Medically Speaking Team

According to new research, an ultrasound scan can be used to detect occurrences of prostate cancer.

In a clinical experiment involving 370 men, researchers from Imperial College London, University College London, and Imperial College Healthcare NHS Trust discovered that a novel form of ultrasound scan may accurately diagnose most prostate cancer cases. When compared to magnetic resonance imaging (MRI) scans, ultrasound scans missed only 4.3 percent more clinically significant prostate cancer cases (cancer that should be treated rather than monitored).

MRI scans are expensive and time-consuming. The team believes that an ultrasound scan should be used as a first test in a community healthcare setting and in low and middle-income countries which do not have easy access to high-quality MRI scans. They say it could be used in combination with current MRI scans to maximise cancer detection. The study is published in Lancet Oncology.

Professor Hashim Ahmed, lead author of the study and Chair of Urology at Imperial College London, said:
“Prostate cancer is the most commonly diagnosed cancer in the UK. One in six men will be diagnosed with the disease in their lifetimes and that figure is expected to rise.

“MRI scans are one of the tests we use to diagnose prostate cancer. Although effective these scans are expensive, take up to 40 minutes to perform and are not easily available to all. Also, there are some patients who are unable to have MRI scans such as those with hip replacements or claustrophobia fears. As cancer waiting lists build as a result of the COVID-19 pandemic, there is a real need to find more efficient and cheaper tests to diagnose prostate cancer.

“Our study is the first to show that a special type of ultrasound scan can be used as a potential test to detect clinically significant cases of prostate cancer. The can detect most cases of prostate cancer with good accuracy, although MRI scans are slightly better.

“We believe that this test can be used in low and middle-income settings where access to expensive MRI equipment is difficult and cases of prostate cancer are growing.”

Prostate cancer is the most common cancer in men in the UK with around 52,300 new cases diagnosed each year. It develops when cells in the prostate grow in an uncontrolled way. Prostate cancer develops slowly and symptoms such as the blood in the urine do not appear until the disease has developed. It usually affects men over 50 and often men with a family history of the disease. Black men are disproportionately impacted by the disease and deaths from prostate cancer have now overtaken those from breast cancer.

One of the main methods to diagnose prostate cancer is a special type of magnetic resonance Imaging (MRI) scan called a multi-parametric MRI (mpMRI) scan, which helps doctors see if there is any cancer inside the prostate and how quickly the cancer is likely to grow. However, the scan takes 40 minutes and costs £350-450.

The new study looked at the use of a different kind of imaging called multiparametric ultrasound (mpUSS), which uses soundwaves to look at the prostate. The test involves the use of a probe called a transducer to make the images of the prostate. It is placed into the rectum and it sends out sound waves that bounce off organs and other structures. These are then made into pictures of the organs.

The doctor doing the test also uses extra special types of ultrasound imaging that look at how stiff the tissue is and how much blood supply the tissue has. These are called elastography, doppler and contrast-enhancement with microbubbles. As cancers are more dense and have greater blood supply, they show up more clearly.

Although mpUSS is more widely available than mpMRI there has been no large-scale studies to validate its effectiveness as a test to detect prostate cancer cases.

In the new trial, called cancer diagnosis by multiparametric ultrasound of the prostate (CADMUS), the team recruited 370 men at risk of prostate cancer. They were identified following initial tests such as a prostate-specific antigen (PSA) test- a blood test to help detect prostate cancer — and/or an abnormal digital rectal examination — a test that examines a person’s lower rectum, pelvis, and lower belly.

The study took place at seven hospitals in the UK including lead site Charing Cross Hospital, part of Imperial College Healthcare NHS Trust, between March 2016-November 2019.

Prostrate Cancer

The men were given both mpUSS and mpMRI scans at separate visits. This was then followed by biopsies — which involves using thin needles to take small samples of tissue from the prostate to analyse under a microscope to check cancer — for 257 patients who had a positive mpUSS or mpMRI test result. The team then compared the results from the tests.
Cancer was detected in 133 men, with 83 men diagnosed with clinically significant cancer.

