JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.
THIS WEEK'S CONTENT
JAMA NEWS RELEASES
(Embargoed for Release: 9:00 a.m. CT, Tuesday, November 14, 2006)
JAMA NEWS RELEASES
COMBINATION THERAPY APPEARS MORE EFFECTIVE THAN SINGLE DRUG FOR TREATING MEN WITH LOWER URINARY TRACT SYMPTOMS
ADDING RADIATION THERAPY FOR TREATMENT OF ADVANCED PROSTATE CANCER MAY OFFER BENEFIT
MEN WHO AVOID CERTAIN RISK FACTORS IN MIDLIFE MAY HAVE LONGER, HEALTHIER LIFE
TESTOSTERONE REPLACEMENT THERAPY APPEARS SAFE FOR PROSTATE
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
STUDY IDENTIFIES MIDDLE-AGE RISK FACTORS THAT PREDICT LIFESPAN FOR MEN
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
TV Note: This week's JAMA Report video is on midlife risk factors and healthy, long-term survival. The report will be fed Tuesday, November 14, from 9:00 - 9:30 a.m. ET and 2:00 - 2:30 p.m. ET, on Intelsat America 6 (formerly Telstar 6), Transponder 11 (C-Band), Downlink Freq: 3920 MHz Vertical, Audio: 6.20/6.80. For more information, call 312/464-JAMA.
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Embargoed for Release: 9:00 a.m. CT, Tuesday, November 14, 2006
Media Advisory: To contact Steven A. Kaplan, M.D., call Jonathan Weil at 212-821-0566.
COMBINATION THERAPY APPEARS MORE EFFECTIVE THAN SINGLE DRUG FOR TREATING MEN WITH LOWER URINARY TRACT SYMPTOMS
NEW YORK—Men with overactive bladder and lower urinary tract symptoms who received a combination therapy were more likely to report improvement in symptoms than men who received only one medication, according to a study in the November 15 issue of JAMA, a theme issue on men’s health.
Steven A. Kaplan, M.D., of Weill Cornell Medical College, New York, presented the findings of the study today at a JAMA media briefing on men’s health in New York.
Overactive bladder is a syndrome characterized by urinary urgency, usually with increased urination frequency during the day and night. An estimated 10 million men 40 years or older have symptoms consistent with overactive bladder, according to background information in the article. Lower urinary tract symptoms include urinary hesitancy and intermittency and weak urinary stream. Some men with these symptoms do not respond to treatment with common medications.
Dr. Kaplan and colleagues evaluated the effectiveness of two widely used medications, tolterodine extended release (ER), an antimuscarinic, and tamsulosin, an a1-receptor antagonist, used alone or in combination in men with overactive bladder and benign prostatic hyperplasia (enlarged prostate). The randomized, double-blind trial was conducted at 95 urology clinics in the United States involving men 40 years or older who had a self-rated bladder condition of at least moderate bother, and a bladder diary documenting urination frequency (8 or more urinations per 24 hours) and urgency (3 or more episodes per 24 hours), with or without urgency urinary incontinence. Patients were randomly assigned to receive placebo (n = 222), 4 mg of tolterodine ER (n = 217), 0.4 mg of tamsulosin (n = 215), or both tolterodine ER plus tamsulosin (n = 225) for 12 weeks. Patients were recruited between November 2004 and February 2006, and the study was completed May 2006.
The researchers found that 80 percent of patients receiving tolterodine ER plus tamsulosin reported treatment benefit by week 12, compared with 62 percent of patients receiving placebo, 65 percent of patients receiving tolterodine ER, or 71 percent of patients receiving tamsulosin. Neither group receiving monotherapy demonstrated significant differences vs. placebo in percentages of patients reporting treatment benefit.
The symptoms of urgency urinary incontinence, urgency, and 24-hour and nocturnal urination frequency were also significantly improved by week 12 in the group receiving tolterodine ER plus tamsulosin vs. placebo but not in the tamsulosin group. In the tolterodine ER group, only urgency urinary incontinence episodes per 24 hours were significantly reduced at week 12. The International Prostate Symptom Score and quality-of-life scores were significantly improved by week 12 among patients receiving tolterodine ER plus tamsulosin. All interventions were well tolerated.
“The results of this study demonstrate that some men bothered by lower urinary tract symptoms, including bladder diary-documented overactive bladder symptoms, might not respond to monotherapy with either a-receptor antagonists or antimuscarinic agents. Treatment with tolterodine ER plus tamsulosin resulted in statistically and clinically significant treatment benefit. Similarly low incidences of acute urinary retention were observed in all treatment groups, and there were no significant differences in maximum urinary flow rate or postvoid residual volume between any 2 groups,” the authors conclude.
(JAMA. 2006;296:2319-2328. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was funded by Pfizer Inc. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 9:00 a.m. CT, Tuesday, November 14, 2006
Media Advisory: To contact Gregory Swanson, M.D., call Rosanne Fohn at 210-450-8808.
ADDING RADIATION THERAPY FOR TREATMENT OF ADVANCED PROSTATE CANCER MAY OFFER BENEFIT
NEW YORK—Treating advanced prostate cancer with radiation therapy after removal of the prostate gland reduces the risk of disease recurrence, but does not appear to significantly improve the length of survival, according to a study in the November 15 issue of JAMA, a theme issue on men’s health.
