Study: Potency after prostate cancer varies widely (AP)

CHICAGO � A new study addresses one of the most worrying questions faced by men with prostate cancer: What are my chances of losing sexual function after treatment?

The answers vary greatly by age, sexual potency before treatment, PSA levels and whether a man has surgery, standard radiation or radioactive seeds, the study found.

Using the findings, men can get a rough idea of their personal odds by answering questions that also include weight and race, experts said. Unsurprisingly, older men whose sexual function is already low have the worst chances of good sexual function after treatment.

"This will make it possible for patients to have a more realistic view of what to expect for themselves, rather than trying to guess where they fit in overall compared to the average guy with prostate cancer," said study co-author Dr. Martin Sanda of Beth Israel Deaconess Medical Center in Boston.

The federally funded study, appearing in Wednesday's Journal of the American Medical Association, included only men with early-stage cancers, and it didn't address cure rates for different treatments. In the real world, some patients have limited treatment choices. For instance, only men with early-stage, slow-growing cancers can choose radioactive pellets.

That means the findings may be most useful in giving a realistic picture of the sexual side effects of a treatment that's already chosen, rather than helping men pick a treatment.

Researchers studied factors affecting potency in men and developed a questionnaire to help measure it. They evaluated its usefulness among 1,027 prostate cancer patients ages 38 to 84 and validated its accuracy in a separate group of more than 1,900 men. It correctly predicted the chances of post-treatment potency in 77 percent of the men who had surgery to 90 percent of the men who had radiation.

The study found great variation in men's odds of having firm erections after treatment.

For surgery, the prospects for maintaining top sexual function for a 50-year-old man could range from 21 percent to 70 percent, depending on his PSA level and whether a nerve-sparing technique was used.

For standard radiation, the study found, the odds for a man keeping top sexual function ranged from 53 percent to 92 percent depending on PSA level and whether hormones were used along with radiation. The researchers couldn't find an age-related difference for standard radiation.

For radiation pellets, a 60-year-old man's chances of keeping top sexual function ranged from 58 percent to 98 percent depending on race and body mass index. African-Americans and trimmer men had better chances.

The study has some deficiencies, experts said.

It didn't include men who chose what's called "active surveillance," where a doctor keeps track of a tumor through regular tests and treats it only if the cancer markedly worsens. Many prostate cancer patients with slow-growing tumors can live their whole lives without symptoms or treatment, said Dr. Durado Brooks, prostate cancer director for the American Cancer Society. They die of something else before the cancer kills them.

"There are a lot of prostate cancers that are not likely to benefit from treatment," Brooks said. Including an active surveillance group would have shown how much sexual function changes because of factors other than treatment, such as age and general health, he said.

Most patients treated for early-stage prostate cancer survive, so the common side effects of treatment � incontinence and sexual problems � have become more important for patients making choices.

Jerry Hardy, 57, of Detroit had nerve-sparing surgery for prostate cancer in 2000 and lost sexual function. It took three years of trying different pills and injections before he decided on a penile implant, which has worked for him and his wife. He's not sure whether having a better prediction method for future sexual function would have meant anything to him � even with all he's been through.

"The most important thing was to cure the cancer. Then we would deal with the side effects later," Hardy said. "If you're not alive, you don't have to worry about sex."

Jonathon Alsop, 54, of Boston was diagnosed with prostate cancer last year. His surgeon, study co-author Sanda, used early data from the study to tell Alsop there was a 70 percent chance he would keep his good sexual function after nerve-sparing surgery. That number was reassuring, Alsop said, and he was convinced surgery was the best choice for him for medical reasons. Now, nine months after treatment, his sexual function is returning, but isn't yet back to where it was.

"I'm feeling good about where I'm headed," Alsop said. "Let's just be frank. It's an important issue. ... My advice to any couple would be to think and act like young lovers, and explore what works for you and what doesn't," Alsop said.

The researchers followed the men for two years after treatment.

In the men who were potent before treatment, 52 percent reported problems with erections two years after treatment. That included 60 percent of the men who had their prostates removed, 42 percent who had regular radiation and 37 percent of the men who had radioactive seeds, also called brachytherapy.