Individually, mpUSS detected 66 cases of clinically significant cancer compared to mpMRI which detected 77 cases.
Although mpUSS detected 4.3 per cent fewer clinically-important prostate cancers compared to mpMRI the researchers said this method would lead to 11.1 per cent more patients being biopsied. This was because the mpUSS sometimes showed up abnormal areas even though there was no cancer.

The researchers believe that the test can be used as an alternative to mpMRI as a first test for patients at risk of prostate cancer, particularly where mpMRI cannot be carried out. Both imaging tests missed clinically-important cancers detected by the other, so using both would increase the detection of clinically-important prostate cancers compared to using each test alone.

First author, Dr Alistair Grey (UCL Division of Surgery & Interventional Science), said:
“Our results provide an accurate test for prostate cancer in patients who were previously without one using a scan that’s cheap and easy to conduct.”

Also Read: FLASH radiation therapy shows promise in a first-in-human trial

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India recorded a slight decline in the Covid-19 infection with 1,334 fresh cases reported in the last 24 hours on Monday as compared to the 1,994 cases a day earlier.

The Ministry of Health and Family Welfare informed that the country has observed 1,557 recoveries from the Covid-19 infection in the last 24 hours, which stand at a current recovery rate of 98.76 per cent, taking the total recoveries of this viral disease to 4,40,91,906. The country’s current active caseload stands at 23,193 with active cases now constituting 0.05 per cent of the country’s total Positive Cases.

The country is currently observing a daily positivity rate of 1.52 per cent and a weekly positivity rate of 0.95 per cent.
The Ministry conducted 90.01 crore total tests since the onset of the pandemic and 87,905 tests were carried out in the last 24 hours.

As per the Health Ministry, a total of 219.56 crore vaccine doses– 95 crore second doses and 22.03 crore precaution doses– have been administered under the Nationwide Vaccination Drive, of which 42,864 were jabbed in the last 24 hours alone.

India’s COVID-19 vaccination coverage exceeded 219.56 Cr (2,19,56,41,807) as per provisional reports till 7 am today.
COVID-19 vaccination for the age group 12-14 years was started on March 16, 2022. So far, more than 4.12 Cr (4,12,35,971) adolescents have been administered with the first dose of COVID-19 vaccine. Similarly, the COVID-19 precaution dose administration for age group 18-59 years also started from 10th April, 2022 onwards, the official statement read.

It is pertinent to note that health concerns have risen in the country as World Health Organization Chief Scientist Soumya Swaminathan on Friday said that there were over 300 sub-variants and XBB being a recombinant virus is a matter of concern as it is immune evasive.

XBB, a recombinant lineage between two Omicron sublineages BJ.1 and BA.2.75, is a fast-spreading variant, which was seen to have caused a spike across Singapore recently.

Last week, a high-level meeting of Union Health Minister Mansukh Mandaviya with the senior health officials regarding the emergence of Omicron’s new sub-variants concluded with the decision to continue masks and COVID-appropriate behaviour across the country.

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According to new research, those who are anxious are just as likely as those who are not to get the COVID-19 vaccine.
The study’s findings were published in the Journal of Anxiety Disorders. The current study, sponsored by the University of Waterloo, sought to evaluate the association between vaccine reluctance, anxiety-related psychological characteristics, and individuals’ reasons for and against receiving the COVID-19 vaccine.

The researchers assessed 148 people with and without anxiety problems for the study. All participants completed an online questionnaire that assessed COVID-19 vaccine apprehension as well as other relevant characteristics such as conspiracy beliefs, individualism, and intolerance of uncertainty.

The researchers also surveyed the top reasons why individuals were motivated to get the vaccine and the top reasons why they were hesitant.

The most common reasons that participants were hesitant to get the vaccine were related to the vaccine’s effectiveness and novelty, and fear of adverse effects. In contrast, the most frequent reasons that participants were motivated to get the vaccine were to protect others, to protect self, and to return to a sense of normalcy.

