Study: Prostate Screening Isn't Saving Lives

By Marilynn Marchione

Europe - A big study of men in Europe gives mixed results about prostate cancer screening that may do little to change minds about its value.

The study finds that PSA blood tests every four years seem to cut the risk of death from prostate cancer. 

But it also finds that screening makes no difference in overall mortality rates because most men die of other causes — not their prostate tumors.

The results underscore a frustrating truth about this disease: most prostate cancers grow too slowly to threaten a man's life and there is no good way to tell which ones will. Finding cancer often leads to treatments that can cause impotence, incontinence and other problems. The PSA test also is just a measure of inflammation, which can be due to many things besides cancer.

"A man needs to make a choice for himself, realizing the benefits exist in theory, but the harms have been shown in every study that we've ever done in prostate cancer," said Dr. Otis Brawley, chief medical officer of the American Cancer Society. "If there is an overall mortality benefit from prostate screening it is very, very small."

He had no role in the study, which was published in Thursday's New England Journal of Medicine.

In October, a government-appointed panel of experts, the U.S. Preventive Services Task Force, recommended against screening with PSA tests. Only two big studies have looked at this — a U.S. one that found annual screening did not cut prostate cancer death risk and a European one that found screening every four years did. (In Europe, prostate screening is less common and is done at wider intervals than in the United States.)

The new research is longer follow-up from the European study: 11-year results on 162,000 men ages 55 to 69. Researchers found that 1,055 men would need to be offered screening and 37 cancers would need to be detected to prevent a single death from prostate cancer. Overall death rates did not differ between the group offered screening and the group not offered it.

About half of the cancers that were detected did not need to be treated, researchers estimate.

The study was led by Dr. Fritz Schroder of Erasmus University Medical Center in the Netherlands. Several authors hold patents or get fees from PSA tests.

Men who choose to be screened should be prepared for a tough discussion of whether to have a biopsy or to treat any cancer that is found, said Dr. Christopher Logothetis, prostate cancer research chief at the University of Texas MD Anderson Cancer Center in Houston.

Prostate cancer "is only one of the causes of death, and it is not the main cause of death in these patients," he said.

Others believe the study supports the value of PSA tests and think the benefit will become clearer with even longer follow-up.

"Urologists are very passionate about it because we see all the bad cases," said Dr. Stephen Freedland, a Duke University urologist who has consulted for a few makers of prostate cancer drugs.

"What we need to do is separate screening from treatment. Not everyone diagnosed needs to be treated. 

But the best way of knowing who to treat is getting a sense of how bad the cancer is," he said. Annual tests may be too often, "but I don't think the solution to that is to give up all screening."

Now You See It, Now You Don't: Time Cloak Created

By Seth Borenstein

WASHINGTON — It's one thing to make an object invisible, like Harry Potter's mythical cloak. But scientists have made an entire event impossible to see. They have invented a time masker.

Think of it as an art heist that takes place before your eyes and surveillance cameras. You don't see the thief strolling into the museum, taking the painting down or walking away, but he did. It's not just that the thief is invisible — his whole activity is.

What scientists at Cornell University did was on a much smaller scale, both in terms of events and time. It happened so quickly that it's not even a blink of an eye. Their time cloak lasts an incredibly tiny fraction of a fraction of a second. They hid an event for 40 trillionths of a second, according to a study appearing in Thursday's edition of the journal Nature.

We see events happening as light from them reaches our eyes. Usually it's a continuous flow of light. In the new research, however, scientists were able to interrupt that flow for just an instant.

Other newly created invisibility cloaks fashioned by scientists move the light beams away in the traditional three dimensions. The Cornell team alters not where the light flows but how fast it moves, changing in the dimension of time, not space.

They tinkered with the speed of beams of light in a way that would make it appear to surveillance cameras or laser security beams that an event, such as an art heist, isn't happening.