Brooks of the American Cancer Society cautioned that sexual problems can show up later for men who have either type of radiation therapy. A two-year follow-up may not have been long enough, he said.

The study was done from 2003 through 2006, a time when laparoscopic surgery, with small incisions and often performed robotically, was less common than it is today.

Dr. Michael Barry of Massachusetts General Hospital in Boston and president of the Foundation for Informed Medical Decision Making said it's not clear yet whether the newer surgical technique is better or worse for sexual function.

"This paper gives us one piece of the puzzle," said Barry, who wrote an accompanying editorial. "It doesn't address what are my chances with problems of incontinence? Or what are my chances of dying of prostate cancer for these different treatments? A patient would want to synthesize all that information to figure out what to do."

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Online:

JAMA: http://jama.ama-assn.org

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Study: Whooping cough vaccination fades in 3 years (AP)

ATLANTA � A preliminary study suggests the vaccine against whooping cough falters after only about three years, adding support to school rules requiring kids to get the vaccination periodically.

California schools have turned away thousands of students this fall who aren't up to date on their shots. That state had a huge spike in whooping cough cases last year, and 10 babies died after exposure from adults or older children.

The study in one California county found the risk of getting the disease was as much as 20 times higher in kids three years or more after they finished receiving a recommended series of vaccinations. But kids vaccinated more recently were well protected.

Dr. David Witt, the lead researcher, presented the findings Monday at an infectious diseases medical conference in Chicago.

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Child abuse rose during recession, research says (AP)

CHICAGO � An increase in child abuse, mostly in infants, is linked with the recent recession in new research that raises fresh concerns about the impact of the nation's economic woes.

The results are in a study of 422 abused children from mostly lower-income families, known to face greater risks for being abused, and the research involved just 74 counties in four states. But lead author Dr. Rachel Berger of Children's Hospital of Pittsburgh said the results confirm anecdotal reports from many pediatricians who've seen increasing numbers of shaken baby cases and other forms of brain-injuring abuse.

Berger decided to study this type of injury, known as abusive head trauma, after noticing an increase at her own hospital from late 2007 through June 2009. Her hospital averaged 30 cases per year during those recession years versus 17 yearly before 2007.

Though this abuse is still uncommon, the number of cases in the counties studied increased sharply, rising from about 9 cases per 100,000 children in pre-recession years, to almost 15 per 100,000 kids during the recession � a 65 percent increase.

By contrast, juvenile diabetes � a better-known condition � affects about 19 per 100,000 children younger than age 10.

Children studied were younger than 5, and most were infants. Most suffered brain damage and 69 died, though the death rate didn't rise during the recession.

Unemployment rates in the 74 counties rose during the five-year study. The proportion of children on Medicaid in those counties also increased, from 77 percent before the recession to 83 percent. However, insurance and family employment information were not reported for the abused children in the study.

Combine the stress of raising a young child with wage cuts or lost jobs and you get "a sort of toxic brew in terms of thinking about possible physical violence," said Mark Rank, a social welfare professor at Washington University in St. Louis. He said the study echoes sociological research linking violence with declines in economic well-being.

Along with U.S. Census data released last week indicating that a record 46 million Americans are poor, the study shows that "as poverty goes up and economic stagnation continues...there are really human costs involved," Rank said.

The study was released online Monday in Pediatrics.

The counties studied included Pittsburgh and western Pennsylvania; central and southern Ohio; and a handful of counties in northern Kentucky and in the Seattle area. The researchers examined medical records and national labor statistics for 2004 through November 2007 and compared them with data from the recession.

Of the 422 children diagnosed with abusive head trauma during the study, roughly 65 cases occurred each year before the recession, versus about 108 yearly during the recession.

Federal government data suggest that the recession did not affect child abuse rates. But the study authors said those numbers are based on reports from child protective services, not medical diagnoses, and did not address brain injuries specifically.

The research doesn't prove that the recession caused the abuse. Studying different regions and children from more middle-class families would help clarify if the recession really played a role, said Dr. Peter Sherman, director of the residency program in social pediatrics at Montefiore Medical Center in New York.

