scholarly journals Why Fish Oil Fails: A Comprehensive 21st Century Lipids-Based Physiologic Analysis

2014 ◽  
Vol 2014 ◽  
pp. 1-15 ◽  
Author(s):  
B. S. Peskin
Keyword(s):  
Prostate Cancer ◽  
Fish Oil ◽  
Medical Community ◽  
Collaborative Group ◽  
High Grade ◽  
Previous Myocardial Infarction ◽  
Prevention Study ◽  
Negative Finding ◽  
High Risk Factors ◽  
Cvd Prevention

The medical community suffered three significant fish oil failures/setbacks in 2013. Claims that fish oil’s EPA/DHA would stop the progression of heart disease were crushed when The Risk and Prevention Study Collaborative Group (Italy) released a conclusive negative finding regarding fish oil for those patients with high risk factors but no previous myocardial infarction. Fish oil failed in all measures of CVD prevention—both primary and secondary. Another major 2013 setback occurred when fish oil’s DHA was shown to significantly increase prostate cancer in men, in particular, high-grade prostate cancer, in the Selenium and Vitamin E Cancer Prevention Trial (SELECT) analysis by Brasky et al. Another monumental failure occurred in 2013 whereby fish oil’s EPA/DHA failed to improve macular degeneration. In 2010, fish oil’s EPA/DHA failed to help Alzheimer’s victims, even those with low DHA levels. These are by no means isolated failures. The promise of fish oil and its so-called active ingredients EPA / DHA fails time and time again in clinical trials. This lipids-based physiologic review will explain precisely why there should have never been expectation for success. This review will focus on underpublicized lipid science with a focus on physiology.

scholarly journals PCPT, MTOPS and the use of 5ARIs: a Canadian consensus regarding implications for clinical practice

2012 ◽  
Vol 1 (1) ◽  
Author(s):  
Laurence Klotz ◽  
Fred Saad
Keyword(s):  
Prostate Cancer ◽  
Clinical Practice ◽  
Cancer Prevention ◽  
Consensus Conference ◽  
Consensus Meeting ◽  
Medical Community ◽  
High Grade ◽  
Urologic Oncology ◽  
Reductase Inhibitors ◽  
Prostate Cancer Prevention

Objectives: Two large, recently published, definitive trials evaluated the benefitsof 5-alpha reductase inhibitors (5ARIs). The Prostate Cancer Prevention Trial(PCPT) tested the effect of finasteride for prostate cancer prevention and the Medical Therapy of Prostatic Symptoms (MTOPS) tested its effect in benign prostatic hyperplasia(BPH). Both trials were strongly positive. However, the role of 5ARIs inthe clinical management of patients remains controversial. The consensus conference,which forms the basis for this report, attempted to develop an expertopinion, based on these studies, as to the optimal use of 5ARIs in patient management.Methods: The Canadian Consensus Meeting, organized by the Canadian Urology Research Consortium and the Canadian Urologic Oncology Group, held inToronto on May 7, 2006, focused on the new data from the PCPT and the MTOPS study. Internationally recognized experts and clinicians discussedthe implications of these data on clinical practice and issued a recommendationon the optimal management of patients with BPH.Results: The Consensus meeting agreed on the following recommendations:1. The overall results from the PCPT and MTOPS studies are of importanceto the urologic, as well as to the greater medical, community.2. Prostate management guidelines should be updated to include the resultsfrom both the MTOPS and the PCPT studies.3. In the PCPT, the incidence of high-grade cancer was higher in the finasteridetreatedgroup (6.4%), compared with the placebo group (5.1%). Subsequentanalyses strongly suggest that this increased prevalence was owing to a detectionbias caused by the reduction in prostate volume in patients takingfinasteride, compared with patients taking placebo. This resulted in animproved detection at biopsy of high-grade cancer in the finasteride group.4. In men who have large prostates and lower urinary tract symptoms (LUTS),5ARIs should be considered, both for the treatment of BPH and for prostatecancer risk reduction.5. For men who are concerned about prostate cancer, it is appropriate to discusschemoprevention with finasteride.6. Urologists are encouraged to disseminate these recommendations amongother healthcare professionals.

