Risultati per: Tumore prostata, test della saliva piu’ attendibile del PSA

Stroke, Ahead of Print. Right-to-left shunt, mainly due to patent foramen ovale (PFO), is likely responsible for ≈5% of all ischemic strokes and 10% of those occurring in young and middle-aged adults. Randomized clinical trials demonstrated that, in selected young and middle-aged patients with otherwise cryptogenic acute ischemic stroke and high-risk PFO, percutaneous PFO closure is more effective than antiplatelet therapy alone in preventing recurrence. However, PFO is generally a benign finding and is present in about one-quarter of the population. Therefore, in clinical practice, identifying PFOs that are likely to be pathogenetic is crucial for selecting suitable patients for PFO closure to prevent recurrent stroke and to avoid potentially harmful and costly overtreatment. Contrast transthoracic echocardiography has a relatively low sensitivity in detecting PFO, whereas transesophageal echocardiography is currently considered the gold standard for PFO detection. However, it is a relatively invasive procedure and may not always be easily feasible in the subacute setting. Contrast transcranial Doppler is a noninvasive, inexpensive, accurate tool for the detection of right-to-left shunt. We conducted a literature review on the use of contrast transcranial Doppler to detect and grade right-to-left shunt after an acute ischemic stroke and present a clinical workflow proposal for young and middle-aged patients.

Donne non corrono rischio maggiore di recidiva o nuove neoplasie

Aiom lancia una campagna per sensibilizzare malati e caregiver

Aiom lancia una campagna per sensibilizzare malati e caregiver

When this scenario occurs during screening, incidence of upper endoscopy–detectable cancer is very low.

In Reply We thank Dr D’Amico for his Letter, in which he states that nonattendance and contamination may have led the CAP study to underestimate the benefit of an invitation to a single PSA screening test for reducing prostate cancer mortality over a median 15-year follow-up (intention-to-treat estimate rate ratio, 0.92 [95% CI, 0.85-0.99]; P = .03). This finding corresponded to a reduction of 1 fewer prostate cancer death per 1000 men invited to screening compared with the control group over a median follow-up of 15 years (8 prostate cancer deaths per 1000 men in the control group vs 7 prostate cancer deaths per 1000 men invited to PSA screening). D’Amico states that the difference in PSA testing between the 2 randomized groups was approximately 30%, whereas, ideally, there should be a 100% difference between groups.

To the Editor Secondary analysis of the CAP study reported 15-year mortality rates among men who received an invitation for a PSA screening test followed by further diagnostic evaluation if the PSA was 3.0 ng/mL or greater compared with a control group who did not undergo PSA screening. Although there was increased detection of low-grade and localized prostate cancer among men in the PSA screening and intervention group, there was minimal absolute reduction in prostate cancer mortality (0.09%) and no reduction in all-cause mortality compared with the control group. This begs the question: Can prostate biopsies trigger the spread of prostate cancer in some men, thereby diminishing any potential benefit from early detection and treatment?

To the Editor In a secondary analysis of the Cluster Randomized Trial of PSA Testing for Prostate Cancer (CAP), the secondary end point of prostate cancer–specific mortality was significantly reduced, with a rate ratio of 0.92 (95% CI, 0.85-0.99; P = .03) after a median follow-up of 15 years. I agree with the authors that this result is modest, yet it is important to note that both nonattendance (ie, individuals randomized to the intervention group who did not have a prostate-specific antigen [PSA] test) and contamination (ie, individuals randomized to the standard group who had at least 1 PSA test) can affect the magnitude of the rate ratio for prostate cancer–specific mortality. Specifically, as the authors noted in their CAP article from 2018, the contamination rate was estimated at 10% to 15%, meaning at least 10% of participants in the standard group received at least 1 PSA test. In the current article, the authors noted that the nonattendance rate in the intervention group was 60% and an additional 6% of participants did not have a valid PSA test result. Therefore, in the best-case scenario, the difference in the PSA testing between the 2 randomized groups would be 30% (40% minus 10%). Specifically, 40% in the intervention group was derived from the 60% nonattendance rate and 10% in the standard group was due to contamination. Ideally, to assess the value of a single PSA test on prostate cancer–specific mortality, the difference in PSA testing between the 2 randomized groups should be 100%. As a result, the effect of a single PSA screen on the end point of prostate cancer–specific mortality is likely to be greater than the reported 8% reduction, as reflected in the rate ratio of 0.92. Therefore, it is important to recognize that the results of the CAP study may have underestimated the true effect of a single PSA screen on prostate cancer–specific mortality.

Anderloni (Aigo): “Contano gli stili di vita e diagnosi precoce”

Anderloni (Aigo): “Contano gli stili di vita e diagnosi precoce”

Fnopi, “aumentare l’attrattività con formazione e retribuzioni”

‘In realtà Elle ha seguito protocolli e rientra nel 60% dei casi senza ricadute’

Oncologa, ‘La medicina olistica non cura, in realtà Elle ha seguito protocolli e rientra nel 60% dei casi senza ricadute’

Intervento mininvasivo alle Molinette salva un uomo di 51 anni

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Volume 177, Issue 9, Page JC107, September 2024.