The researchers found that anxious and non-anxious participants did not differ in vaccine hesitancy. However, discomfort with uncertainty predicted greater vaccine hesitancy in non-anxious participants, and in both groups’ vaccine hesitancy was predicted by individualistic worldviews, conspiracy beliefs, and a lack of trust in authority.

“People with anxiety difficulties were not more hesitant about the vaccine, rather, the more discomfort they had with uncertainty, the less hesitant they were,” said Dr. Christine Purdon, professor of Clinical Psychology at Waterloo. “The opposite was true of those without anxiety, suggesting that discomfort with uncertainty may be an important factor when addressing vaccine hesitancy.”

Aliya McNeil, lead author of the study and a master’s candidate in clinical psychology at Waterloo, adds that the findings could suggest that people without anxiety disorders are concerned with uncertainty related to the vaccine itself, whereas people with anxiety disorders might view the vaccine as an opportunity to reduce stress and uncertainty related to the virus. This may indicate that vaccine hesitancy is related to how one values independence.

These findings help shed light on the best way for the government to promote vaccination.

“Governments and public health departments might want to consider advertising vaccines in ways that activate fewer feelings of individualism,” McNeil said. “It’s important for campaigns to enhance trust in the vaccine focusing on the scientists responsible for vaccine development rather than large corporations. In addition, by normalizing feelings of uncertainty and providing evidence-based information, governments can guard against the worrying that occurs with vague and uncertain information.”

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The first-in-human study on a small number of bone cancer patients suggests that FLASH radiation therapy, which delivers therapeutic quantities of radiation in a fraction of a second, may hold promise as a viable treatment for difficult-to-kill cancers.

The approach was previously tried on animals and shown to be equally safe and effective, with no unexpected side effects. The FAST-01 trial (NCT04592887) results will be discussed today at the American Society for Radiation Oncology (ASTRO) Annual Meeting.

“Our study shows FLASH radiotherapy with protons is a practical modality to reduce pain,” said Emily C. Daugherty, MD, lead author of the study and an assistant professor of clinical radiation oncology at the University of Cincinnati Cancer Center. “It deserves further exploration because of its potential to decrease the side effects associated with conventional radiation treatments.”

When compared to traditional radiation treatments, FLASH radiotherapy (RT) delivers radiation at dose rates that are more than 300 times higher. This causes a phenomenon known as the FLASH effect, which lessens the damage that conventional radiation therapy may do to healthy tissue surrounding a tumour while still killing the cancer cells at the tumour location.

“Because FLASH radiotherapy is given at ultra-high dose rates, it appears to cause less normal tissue injury. This offers the possibility of delivering larger doses of radiation – which could result in higher cure rates for patients with resistant tumours – without increasing side effects,” said John Breneman, MD, FASTRO, principal investigator on the trial and a professor of radiation oncology and neurosurgery at the University of Cincinnati Cancer Center.

Since electron beams don’t enter tissue very deeply, they have mostly been used in early FLASH RT studies, which restricted their usefulness for this therapeutic strategy. Proton beams can penetrate enough to reach tumour sites in most patients when used for ultra-high dose-rate radiation. FLASH-RT had never been evaluated in a clinical study in humans before the FAST-01 trial, despite pre-clinical animal studies suggesting it could deliver high radiation doses safely and with fewer adverse side effects.

In this study, 10 patients having one to three painful bone metastases in their extremities, ranging in age from 27 to 81, received ultra-high dose rate radiation. A total of 12 metastatic spots in the patient’s arms and legs received treatments.

Patients received 8 Gy of radiation in a single fraction, administered using a FLASH-enabled proton therapy device at a rate of about 40 Gy per second. On the day of treatment, 15 days later, and one, two, and three months later, pain, the usage of painkillers, and adverse events were all recorded. For up to 13 months, the researchers checked these outcomes every two months. The follow-up period was on average 4.8 months.