Sherman noted that most children studied were publicly insured even before the recession, suggesting that their families were already struggling financially.

Still, the recession affected many lower-income families, and Sherman said the study highlights "a very important issue."

Many of his patients are from poor families and abuse is not uncommon, he said.

He said pediatricians could help with prevention by asking families about difficulties paying for food or shelter and referring those in need to social service agencies. Sometimes just asking parents about stresses in their lives and acknowledging their struggles can help, he said.

Most parents who abuse young children aren't "ill-intentioned," he said. "Most of it is kind of just snapping...maybe being sleep-deprived and just losing it. It's something that can happen to anyone. Economics is just another stress" that can increase the risks, Sherman said.

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Online:

Pediatrics: http://www.pediatrics.org

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AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner

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UK surgeons separate twin girls joined at head (AP)

LONDON � Sudanese twins born with the tops of their heads joined together have been separated in a rare and risky series of operations at a London children's hospital, officials said Sunday.

Facing the World, a charity which helps disfigured children, said it had helped fund the four-stage operation on 11-month-olds Rital and Ritag Gaboura. Twins born joined at the head are known as craniopagus twins and they occur in about one in 2.5 million births.

Separating them can be dangerous, especially if � as in this case � there's significant blood flow between their brains.

"Incidences of surviving twins with this condition is extremely rare," lead surgeon David Dunaway said in a statement released by the charity. "The task presented innumerable challenges and we were all very aware of our responsibilities to the family and these two little girls."

The charity released before and after photographs of the girls. The before photo showed the two sprawled out on a bed, with their heads joined just above the hairline to form what appeared to be a single, solid unit. Facing the World said that separation took place in stages at London's Great Ormond Street Hospital, with two operations in May, the insertion of tissue expanders in July and the final separation on Aug. 15.

"Within days the twins were back on the general ward interacting and playing as before," the charity said. Its executive coordinator, Sarah Driver-Jowitt, predicted that the girls' parents � who haven't been named � may soon return home "with two healthy, separate girls."

Although rare, operations to separate twins linked by their heads aren't unheard of. In 2004, a team of doctors at New York's Montefiore Children's Hospital separated Filipino twins in four major surgeries that took place over 10 months. In 2003, surgeons in Dallas successfully separated 2-year-old Egyptian twins joined at the head.

One of the first successful operations to separate craniopagus twins took place in 1956, according to the U.S. National Library of Medicine.

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Online:

http://www.facingtheworld.net

http://www.gosh.nhs.uk/

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UK says metal hip replacements more troublesome (AP)

LONDON � People who get metal hip replacements are more likely to need a replacement compared to those who get a traditional plastic one, according to a new report from a large British registry.

The report Thursday from the National Joint Registry of England and Wales could lead to more caution among doctors when performing hip replacements. Earlier studies already led to a drop in the use of metal joints.

The report says almost 14 percent of patients who got an all-metal replacement needed the joint removed or replaced after seven years. That compares with just 3 percent of patients who got a joint made of plastic and needed a replacement within the same time.

Traditional hip replacements usually last more than 10 years, but British officials noted some of the metal hip replacements were failing within a few years. The average age of patients getting hip replacements was 67.

The U.K. registry includes records from about 1 million people who had hip, knee, and ankle replacements and is the world's largest joint database. There is no similar registry in the U.S.

Last year, a report by the British registry on the failure rate of one type of metal hip replacements made by a division of Johnson & Johnson led to its recall by the U.S. Food and Drug Administration. Among patients who received the Johnson & Johnson metal hip, almost 30 percent needed a new one.

Since the recall, use of all-metal hip replacements has fallen. In 2006, metal hip replacements were used in about 15 percent of procedures; that's now dropped to about 5 percent.

The report also found the obesity epidemic is having an impact. Experts said an increasing number of patients needing hip and knee replacements were overweight or obese.

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Dr. Oz accused of fear-mongering on apple juice (AP)

Arsenic in apple juice! Fed to babies! And it probably came from China! Television's Dr. Mehmet Oz is under fire from the FDA and others for sounding what they say is a false alarm about the dangers of apple juice.

