friends around the world from Johns Hopkins International. To receive reports, please send e-mail to patientnewsletter@jhmi.edu or visit our website at www.jhintl.net.
June 2004
Prostate Cancer Pill May Prevent Progression of Disease
A High-Tech Solution to Chronic Pain
Are You at Risk for Diabetes?
Gynecologist Nikos Vlahos on Hormone Replacement Therapy
Prostate Cancer Pill May Prevent Progression of Disease
Treatment options have been limited for patients whose prostate cancer has spread and does not respond to hormone therapy. "Some of these men are looking for less toxic alternatives than chemotherapy at this point in their lives," says Hopkins oncologist Michael Carducci, M.D. Recent clinical studies led by Dr. Carducci have found that a drug called atrasentan reduces the risk by 20 percent that cancer will progress in men with advanced hormone-resistant prostate cancer.
"This drug's largest effect may be its ability to stabilize the progression of prostate cancer to the bone," says Dr. Carducci. "Atrasentan slows the rise in PSA levels and delays the development of pain while maintaining quality of life." Dr. Carducci plans to continue studies of atrasentan in patients whose cancer has not spread and in combination with other drugs. He adds that atrasentan could be an option after hormonal therapy or when patients are waiting to begin chemotherapy.
A High-Tech Solution to Chronic Pain
A small device connected to the spine controls searing pain when nothing else works. Spinal cord stimulation (SCS) has been around for 35 years but recently has been technologically updated to become more controllable and exact. It works best when monitored by an experienced neurosurgeon and at Johns Hopkins that person is Richard North, M.D., co-director of functional neurosurgery.
The technique, used in patients with excrutiating back or leg pain despite surgery or from scar tissue around nerve roots, involves implanting into the spine a small system of multichannel pulse generators and electrodes with contacts assigned to the points of pain. Once the implant is in place, patients use a small, pocket-sized radiofrequency transmitter attached to their belts to substitute a tingling sensation, a much more tolerable feeling to cover the pain.
According to Dr. North, it usually takes an hour for someone who has been in deep discomfort to determine the best setting for overlapping their pain.
1. Are You at Risk for Diabetes?
Millions of people around the world have a condition that has just been designated prediabetes. The term refers to blood sugars between meals of 100 to 125 milligrams per deciliter, and it defines those at risk for full blown diabetes.
The good news, says Hopkins diabetes expert Chrisopher Saudek, is that people who hear they are prediabetic can do something about it. "Prediabetics are at a very high risk for going on to be diabetic. Secondly, there is something that can be done to prevent that sequence. The Diabetes Prevention Program is a large study which came out several years ago and proves that a rigorous diet and exercise program can actually prevent diabetes in these high risk, prediabetic people".
You can find out if you have prediabetes with a glucose tolerance test ordered by your primary care physician.
Gynecologist Nikos Vlahos, M.D., on Hormone Replacement Therapy
How has HRT changed in the last few years?
Dr. Vlahos: For the past 30 years, our understanding was that, among other benefits such as prevention of hot flushes, vaginal atrophy (degeneration of tissues) and osteoporosis, HRT also had a strong protective effect against cardiovascular disease. Since cardiovascular disease is a main cause of death for menopausal women, many doctors advised their patients to be on HRT.
In the past four years there has been a significant change in our understanding of the role of hormones on several health issues. The take-home message is that yes, hormones prevent osteoporosis and fractures, and improve menopausal symptoms; but they do not offer protection against cardiovascular disease. And this was the surprise.
How do you approach women that come to your practice seeking hormonal replacement therapies?
Dr. Vlahos: This is by no means an easy question. We do know that estrogen is the best medication available to treat hot flashes. Also, it is the best medication for vaginal atrophy. This is especially true for young women who had early menopause. For these women hormone replacement is appropriate if they are willing to accept some additional risks.
The second thing I do is reduce the dose to a minimal amount that treats their symptoms. Finally, I use hormones that are chemically the same as those naturally produced by the ovaries. We were under the impression that HRT was a panacea. Apparently this is not true. What I always tell my patients is that there's no paradise on earth. When they decide to take any treatment they will have to balance the risks and benefits. They have to investigate, they have to talk to their doctors and they have to ask questions.
Are there alternative treatments to HRT?
Dr. Vlahos: The alternative is to treat symptoms separately. For example, for women suffering with vaginal atrophy I have been using vaginal estrogen preparations that act locally with minimal absorption. In terms of the hot flashes, which are the most difficult to treat, I initially recommend lifestyle chances, like wearing more comfortable clothing, changing the temperature of the room and lighter covers at night.
A new medication called Gabapeptin has also been found effective for hot flashes. What I tell my patients is that after 1-2 years only 20% of them will continue having significant hot flashes, so if you pass this initial phase of hormone deprivation, chances are that they are going to feel much better.
For prevention of osteoporosis I routinely recommend taking at least 1500 mg/day of calcium combined with weight-bearing exercise.
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