Researchers chose patients who would have received conventional radiation therapy at the same dose as they were given with FLASH RT. “We used the exact same regimen, but with FLASH dose-rate radiation. The patient experience is the same as it would have been receiving conventional radiation, only the treatment delivery process is shorter,” said Dr Daugherty.
Following FLASH RT, seven of the 10 patients experienced complete or partial pain relief. Of the 12 treated sites, the pain was relieved completely for six sites and partially for two additional sites. Temporary pain flares occurred in four of the 12 sites treated.

Side effects from treatment were mild. Four patients experienced mild skin hyperpigmentation (darkening skin tone), one experienced skin discolouration, two experienced mild limb oedema (swelling or puffiness), two experienced pruritis (itchy skin), one experienced fatigue, one experienced erythema (reddening of the skin) and one experienced extremity pain.
Each FLASH treatment takes about 3/10 of a second, Dr Daugherty explained.

Following treatment, “both pain relief and side effects were in-line with what might have happened with conventional radiation. We did not see any unexpected additional toxicity with the substantially shorter treatment.”

In the brain, lungs, or gastrointestinal tract, where healthy tissue surrounding tumours is most sensitive to radiation exposure, FLASH RT may be most helpful in treating difficult-to-treat malignancies. Clinical trials in these locations, however, cannot be approved until research demonstrates that ultra-high dose-rate radiation is both safe and efficient in other, less sensitive regions. The FDA only approved this trial for persons who had bone metastases in their arms and legs, which are locations that are considerably less likely to experience difficulties.

“From a practical standpoint, this is not the type of cancer that FLASH is designed to treat, but we need human data to see if there are any unexpected side effects. Treating arms and legs is not as risky as treating someone’s brain or lungs,” said Dr Breneman, who he also serves as medical director of the Cincinnati Children’s/UC Medical Center Proton Therapy Center.

Since children are more susceptible to the negative effects of radiation therapy, FLASH RT may eventually prove helpful in treating paediatric malignancies, according to the researcher. But before that can happen, much more research must be conducted.

Further study is required to identify the biological principles underlying the FLASH effect because it is yet unclear why FLASH RT eliminates cancers with fewer adverse effects than traditional radiation, according to Dr Daugherty.

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A multidisciplinary team from the University of Texas at Arlington will conduct new research on how to improve the safety and effectiveness of medical procedures done on patients with inoperable enlarged hearts.

Jun Liao, associate professor of bioengineering, developed a controlled septal ablation for inoperable hypertrophic cardiomyopathy. The cash will be used to strengthen the research environment at UTA as well as provide undergraduate students with access to cutting-edge biomedical research opportunities.

“This project bridges bioengineering innovation to clinical need,” Liao said. “When (coinvestigator) Dr Pietro Bajona brought up the clinical challenges in septal ablation, we answered with a novel idea and started working on it. This collaborative research paves a new avenue to better health for patients with inoperable enlarged hearts.”

Professor Kytai Nguyen, an expert in nanofabrication, and Associate Professor Yi Hong, an expert in biomaterials, are co-investigators from UTA Bioengineering. Other associates include Dr Matthias Peltz, surgical director of cardiac transplant at UT Southwestern Medical Center, and Bajona, director of the Allegheny Health Network’s Hypertrophic Cardiomyopathy Program. Both doctors will contribute their clinical knowledge and viewpoints to the contemplated study.

In order to lessen a left ventricular outflow obstruction, Liao said patients with inoperable enlarged hearts undergo a technique known as alcohol septal ablation in which a portion of the overgrowth septal muscle is removed. However, problems can develop from drinking only pure alcohol, resulting in uncontrollable cardiac muscle destruction.

“The current procedure brings with it some risky complications,” Liao said. “There is about a 2% mortality rate, with complications such as ventricular fibrillation, possible heart attack and a complete heart block due to indiscriminate tissue destruction.”

Liao claimed that recent studies even used super glue for pure alcohol, which presented problems regarding long-term safety and effectiveness.

“Our goal is to design a novel nanoparticle ablation system to replace the pure alcohol procedure,” Liao said. “We want to achieve a controllable, localized tissue shrinkage leading to a safer ablation.”

