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New Guidance Says Doctors Should Discuss Vaping as One Option to Help Adults Quit Smoking

Quitting smoking is one of the best things a person can do for their health—but it's also one of the hardest habits to break. Many smokers make several attempts before they successfully quit, even when using medications or nicotine replacement products. Now, a panel of tobacco treatment experts is encouraging healthcare providers to expand the conversation about smoking cessation by discussing nicotine e-cigarettes as one possible option for adults who smoke cigarettes. The recommendations, published in JAMA , were developed by the Harm Reduction Work Group of the Society for Research on Nicotine and Tobacco’s Treatment Research Network. Rather than promoting vaping, the group says clinicians should focus on helping patients choose the quit-smoking method that best fits their individual circumstances. A Personalized Approach to Quitting Smoking cessation isn't the same for everyone. What works well for one person may not work for another, which is why the authors recommend mo...
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Rising PSA no indication for biopsy, prostate cancer


High PSA velocity no predictor of prostate cancer risk


Researchers from Memorial Sloan Kettering Cancer Center say a sudden rise in PSA (prostate specific antigen) level, known as PSA velocity, is not a predictor of prostate cancer, as long as the total PSA remains low and clinical exam is otherwise normal.

The scientists studied 5000 men, finding strong evidence that using PSA velocity can lead to unnecessary biopsies. The researchers say men should be cautious about consenting to a prostate biopsy when digital exam is normal but there are variations in the test. 

According to Peter T. Scardino, MD, Chair of the Department of Surgery, "This study should change practice. We have previously published papers determining that PSA naturally varies from month to month and have urged men whose PSA suddenly rises to wait six weeks and repeat the test before agreeing to a needle biopsy."

Guidelines from the the National Cancer Center Network and the American Urological Association recommend that men with a rapid rise in PSA or high PSA velocity undergo biopsy even if baseline PSA is normal and there are no changes in the prostate gland with a digital rectal exam. 

In the study, men with PSA of 3.0 ng/mL were either given a drug to shrink the prostate gland known as finasteride or a placebo. The researchers focused on the group given placebo. The men were followed for 7 years with yearly PSA testing. Those with a PSA level greater than 4.0 ng/mL were recommended to undergo biopsy.

The study included men from the Prostate Cancer Prevention Trial who were 55 years of age or older and had no history of prostate cancer, normal digital rectal exam and PSA 3.0 ng/mL or less.

At the end of the seven years, men without prostate cancer diagnosis were asked to consent to biopsy. The researchers found there was no association between results of the PSA velocity and outcomes of biopsy. The researchers found PSA testing is a better indicator for prostate cancer than PSA velocity. 

JNCI J Natl Cancer Inst (2011)103 (6): 462-469.doi: 10.1093/jnci/djr028
“An Empirical Evaluation of Guidelines on Prostate-specific Antigen Velocity in Prostate Cancer Detection”  

Image credit: Wikipedia commons
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