Oz, one of TV's most popular medical experts, said on his Fox show Wednesday that testing by a New Jersey lab had found what he suggested were troubling levels of arsenic in many brands of juice.

The Food and Drug Administration said its own tests show no such thing, even on one of the same juice batches Oz cited.

"There is no evidence of any public health risk from drinking these juices. And FDA has been testing them for years," the agency said in a statement.

The flap escalated Thursday, when Oz's former medical school classmate Dr. Richard Besser lambasted him on ABC's "Good Morning America" show for what Besser called an "extremely irresponsible" report that was akin to "yelling `Fire!' in a movie theater."

Besser was acting head of the Centers for Disease Control and Prevention before joining ABC news as health and medical editor several years ago.

Arsenic is naturally present in water, air, food and soil in two forms � organic and inorganic. According to the FDA, organic arsenic passes through the body quickly and is essentially harmless. Inorganic arsenic � the type found in pesticides � can be toxic and may pose a cancer risk if consumed at high levels or over a long period.

"The Dr. Oz Show" did not break down the type when it tested several dozen juice samples for total arsenic. As a result, the FDA said the results are misleading.

Furthermore, the agency's own tests found far lower total arsenic levels from one of the same juice batches the Oz show tested � 2 to 6 parts per billion of arsenic versus the 36 that Oz's show had claimed.

Tests of the same batch conducted by two different food testing labs for the juice's maker, Nestle USA, which sells Juicy Juice under the Gerber brand, also found levels consistent with the FDA results.

In a letter published on the Oz show's website, Nestle said it told the program's producer in advance that the method the show's lab used was intended for testing waste water, not fruit juice, and "therefore their results would be unreliable at best."

The FDA also sent a letter in advance to the show and threatened to post its findings and the letters online if the program proceeded.

Oz went ahead.

"American apple juice is made from apple concentrate, 60 percent of which is imported from China," the website version of his report says. "Other countries may use pesticides that contain arsenic, a heavy metal known to cause cancer."

The show tested three dozen samples from five brands, and Oz claimed that 10 had more arsenic than the limit allowed in drinking water � 10 parts per billion.

However, the FDA said the arsenic in water tends to be inorganic, justifying the strict limit. In contrast, organic arsenic is the form usually found in food and juices. Tests over the last 20 years show apple juice typically has fewer than 10 parts per billion total arsenic.

The mercurial Oz is a heart surgeon at Columbia University and heads an alternative medicine program at New York Presbyterian Hospital. He was a regular on Oprah Winfrey's show for many years before getting his own program two years ago.

This is the first week of a new TV season, the first in two decades without Winfrey dominating the talk show scene.

Tim Sullivan, a spokesman for Oz's show, said in an interview: "We don't think the show is irresponsible. We think the public has a right to know what's in their foods."

Sullivan said Oz does not agree that organic arsenic is as safe as authorities believe. The show will do further tests to distinguish organic from inorganic arsenic in juice samples, he said.

"The position of the show is that the total arsenic needs to be lower," he said. "We did the tests. We stand by the results and we think the standards should be different."

In an interview with The Associated Press on Thursday, even Oz said he wouldn't hesitate to keep giving his four children apple juice.

"There's no question in my mind folks can continue drinking apple juice. ... There have been no cases at all of kids being harmed by elevated levels of arsenic, and the kinds of numbers we are talking about are not high enough to cause acute injury," he said.

He said he was concerned instead about the possible ill effects from drinking apple juice for many years.

An independent lab agreed with the FDA's contention that the form of arsenic matters.

Oz's testing "certainly begs the question how much of that is inorganic," the type of arsenic that is of prime concern, said Dr. Tod Cooperman, president of ConsumerLab.com. The company tests dietary supplements and publishes ratings for subscribers, much as Consumer Reports does with household goods.

However, Cooperman and others have long called on the FDA to strengthen regulation of contaminants.

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AP television writer David Bauder contributed to this report.

Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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Online:

FDA: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm271394.htm

and http://www.fda.gov/Food/ResourcesForYou/Consumers/ucm271746.htm

"The Dr. Oz Show": http://www.doctoroz.com/videos/arsenic-apple-juice

Besser-Oz faceoff: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm271394.htm

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