According to the Cleveland Clinic, between 600,000 and 1.5 million Americans suffer from an enlarged heart.

“This research could have a significant impact on hypertrophic cardiomyopathy, a genetic disease that results in abnormal thickening of the ventricular muscle, particularly the septum,” said Michael Cho, professor and chair of the Department of Bioengineering. “The research highlights UT Arlington’s ability to collaborate with other clinical institutions and their specialities to drive forward translational and transformative research.”

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The first induced pluripotent stem cell model of PTSD has provided fresh insights into underlying genetics as well as prospects for new therapeutics.

The study, published in Nature Neuroscience, is the first to investigate PTSD using induced pluripotent stem cell models. It was carried out by a group of scientists from Mount Sinai’s Icahn School of Medicine, the James J. Peters Veterans Affairs Medical Center, Yale School of Medicine, and The New York Stem Cell Foundation Research Institute (NYSCF). Post-traumatic stress disorder (PTSD) can develop in the aftermath of extreme trauma and is a major public health issue for both veterans and civilians. However, it is unknown how much hereditary and environmental factors influence individual clinical outcomes.

To bridge this information gap, the research team studied a cohort of 39 combat veterans with and without PTSD who were recruited from the James J Peters Veterans Affairs Medical Center in the Bronx. Veterans underwent skin biopsies and their skin cells were reprogrammed into induced pluripotent stem cells.

“Reprogramming cells into induced pluripotent stem cells is like virtually taking cells back in time to when they were embryonic and had the ability to generate all the cells of the body,” said Rachel Yehuda, PhD, Professor of Psychiatry, and Neuroscience, at Icahn Mount Sinai, Director of Mental Health for the James J. Peters Veterans Affairs Medical Center, and senior author of the paper.

Rachel added, “These cells can then be differentiated into neurons with the same properties as that person’s brain cells had before trauma occurred to change the way they function. The gene expression networks from these neurons reflect early gene activity resulting from genetic and very early developmental contributions, so they are a reflection of the ‘pre-combat’ or ‘pre-trauma’ gene expression state.”

“Two people can experience the same trauma, but they won’t necessarily both develop PTSD,” explained Kristen Brennand, PhD, Elizabeth Mears and House Jameson Professor of Psychiatry at Yale School of Medicine and a NYSCF — Robertson Stem Cell Investigator Alumna, who co-led the study. “This type of modeling in brain cells from people with and without PTSD helps explain how genetics can make someone more susceptible to PTSD.”

To mimic the stress response that triggers PTSD, the scientists exposed the induced pluripotent stem cell-derived neurons to the stress hormone hydrocortisone, a synthetic version of the body’s own cortisol that is used as part of the “fight-or-flight” response.

“The addition of stress hormones to these cells simulates biological effects of combat, which allows us to determine how different gene networks mobilize in response to stress exposure in brain cells,” explained Dr. Yehuda.

Using gene expression profiling and imaging, the researchers discovered that neurons from PTSD patients were hypersensitive to this pharmacological trigger. The researchers were also able to identify distinct gene networks that responded differently after being exposed to stress chemicals.

Also Read: Study finds number of hours worked in stressful jobs led to risk of depression

According to current research, the longer someone works in a stressful job each week, the more likely they are to develop depression.

Working 90 or more hours per week resulted in three times the number of changes in depression symptom ratings as working 40 to 45 hours per week. Furthermore, when compared to those working fewer hours, a higher proportion of those working numerous hours had a score high enough to be labelled with moderate to severe depression, which requires therapy.

The researchers at the University of Michigan used advanced statistical techniques to recreate a randomised clinical trial while accounting for a variety of other variables of the doctors’ personal and professional lives.

With an average symptom increase of 1.8 points on a standard scale for those working 40 to 45 hours, and going up to 5.2 points for those working more than 90 hours, researchers discovered a “dose-response” relationship between the number of hours worked and depressive symptoms.

They come to the conclusion that, out of all the stressors that impact doctors, working a lot of hours is a significant factor in depression.