Another way to think of it is as if scientists edited or erased a split second of history. It's as if you are watching a movie with a scene inserted that you don't see or notice. It's there in the movie, but it's not something you saw, said study co-author Moti Fridman, a physics researcher at Cornell.

The scientists created a lens of not just light, but time. Their method splits light, speeding up one part of light and slowing down another. It creates a gap and that gap is where an event is masked.

"You kind of create a hole in time where an event takes place," said study co-author Alexander Gaeta, director of Cornell's School of Applied and Engineering Physics. "You just don't know that anything ever happened."

This is all happening in beams of light that move too fast for the human eye to see. Using fiber optics, the hole in time is created as light moves along inside a fiber much thinner than a human hair. The scientists shoot the beam of light out, and then with other beams, they create a time lens that splits the light into two different speed beams that create the effect of invisibility by being too fast or too slow. The whole work is a mess of fibers on a long table and almost looks like a pile of spaghetti, Fridman said.

It is the first time that scientists have been able to mask an event in time, a concept only first theorized by Martin McCall, a professor of theoretical optics at Imperial College in London. Gaeta, Fridman and others at Cornell, who had already been working on time lenses, decided to see if they could do what McCall envisioned.

It only took a few months, a blink of an eye in scientific research time.

"It is significant because it opens up a whole new realm to ideas involving invisibility," McCall said.

Researchers at Duke University and in Germany's Karlsruhe Institute of Technology have made progress on making an object appear invisible spatially. The earlier invisibility cloak work bent light around an object in three dimensions.

Between those two approaches, the idea of invisibility will work its way into useful technology, predicts McCall, who wasn't part of either team.

The science is legitimate, but it's still only a fraction of a second, added City College of New York physicist Michio Kaku, who specializes in the physics of science fiction.

"That's not enough time to wander around Hogwarts," Kaku wrote in an email. "The next step therefore will be to increase this time interval, perhaps to a millionth of a second. So we see that there's a long way to go before we have true invisibility as seen in science fiction."

Gaeta said he thinks he can get make the cloak last a millionth of a second or maybe even a thousandth of a second. But McCall said the mathematics dictate that it would take too big a machine — about 18,600 miles long — to make the cloak last a full second.

"You have to start somewhere and this is a proof of concept," Gaeta said.

Still, there are practical applications, Gaeta and Fridman said. This is a way of adding a packet of information to high-speed data unseen without interrupting the flow of information. But that may not be a good thing if used for computer viruses, Fridman conceded.

There may be good uses of this technology, Gaeta said, but "for some reason people are more interested in the more illicit applications."

New England Journal: 200 Years of Medical History By Marilyn Marchione

Unhappy with today's health care? Think of what it was like to be sick 200 years ago.

No stethoscopes, antibiotics, X-rays or vaccines. Bloodletting was a common treatment. If you had a heart attack or a stroke, doctors put you in bed and hoped for the best. If you needed surgery, you got a few shots of whiskey and a bullet to bite.

Into this medical dark age, two Boston doctors brought a beacon of light. They started what is now the New England Journal of Medicine with the idea that science should guide care — not whoever argued loudest or had the most persuasive theory.

The first 100 copies in January 1812 were delivered by horseback. Today, 2 million people read the journal online every month. It is the oldest continuously publishing medical journal in the world, and it has touched lives in more ways than you may know. Some examples:

—Stroke victims now get clot-busting medicine, not dark rooms to ride out their brain trauma, because a 1995 study in the journal proved its benefit.

—Heart attack patients have arteries unclogged without surgery, then go home on medicines that studies in the journal showed could prevent future attacks.

—Women with early stage breast cancer can have just the lump removed followed by radiation instead of losing the whole breast, thanks to a 1985 study that found the lesser surgery just as good.

—Bone marrow and organ transplants — radical ideas when first tried half a century ago — are now routine. Even face transplants are becoming more common: three were described in last week's issue.