Impact of 5-ALPHA reductase inhibitor use on prostate cancer risk at the time of urology referral.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 226-226
Author(s):  
James T Kearns ◽  
Justin T. Matulay ◽  
William E. Anderson ◽  
Timothy C. Hetherington ◽  
Claud Grigg ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Demographic Data ◽  
Laboratory Data ◽  
Prostate Cancer Risk ◽  
Collaborative Group ◽  
Ambulatory Setting ◽  
High Grade ◽  
Reductase Inhibitors ◽  
Psa Testing ◽  
The Impact

226 Background: 5-alpha reductase inhibitors (5-ARIs) are commonly used medications for the treatment of lower urinary tract symptoms caused by benign prostatic hyperplasia. One of the consequences of 5-ARI use is a 50% drop in serum PSA without a concomitant reduction in prostate cancer (PCa) risk. Previous work has suggested that 5-ARI use is associated with worse PCa-specific outcomes. The objective of this study was to evaluate the impact of 5-ARI use on patients’ PCa risk at the time of referral from primary care to urology. Methods: This retrospective cohort study included all men ≥ 40 years who had a PSA resulted between 2018-2019 and were seen in an ambulatory setting. PSA testing was determined through laboratory data in the electronic health record (EHR). Clinical and demographic data were collected for all men. 5-ARI use was determined through orders in the EHR. Men were assigned PCa risk according to both the Prostate Biopsy Collaborative Group (PBCG) and Prostate Cancer Prevention Trial (PCPT) risk calculators. PSA values were doubled for 5-ARI users prior to calculating risk. Referral to urology for PCa risk was determined using the narrative reason for referral associated with the referral order. Results: Between 2018-2019, 91,368 men had a PSA test, including 2,939 5-ARI users, and 88,429 non-users. Uncorrected median PSA and the proportion of men referred to urology for PCa risk were similar between the two groups (p = 0.60 and p = 0.17, respectively). Of men referred to urology for PCa risk, 5-ARI users had similar uncorrected PSA to non-users (p=0.86) but higher risk for high grade PCa once PSA correction was performed, median (IQR) 48% (24%) vs 28% (18%) using the PBCG and 21% (17%) vs 10% (10%) using the PCPT (p < 0.01 for both) (Table). Conclusions: Men taking 5-ARIs have significantly higher risk for high-grade PCa at time of referral to urology than non-users in this cohort. As the unadjusted PSA at referral to urology for PCa risk was the same between 5-ARI users and non-users, this indicates that the effect of 5-ARI use on serum PSA levels is not routinely accounted for when assessing PCa risk. Further study on interventions to account for 5-ARI use when screening for PCa are warranted. [Table: see text]

Fish Oil Fails to Boost Secondary CVD Prevention

2007 ◽  
Vol 40 (13) ◽  
pp. 40
Author(s):  
MITCHEL L. ZOLER
Keyword(s):  
Fish Oil ◽  
Cvd Prevention

Fish Oil, Secondary CVD Prevention Link Still Murky

2007 ◽  
Vol 37 (13) ◽  
pp. 9
Author(s):  
MITCHEL L. ZOLER
Keyword(s):  
Fish Oil ◽  
Cvd Prevention

scholarly journals Glyoxalase 1 Expression as a Novel Diagnostic Marker of High-Grade Prostatic Intraepithelial Neoplasia in Prostate Cancer

Cancers ◽  
2021 ◽  
Vol 13 (14) ◽  
pp. 3608
Author(s):  
Liliana Rounds ◽  
Ray B. Nagle ◽  
Andrea Muranyi ◽  
Jana Jandova ◽  
Scott Gill ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Diagnostic Marker ◽  
Precancerous Lesion ◽  
Immunohistochemical Analysis ◽  
Intraepithelial Neoplasia ◽  
Prostatic Intraepithelial Neoplasia ◽  
Glycolytic Flux ◽  
Gleason Grade ◽  
High Grade ◽  
Glyoxalase 1

