Veterans told of risk from prostate tests

The Veterans Affairs Palo Alto Health Care System is notifying about 1,000 veterans that a medical device used in prostate biopsies may not have been properly cleaned.

While hospital officials said the possibility of infection is very small, they are offering affected patients testing for hepatitis and HIV, the virus that causes AIDS.

Tests using the device were performed between 1997 and 2001 in Palo Alto, although they were performed as early as 1985 and as late as April of this year in other VA hospitals. About 30,000 patients nationwide are being notified.

Dr. Stephen Ezeji-Okoye, deputy chief of staff at the VA-Palo Alto, described the risk as "exceedingly low,'' although not zero. "We're doing it more in the spirit of full disclosure,'' he said of notification letters that will be sent out later this month. He said affected patients will not need another prostate biopsy, since there have been no problems with the original test results.The device, known as the B-K Prostate Biopsy Transducer, is inserted into the rectum to take ultrasound pictures and samples of the prostate for biopsy. Doctors conduct such biopsies to rule out or diagnose prostate cancer; it is a fairly common test.In January, medical staff conducting a safety inspection at a veterans hospital in Maine found that while the devices were disinfected, the method for disinfecting them was not complete: A channel in the device should have been scrubbed with a brush in addition to being rinsed with disinfectant. Of Veteran Affairs' 154 hospitals, 21 were found to have used the device, including Palo Alto.
After being alerted to the problem in April, Palo Alto hospital staff could not document that the devices had been cleaned properly because they stopped using them in 2001, said Ezeji-Okoye.

"We are trying to do everything we can to make sure no one has been exposed to any sort of risk,'' he said.

Prostate cancer screening may not be needed in older men

Elderly men may not benefit from aggressive treatment for prostate cancer, a new study suggests.

Even though prostate cancer can eventually be fatal, it often progresses so slowly that many men – particularly those over 75 – are more likely to die from some other disease. And aggressive treatments such as radical prostatectomy or radiation, while eradicating the cancer, can have negative effects on quality of life, including urinary incontinence and impotence.

As a result, aggressive therapy's side effects may not be worthwhile for elderly patients, the researchers said.

"This raises the question: Should we be aggressively looking for prostate cancer in these older men? The answer, I think, is no," said lead researcher Dr. Richard M. Hoffman, an associate professor of medicine at the University of New Mexico Cancer Research and Treatment Center.

There's no evidence there is going to be a significant survival benefit from treatment, Hoffman added. "But we are going to cause complications that are going to affect quality of life," he said.

Conservative treatments – such as hormone therapy or so-called "watchful waiting" – may preserve quality of life, but might not be appropriate for aggressive cancer that progresses quickly. Current guidelines suggest that men aged 75 or older may not benefit from screening. But many older men continue to be screened.

For this population-based study, Hoffman and his colleagues followed 465 men aged 75 to 84 who had been diagnosed with localized prostate cancer in 1994 or 1995. One hundred seventy-five men underwent aggressive treatment such as surgery or radiation therapy, while 290 received hormone therapy or no treatment.

The researchers then looked at health-related quality of life and survival two and seven years after the diagnosis.

"Men who received aggressive treatment for prostate cancer were much more likely to have problems with urinary incontinence and sexual dysfunction, compared with men who received watchful waiting or hormone treatment," Hoffman said.

Fewer of the men who got aggressive treatment died from the disease, Hoffman said, "but that wasn't statistically significant. Most of the men died from other causes."

The findings appear in the May issue of The American Journal of Medicine.

Hoffman said screening and treatment for prostate cancer may be worthwhile for healthy older men who have a life expectancy of 10 to 15 years. "But it's not proven," he said. "People need to understand that if they start down the pathway of looking for prostate cancer, it can lead to aggressive treatment that can cause complications that will negatively affect their quality of life."

Dr. Anthony D'Amico, chief of radiation oncology at Brigham and Women's Hospital, in Boston, said deciding who these study results apply to isn't so simple. "It depends on what kind of man over 75 with what kind of prostate cancer," he said.

Men over 75 who have non-aggressive prostate cancer will often die from something other than prostate cancer, D'Amico said. "But if you have aggressive prostate cancer, I don't think these results apply."