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Radiation May Help When Prostate Cancer Returns
 TUESDAY, June 17 (HealthDay News) -- Countering common medical theory, a new study finds that radiation therapy may save the lives of many men whose prostate cancer recurs aggressively after surgery.
"We show that even men with aggressive disease that recurs after surgery seem to benefit from salvage radiotherapy," said lead researcher Bruce J. Trock, associate professor of urology at Johns Hopkins University in Baltimore. "In the past, surgeons would have said that the tumor had spread to other parts of the body and that salvage radiotherapy was not appropriate," he noted.
The belief was that radiation therapy would not help, because it was aimed only at the original tumor site.
But the study of 635 men who had surgery for prostate cancer and then showed signs of recurrence found that the death rate for those who got radiation therapy was half that of men who didn't.
The study, published in the June 18 issue of the Journal of the American Medical Association, was relatively small and needs confirmation, Trock said. "But if it is true, it suggests that more men have recurrence at the local site than has been suspected in the past," he said.
The benefit was greatest for those men with aggressive cancers -- patients whose blood levels of prostate-specific antigen (PSA), a marker for disease activity, doubled in less than six months. Among the 126 men in the study with aggressive disease, the death rate was 75 percent lower for those given salvage radiotherapy versus those who didn't get the treatment.
Over a follow-up period averaging six years after recurrence, death rates were 11 percent for those who had salvage therapy alone, 12 percent for those who got radiation plus hormonal therapy, and 22 percent for men who had no salvage radiation therapy.
The study was called "a very important contribution to our further knowledge about salvation radiotherapy after recurrence" by Dr. Michael J. Zelefsky, professor of radiation oncology at Memorial Sloan-Kettering Cancer Center in New York City.
"It makes two very important points," Zelefsky said. "One is that in order to achieve optimal results, you have to give salvation radiotherapy sooner rather than later, before two years have elapsed. After two years, the results are less optimal.
"Second, the surprising thing to come out of the study is about people who have rapid PSA doubling time. Normally, you think of those patients as having more aggressive disease that has spread elsewhere. This suggests otherwise, that even though the doubling time is more rapid, you still get excellent outcomes with radiotherapy."
Cancer specialists might have to start thinking differently about such cases, Zelefsky said. "People usually have a fatalistic approach when it comes to those patients who present with recurrence and a rapid PSA doubling time," he said. "Now, you might be able to cure them."
It is hard to say whether the report will have an immediate impact on medical practice, both Trock and Zelefsky said. "The study needs to be validated in a formal, randomized controlled trial," Zelefsky said.
But such a study might be beyond the capability of an individual cancer center, Trock said. "You would need at least one or more large institutions with large data bases to validate our results," he said.
More information
Facts on the incidence and treatment of prostate cancer are available from the National Cancer Institute.
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Fitness a Key Element in Determining Male Diabetic's Longevity
 SUNDAY, June 15 (HealthDay News) -- If you're a man with type 2 diabetes, how long you live may be determined more by how physically fit you are than by how much you weigh.
A new study expected to be presented in San Francisco this weekend at the annual meeting of the Endocrine Society found that physical fitness appeared to be more important than weight in estimating a male diabetic's longevity.
"Death rates were the highest for those who were 'low fit' in all weight categories," researcher Dr. Roshney Jacob-Issac, an endocrinology fellow at George Washington University Hospital, said in a prepared statement.
Researchers used 2,690 male diabetic veterans in VA hospitals, most of whom were overweight or obese based on their body mass index (BMI), a measure of body fat using height and weight.
The vets were categorized as having low, moderate or high fitness level, depending on their performance on a standard treadmill exercise tolerance test.
The researchers found that the higher the man's level of fitness, the lower his risk of dying during the study period. For example, those in the high fitness level -- whether at normal body weight or overweight -- reduced their risk of death by 40 percent. The findings were even more dramatic for those classified as obese but in reasonable good shape: a cut in death risk of 52 percent, when compared to peers not physically fit, the study found during its seven-year follow-up period.
"Diabetics should improve their fitness level or exercise capacity to at least a moderate level, by being physically active. Weight loss is great, but being active is just as important," Jacob-Issac advised.
She said people should get at least 30 minutes of moderate-intensity physical activity -- the equivalent to brisk walking at least five days of the week -- to achieve the health benefits reported in the current study.
More information
The American Diabetes Association has more about diabetes  .
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Abnormal Sleep Patterns in Older Men Spell Trouble
 THURSDAY, June 12 (HealthDay News) -- A new study suggests that older men with abnormal sleeping patterns may face a higher risk of death.
The findings aren't conclusive, and they don't indicate why unusual sleep patterns could be unhealthy. Still, they're food for thought, especially for older men, said study author Misti Paudel.
"If people think they have disruptions in their sleep, they really do need to see their physician and try to find potential causes or treatment options," said Paudel, a sleep researcher at the University of Minnesota-Twin Cities in Minneapolis.
The study, the first of its kind, sought to determine whether sleep patterns in older men had anything to do with their mortality rates, Paudel said.
She and her colleagues recruited 3,053 men aged 67 and older. They told the men to wear wrist actigraphs, wristwatch-like devices that measure body movement and allow researchers to analyze when people are awake or sleeping.
The participants wore the devices for up to 13 nights. "Over the course of a few days, we can see the activity patterns and compare them with other men in the group, start to look at what's normal and not normal," Paudel explained.
The researchers then followed the participants for about six years, checking to see if and when they died.
The researchers released the findings Wednesday at the annual meeting of the Associated Professional Sleep Societies, in Baltimore.
"What we found was that men who had [sleeping patterns] that were shifted either earlier or later in the day had an increased risk of mortality," Paudel said.
Even after researchers adjusted their findings to lessen the effect of factors like poor health, race and alcohol use, the differences in mortality rates remained. The men who hit their peaks of activity at the earliest and latest times of day were 80 percent more likely to die than the others, Paudel said.
The researchers didn't calculate how many years earlier the subjects died if they had abnormal sleeping patterns. The study also doesn't make it clear if night owls or early birds are at risk, although that could explain why some of the men were active at early or late times of day, Paudel said.
Why would abnormal sleep patterns make death more likely? "We don't really know how this is related to mortality," Paudel said. "It could be that there is some other medical condition that wasn't accounted for."
Sleep researcher Dr. Daniel Kripke said early or late sleep patterns may disrupt the body's metabolism or reflect cases of Alzheimer's disease. It's also possible that unusual sleep patterns could reflect problems in the body's genes, said Kripke, a professor of psychiatry at the University of California at San Diego, who plans to collaborate on future research with one of the study's authors.
Kripke isn't ready to advise older men to adjust their sleep patterns. "As yet, there is no evidence in this type of person that changing a person's hours would improve survival," he said. "It means it is not a bad idea to have normal hours, but we cannot yet say that not having them is a willful mistake."
More information
Learn more about sleep from the National Sleep Foundation .
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