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Popular Articles

Call For Primary Care Reform From AAFP, ACP And AOA
Leaders of three national organizations representing nearly a third of a million physicians recently visited Capitol Hill offices to express their continued concern for America"s patients who do not have access to primary care physicians. The American Academy of Family Physicians (AAFP), the American College of Physicians (ACP) and the American Osteopathic Association (AOA) represent the majority of physicians who care for Medicare patients. The leaders noted that only 17 percent of U.S. medical school graduates in 2008 expressed a preference for a primary care specialty - an all-time low - at a time when demand for primary care is rapidly increasing.

Obama Adminstration Releases Final Rules On Stem Cell Research
The Obama administration released final regulations governing stem cell research on Monday. The New York Times reports that the rules will allow many older stem cell lines to be eligible for federally financed research. "The changes came in response to criticism from scientists that the rules that the administration proposed in April - requiring that donors of fertilized eggs sign extensive consent forms - would have made even some of the stem cell lines approved by the Bush administration ineligible for further money," the Times reports. "Scientists using stem cell lines created before Tuesday may seek review by a group of the Advisory Committee to the Director."
News of the day
Regulations Seek To Crack Down On Medical ID Theft
New regulations seek to crack down on a little known form of identity theft -- medical identity theft, according to Kaiser Health News. "Armed with as little as a stolen name, Social Security number and date of birth, an imposter can walk into a doctor"s office or hospital and receive services billed to the victim or the insurance provider. Although few statistics are available, the Federal Trade Commission reports that medical identity theft accounts for 1.3 percent to 3 percent of all identity theft crime -- about 250,000 cases each year."
Oncology

Is It Time To Consider A Role For MRI Before Prostate Biopsy?

UroToday.com - The prevailing view is that MRI has a limited role in the management of prostate cancer. Currently, the threshold for requesting a pre-treatment staging MRI is variable with most advocating this for only those classified as high risk localized prostate cancer, although some also advocate men with intermediate risk disease. The rationale for this view is that verification of organ-confined cancer in men with a low risk of locally advanced disease using a test that is both expensive and time consuming is not warranted. It has arisen due to poor quality scans as a result of low-resolution magnetic field strengths combined with biopsy artifact. There is increasing evidence, however, that the threshold for requesting MRI should be lowered. This is related to improved technology, but is also linked to changes in diagnosis and management of prostate cancer, in which improved risk stratification is linked to reductions in treatment burden. In this Review, we outline the artifact problem that occurs if MRI is used after biopsy. We also discuss the potential advantages in diagnosis and risk stratification that may be derived from using MRI prior to biopsy. Pre-biopsy MRI is currently nested within a small number of groups in France, Japan, India and in our own centre. We describe how local staging may improve as a result of using MRI and its association with improved clinical outcomes. Finally, we review the limitations in the current literature and recommend strategies that will overcome these limitations. Advocating the widespread use of MRI prior to biopsy in a population of men with risk parameters for harboring prostate cancer has a number of advantages which may ultimately benefit the care these men undergo. Increasing the detection of prostate cancer that requires treatment whilst avoiding biopsy - and hence unnecessary treatment - in those with insignificant or no cancer are compelling arguments for this approach. Conferring better staging accuracy and determining disease burden may also lead to greater benefit for those who undergo treatment. Key Points: 1. The role of MRI in prostate cancer management is controversial; most guidelines recommend its use only in high-risk patients based on evidence that used early-generation machines rather than using up-to-date data 2. The use of spectroscopy, dynamic contrast enhancement and diffusion weighting in combination with traditional T2-weight scans increases the accuracy of MRI to detect and stage prostate cancer 3. If multi-sequence MRI was applied in the pre-biopsy setting to overcome biopsy artifact, it could potentially increase the detection of significant prostate cancer, and decrease the diagnosis of indolent disease that requires no treatment 4. Such scans could potentially guide traditional therapy such as surgery and radiotherapy and also select those men with high-risk disease that require dose escalation whilst selecting groups with a low burden of disease that would be candidates for surveillance Written by: H.U. Ahmed, M. Arya, R. Illing, A. Kirkham, C. Allen, A. Freeman and M. Emberton as part of Beyond the Abstract on UroTodya.com. Author Print Biographies HU Ahmed is an MRC Clinical Research Fellow and Specialist Registrar in Urology, and M Arya is a Specialist Registrar in Urology, both at the Division of Surgical and Interventional Sciences, University College London, UK. R Illing is a Specialist Academic Registrar in Radiology and A Kirkham and C Allen are both Consultant Radiologists, both at University College London Hospitals NHS Foundation Trust with specialist expertise in uro-radiology. A Freeman is a Consultant Histopathologist with expertise in uro-oncology based at University College London Hospitals NHS Foundation Trust. M Emberton is Reader in Interventional Oncology and Consultant Urological Surgeon, University College London as well as Clinical Director of the Clinical Effectiveness Unit, The Royal College of Surgeons of England, 35-43 Lincoln Inn Fields, London, UK. Conflicts of Interest and Funding Hashim Uddin Ahmed and Mark Emberton receive funding from the following charities: The Medical Research Council, Pelican Cancer Foundation, Prostate Research Campaign UK, Prostate Cancer Research Centre UK and St Peters Trust for work in focal therapy of prostate cancer. In addition, Mark Emberton receives funding from Negma Lerads, France (manufacturers of TOOKAD, a photodynamic agent used in prostate cancer therapy) and Misonix/Focus Surgery (manufacturers of the Sonablate® 500 HIFU device) as a Medical Consultant. Manit Arya, Clare Allen, Alex Kirkham and Alex Freeman have no conflicts of interest. None of the funding s had any role in the writing of this article. UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice. To access the latest urology news releases from UroToday, go to: www.urotoday.com Copyright © 2009 - UroToday


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