Glyoxalase 1 (GLO1) is an enzyme involved in the detoxification of methylglyoxal (MG), a reactive oncometabolite formed in the context of energy metabolism as a result of high glycolytic flux. Prior clinical evidence has documented GLO1 upregulation in various tumor types including prostate cancer (PCa). However, GLO1 expression has not been explored in the context of PCa progression with a focus on high-grade prostatic intraepithelial neoplasia (HGPIN), a frequent precursor to invasive cancer. Here, we have evaluated GLO1 expression by immunohistochemistry in archival tumor samples from 187 PCa patients (stage 2 and 3). Immunohistochemical analysis revealed GLO1 upregulation during tumor progression, observable in HGPIN and PCa versus normal prostatic tissue. GLO1 upregulation was identified as a novel hallmark of HGPIN lesions, displaying the highest staining intensity in all clinical patient specimens. GLO1 expression correlated with intermediate–high risk Gleason grade but not with patient age, biochemical recurrence, or pathological stage. Our data identify upregulated GLO1 expression as a molecular hallmark of HGPIN lesions detectable by immunohistochemical analysis. Since current pathological assessment of HGPIN status solely depends on morphological features, GLO1 may serve as a novel diagnostic marker that identifies this precancerous lesion.

scholarly journals Clinical use of the SelectMDx urinary-biomarker test with or without mpMRI in prostate cancer diagnosis: a prospective, multicenter study in biopsy-naïve men

2021 ◽  
Author(s):  
Rianne J. Hendriks ◽  
Marloes M. G. van der Leest ◽  
Bas Israël ◽  
Gerjon Hannink ◽  
Anglita YantiSetiasti ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Risk Stratification ◽  
Specific Antigen ◽  
Low Grade ◽  
Diagnostic Study ◽  
High Grade ◽  
Net Benefit ◽  
Conditional Strategy ◽  
Detection Rates ◽  
Guided Biopsy

Abstract Background Risk stratification in men with suspicion of prostate cancer (PCa) requires reliable diagnostic tests, not only to identify high-grade PCa, also to minimize the overdetection of low-grade PCa, and reduction of “unnecessary” prostate MRIs and biopsies. This study aimed to evaluate the SelectMDx test to detect high-grade PCa in biopsy-naïve men. Subsequently, to assess combinations of SelectMDx test and multi-parametric (mp) MRI and its potential impact on patient selection for prostate biopsy. Methods This prospective multicenter diagnostic study included 599 biopsy-naïve patients with prostate-specific antigen level ≥3 ng/ml. All patients underwent a SelectMDx test and mpMRI before systematic transrectal ultrasound-guided biopsy (TRUSGB). Patients with a suspicious mpMRI also had an in-bore MR-guided biopsy (MRGB). Histopathologic outcome of TRUSGB and MRGB was used as reference standard. High-grade PCa was defined as ISUP Grade Group (GG) ≥ 2. The primary outcome was the detection rates of low- and high-grade PCa and number of biopsies avoided in four strategies, i.e., (1) SelectMDx test-only, (2) mpMRI-only, (3) SelectMDx test followed by mpMRI when SelectMDx test was positive (conditional strategy), and (4) SelectMDx test and mpMRI in all (joint strategy). A positive SelectMDx test outcome was a risk score of ≥−2.8. Decision curve analysis (DCA) was performed to assess clinical utility. Results Prevalence of high-grade PCa was 31% (183/599). Thirty-eight percent (227/599) of patients had negative SelectMDx test in whom biopsy could be avoided. Low-grade PCa was not detected in 35% (48/138) with missing 10% (18/183) high-grade PCa. Yet, mpMRI-only could avoid 49% of biopsies, not detecting 4.9% (9/183) of high-grade PCa. The conditional strategy reduces the number of mpMRIs by 38% (227/599), avoiding biopsy in 60% (357/599) and missing 13% (24/183) high-grade PCa. Low-grade PCa was not detected in 58% (80/138). DCA showed the highest net benefit for the mpMRI-only strategy, followed by the conditional strategy at-risk thresholds >10%. Conclusions SelectMDx test as a risk stratification tool for biopsy-naïve men avoids unnecessary biopsies in 38%, minimizes low-grade PCa detection, and misses only 10% high-grade PCa. Yet, using mpMRI in all patients had the highest net benefit, avoiding biopsy in 49% and missing 4.9% of high-risk PCa. However, if mpMRI availability is limited or expensive, using mpMRI-only in SelectMDx test positive patients is a good alternative strategy.

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