—Rehydration is now recognized as the main treatment for many diarrheal diseases. A journal article warned against bloodletting in 1832 as cholera ravaged New York City.

—People no longer suffer surgery without anesthesia, a field that grew from Henry Jacob Bigelow's 1846 report on the first successful use of inhaled ether.

—Medicine is more ethical, and study participants have more protections, because of a 1966 report in the journal about researchers failing to get informed consent. Another top journal had rejected the article as too controversial.

The New England Journal started decades before the American Medical Association was founded in 1847 and is widely credited with promoting evidence-based care.

"It has been very good for society," said Pat Thibodeau, head librarian and associate dean for the Medical Center Library at Duke University. "When I go in, I'm hoping my doctor has read the New England Journal of Medicine or something similar and is following that information."

"It's the cream of the crop," said Dr. Barron Lerner, a Columbia University physician and medical historian.

"They get the best research submitted to them, and they do an extremely good job of peer reviewing" to make sure it is solid, he said.

That's what Boston surgeon John Collins Warren and James Jackson, who helped found Massachusetts General Hospital, hoped for the journal, which is now published weekly. It got its current name in 1928, seven years after it was bought by the Massachusetts Medical Society.

Warren's father, John Warren, surgeon to George Washington's troops, wrote the first article, on chest pain. Doctors had been debating whether it was caused by plaque — "the cement that builds up in arteries" — or blood clots, said Dr. Jeffrey Drazen, the journal's editor-in-chief since 2000. Both proved correct — the "cement" fractures and allows a clot to form that blocks an artery, he said.

Heart care has been a journal specialty, and two prominent doctors — Elizabeth Nabel and Eugene Braunwald of Brigham and Women's Hospital — trace its evolution in this week's issue. Nabel is former director of the National Heart, Lung and Blood Institute and now is president of the Boston hospital.

They describe the first human cardiac catheterization — now a common diagnostic procedure — that Werner Forssman performed on himself in 1929. Under local anesthesia, he put a catheter into his arm and maneuvered it into his own heart.

For a heart attack, "it used to be that all we did was put people to bed for five weeks," but studies in the journal showed "that that was the worst thing you could do," said Dr. Jerome Kassirer, its top editor from 1991 to 1999.

The journal also helped prove "germ theory" and the nature of infectious diseases.

"People didn't realize you could infect people when you were using your dirty gloves or not using gloves. People didn't realize tuberculosis was communicable. They thought it emanated from clouds they called miasma, clouds of dirty smoke in cities," said Lerner, the Columbia historian.

Not all was grand in the journal's history, though, as Allan Brandt, a Harvard University medical historian writes in this week's issue.

When Harvard Medical School debated admitting female students in 1878, the journal expressed concern about men and women mingling during surgeries normally witnessed only by one sex. The school didn't admit women until 1945, when World War II caused a shortage of men.

The journal also agreed with mandatory sterilization of "mental defectives" in the early 20th century. "Most alarming," Brandt writes, was its declaration in 1934 that "Germany is perhaps the most progressive nation in restricting fecundity among its unfit." The journal later condemned Nazi medicine.

In recent years, it has tracked health policy, from the Clinton health care plan and the advent of managed care to current debates about Medicare.

There were oddball reports along the way, like the 2007 account of a cat named Oscar that had a knack for predicting when patients at a Providence, R.I., nursing home were close to death by curling up to them in their final hours.

The journal has printed few studies on alternative medicine because so little good research has been done on it, Drazen said. Unlike some other journals that like controversial research, the New England Journal tries to avoid it.

"People think the cutting edge is sharp. The cutting edge is very dull. It's very foggy and you don't know what the right answer is," so editors try to pick studies that are definitive enough to affect care, Drazen said.

That's why it publishes very few observational studies, the kind that in the 1990s led to pronouncements like "margarine is better than butter" only to be reversed by the next such study.

"Some of those are papers that we've seen and turned back," Drazen said. "I'm looking for a higher evidence standard."