The team from Michigan Medicine, the academic medical institution of the University of Michigan, reports their findings in the New England Journal of Medicine after examining 11 years’ worth of data on more than 17,000 first-year medical residents. The recently graduated physicians were undergoing training at numerous hospitals throughout the country.

The information comes from the Michigan Neuroscience Institute and the Eisenberg Family Depression Center’s Intern Health Study. Every year, the project enlists fresh graduates from medical schools to participate in a year-long tracking of their depressed symptoms, work hours, sleep, and other factors as they finish the first year of residency, also known as the intern year.

The impact of high numbers of work hours & depression

This study comes at a time when major national organisations like the National Academy of Medicine and the Association of American Medical Colleges are debating how to address the high incidence of depression among physicians, physicians-in-training, and other healthcare professionals. Despite the fact that the interns in the survey indicated a wide range of previous-week work hours, the most common work hours levels were between 65 and 80 hours per week.

Resident work weeks are currently limited to 80 hours by the Accreditation Council for Graduate Medical Education, which establishes national standards for residency programmes. However, this maximum can be averaged across four weeks and there may be exceptions. Additionally, the ACGME places restrictions on how many days in succession and how long one shift can last for residents. Studies on the effects of these restrictions on resident well-being and patient safety hazards have produced conflicting results.

According to the authors, their findings show a definite need to significantly cut back on the typical amount of hours inhabitants work each week.

“This analysis suggests strongly that reducing the average number of work hours would make a difference in the degree to which interns’ depressive symptoms increase over time, and reduce the number who develop diagnosable depression,” says Amy Bohnert, PhD, the study’s senior author and a professor at the U-M Medical School. “The key thing is to have people work fewer hours; you can more effectively deal with the stresses or frustrations of your job when you have more time to recover.”

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A study of over 38,000 participants discovered that standard cholesterol-lowering statins may reduce the risk of death and the severity of COVID-19 disease.

“While there is no ‘magic bullet’ to help patients who are very ill with COVID-19, statins decrease inflammation, which may help reduce the severity of the disease,” said Ettore Crimi, M.D., MBA, lead author of the study and professor of anesthesiology and critical care medicine, University of Central Florida, Orlando.

“Results of our study clearly showed regular statin use is associated with reduced risk of death and improved outcomes in hospitalized COVID-19 patients.” The retrospective study is one of the most extensive of regular statin use in patients with COVID-19. Researchers analyzed the electronic medical records of 38,875 patients hospitalized for COVID-19 at 185 hospitals in the United States between Jan. 1 and Sept. 30, 2020. Of those patients, 30% regularly used statins to treat high cholesterol.

Statin users had a 37% lower risk of dying from COVID-19 than those who didn’t use statins. In addition, regular statin users were significantly less likely to be discharged to hospice, be admitted to the intensive care unit (ICU) or develop blood clots. They also had shorter hospital stays and spent less time on a ventilator.

While COVID-19 promotes inflammation, in some circumstances the immune system induces further inflammation by overreacting to the infection. This strong reaction causes much of the body’s harm, including breathing difficulties and damage to the lungs, kidneys, heart, brain, and vascular system. Statins’ anti-inflammatory properties “cool the process,” allowing the disease to progress more slowly, according to Dr. Crimi.

According to the American Heart Association, one in every four Americans over the age of 40 takes statins to lower their cholesterol and reduce their risk of heart attack, stroke, and other cardiovascular disorders, making them one of the most regularly prescribed drugs.

“This research illustrates the importance of evaluating medications that could be repurposed to help patients in ways other than their intended use,” said Dr. Crimi. “Our results suggest statins could be an additional cost-effective solution against COVID-19 disease severity and should be studied further.”

THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 55,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.

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Sexual side effects of cancer therapy are discussed significantly less frequently in female patients than in male patients, according to a new study, even when the medicine directly affects genital organs. In a high-volume cancer centre, 9 out of 10 males having brachytherapy for prostate or cervical cancer were asked about their sexual health, but just 1 out of 10 women were asked.

