Revisiting the donor screening protocol of faecal microbiota transplantation (FMT): a systematic review

We read with interest the recent work by Haifer et al,1 which highlighted the importance of donor selection in determining the clinical efficacy of treating ulcerative colitis (UC) using faecal microbiota transplantation (FMT), with one donor having 100% efficacy compared with a second donor (36% efficacy). Considering the impact of COVID-19 pandemic on FMT, updated guidance including patient selection, donor recruitment and selection, FMT procedures and stool manufacturing was provided by worldwide FMT experts in international guideline by Ianiro et al.2 The US Food and Drug Administration (FDA) has recommended that FMT donor screening must include a questionnaire specifically addressing risk factors for colonisation with multidrug-resistant organisms (MDROs) and stool testing for MDROs, including extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, vancomycin-resistant enterococci (VRE), carbapenem-resistant Enterobacteriaceae (CRE) and methicillin-resistant Staphylococcus aureus (MRSA) at minimum.3 The evolution of FMT and the introduction of essential donor screening requirements…

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Maggio 2024

A Pragmatic Approach to Prostate Cancer Screening

The introduction of prostate-specific antigen (PSA)–based screening for prostate cancer in the early 1990s was followed by a nearly 2-decade long decline in prostate cancer metastasis and mortality. However, clinical trial data revealed that screening was associated with substantial harms. Under the traditional clinical approach in which elevated serum PSA triggered prostate biopsy, roughly 1 in 5 screened men underwent biopsies, with more than 75% found to be negative and a majority of positive biopsies harboring low-grade, clinically insignificant cancers. Prostate biopsies are uncomfortable for patients and carry a risk of bleeding and infection requiring hospitalization. Moreover, during a previous era in which a cancer diagnosis was inexorably linked to treatment, overdiagnosis (ie, detection of indolent cancers that would not have been detected during life in the absence of screening) and overtreatment resulted in significantly reduced quality of life. In 2012, the US Preventive Services Task Force (USPSTF) provided a grade D recommendation against the use of PSA screening, concluding that the benefits of PSA-based screening for prostate cancer do not outweigh the harms.

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Maggio 2024