The findings suggest that physicians have an opportunity to obtain a better grasp of their patients’ cancer treatment experiences.

“There seems to be a big disparity in the way we approach sexual dysfunction with our patients, where female patients are asked about sexual issues much less often than male patients are,” said Jamie Takayesu, MD, lead author of the study and a radiation oncology resident physician at the University of Michigan Rogel Cancer Center in Ann Arbor, Mich. “Equally importantly, we see this trend on a national level in clinical trials.”

Each year, roughly 13,000 news cases of cervical cancer and more than 220,000 new cases of prostate cancer are diagnosed in the U.S. Both diseases respond well to radiation therapy and other treatments, and an estimated 96% of patients with prostate cancer and 67% with cervical cancer survive at least five years after their diagnosis.

Because these patients can generally expect to live a long time following therapy, the possibility of long-term adverse effects such as sexual dysfunction must be considered, according to Dr. Takayesu. Brachytherapy for prostate or cervical cancer involves inserting radioactive sources directly into the tumour, which can be hazardous to the genital organs.

Approximately half of the women who receive cervical brachytherapy have sexual adverse effects, the most prevalent of which are changes in vaginal tissue and dryness, which can cause pain and discomfort. Erectile dysfunction affects between a quarter and half of men who have prostate brachytherapy. Side effects can occur during, following, or long after treatment.

The study design combined a retrospective analysis of institutional data with an analysis of national clinical trials. For the institutional analysis, researchers reviewed consult notes in the records of 201 patients who were treated with brachytherapy for prostate cancer (n=75) or cervical cancer (n=136) between 2010 and 2021.

Sexual health

They found a stark difference between how many male versus female patients were asked about sexual health at their initial consult – 89% of men, compared to 13% of women (p<0.001). None of the patients with cervical cancer had their sexual health assessed with a patient-reported outcomes (PRO) tool, compared to 81% of those with prostate cancer.

The research team also examined how often sexual health was assessed in clinical trials nationwide by analyzing trials in the National Institutes of Health Clinical Trials Database (clinicaltrials.gov) that involved brachytherapy for prostate (n=78) or cervical (n=53 trials) cancer.

Prostate cancer trials, compared to cervical cancer trials, were significantly more likely to include sexual function as a primary or secondary endpoint (17% vs. 6%, p=0.04). They also were more likely to include overall quality of life as an endpoint (37% vs. 11%, p=0.01).

This disparity likely stems from several factors, said Dr. Takayesu, including some specific to the diseases studied. With prostate cancer, for example, patients often have multiple treatment options, and sexual side effects are a common consideration when choosing between therapies. With cervical cancer, however, there is less variability in the treatment paradigm.

But physician comfort in talking about sexual dysfunction with female patients cannot be discounted, she said. “Culturally, there are differences in how we talk about sexual dysfunction that affects men versus women. We see ads on television about erectile dysfunction, for example, but there’s no equivalent to these for women.”

Currently, there are no FDA-approved medications specifically for female sexual dysfunction, although multiple options – medications, implants and other treatments – are available for male impotence.

“The only tools that we commonly recommend for women are lubricants and dilators, but even these are not great options,” said Dr. Takayesu. Several large studies have confirmed that existing treatments for women are often ineffective. “It’s easy for us to prescribe different medications for our male patients, but for our female patients, we don’t have that first step. I think that creates a barrier to bringing these issues up,” she said.

Until more research is conducted to find effective medical options for female sexual dysfunction, interventions such as pelvic floor therapy can provide some relief for patients, said Dr. Takayesu. Survivorship programs and sexual therapists also can help patients better understand possible long-term sexual side effects of cancer and treatment.

And specific to brachytherapy, Dr. Takayesu said sexual function might be preserved through modifications made during the treatment planning process, such as placing the brachytherapy sources differently or tailoring their radiation doses differently.

Ultimately, she said the onus is on doctors to start asking female patients about their sexual health more frequently. “If we don’t know about problems, we can’t solve them.”

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