Gregory Swanson, M.D., of the University of Texas Health Science Center, San Antonio, presented the findings of the study today at a JAMA media briefing on men’s health in New York.
Radical prostatectomy (removal of the prostate gland) is selected for treatment of localized prostate cancer by approximately one-third of the 230,000 patients newly diagnosed each year in the United States. It is commonly accepted that this treatment has optimal results in patients with cancer confined to the prostate. But cancer outside of the prostate is detected at radical prostatectomy in 38 percent to 52 percent of patients, and this is associated with a risk of disease recurrence, progression, and death, according to background information in the article. Adding (adjuvant) radiation therapy to treatment has been used for more than 4 decades to reduce the risk of disease recurrence, but it is unknown if this reduces the risk of the cancer spreading or improves survival.
Dr. Swanson and colleagues conducted a study comparing usual care with adjuvant radiation therapy for 425 men with cancer outside of the prostate after radical prostatectomy to determine the effect on metastasis-free survival and overall survival. The patients were enrolled between August 1988 and January 1997, with median (midpoint) follow-up of 10.6 years. Men were randomly assigned to receive external beam radiotherapy (n = 214) or usual care plus observation (n = 211).
A total of 43.1 percent of the patients in the observation group were diagnosed with metastatic disease or died (median metastasis-free estimate, 13.2 years) vs. 35.5 percent of the patients in the adjuvant radiotherapy group (median metastasis-free estimate, 14.7 years), a difference that was not statistically significant. There were no significant between-group differences for overall survival (71 deaths in the radiotherapy group vs. 83 deaths in the observation group).
The researchers did find that patients in the adjuvant radiotherapy group had a 57 percent lower risk of PSA relapse, and a 38 percent reduced risk of disease recurrence, compared to patients in the observation group.
Adverse effects were more common with radiotherapy vs. observation (23.8 percent vs. 11.9 percent), including rectal complications and urinary incontinence.
“The results of this study provide guidance for clinicians and patients in weighing options for adjuvant radiotherapy for pathologically advanced disease. Arguments in favor of radiation include the approximately 50 percent reduction in risk of PSA relapse or disease recurrence, and perhaps the nonsignificant reduction in risk of metastasis-free survival, the primary study end point,” the authors write. “Arguments against adjuvant radiotherapy must include that the study had negative findings, ie., a significant reduction in metastatic disease was not demonstrated. Despite prolonged follow-up of these patients, the rate of metastatic disease was significantly less than anticipated.”
(JAMA. 2006;296:2329-2335. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported in part by Public Health Service Cooperative Agreement grants awarded by the National Cancer Institute, Department of Health and Human Services, and by a National Cancer Institute of Canada grant. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 9:00 a.m. CT, Tuesday, November 14, 2006
Media Advisory: To contact Bradley J. Willcox, M.D., call 808-722-1703.
MEN WHO AVOID CERTAIN RISK FACTORS IN MIDLIFE MAY HAVE LONGER, HEALTHIER LIFE
NEW YORK—Avoiding health risk factors in midlife such as smoking, being overweight, excessive drinking and hypertension is associated with a longer and healthier life in men, according to a study in the November 15 issue of JAMA, a theme issue on men’s health.
Bradley J. Willcox, M.D., of the Pacific Health Research Institute and Kuakini Medical Center in Honolulu, presented the findings of the study today at a JAMA
media briefing on men’s health in New York.
Persons alive at age 85 years or older are the fastest-growing age group in most industrialized countries and are among the largest consumers of health care resources. Identifying strategies for remaining healthy, vigorous, and disability-free at older ages has become a major priority, according to background information in the article. Studies with substantial numbers of long-lived participants and characteristics associated with longer survival are rare but essential to identify risk factors for health and survival at older ages.
Dr. Willcox and colleagues examined potential biological, lifestyle, and sociodemographic risk factors present at middle-age to identify risk factors for healthy survival. The study included 5,820 Japanese-American middle-aged men (average age, 54) in the Kuakini Honolulu Heart Program/Honolulu Asia Aging Study. The participants were free of illness and functional impairments and were followed for up to 40 years (1965-2005) to assess overall and exceptional survival. Exceptional survival was defined as survival to a specified age (75, 80, 85, or 90 years) without incidence of 6 major chronic diseases and without physical and cognitive impairment. The diseases were coronary heart disease, stroke, cancer (excluding nonmelanoma skin cancer), chronic obstructive pulmonary disease, Parkinson disease, and treated diabetes. Of the 5,820 original participants, 2,451 participants (42 percent) survived to age 85 years and 655 participants (11 percent) met the criteria for exceptional survival to age 85 years.
The researchers found that high grip strength and avoidance of overweight, hyperglycemia, hypertension, smoking, and excessive alcohol consumption were associated with both overall and exceptional survival. In addition, high education and avoidance of hypertriglyceridemia (elevated triglyceride level) were associated with exceptional survival, and lack of a marital partner was associated with death before age 85 years.
Risk factor models based on cumulative risk factors (survival risk score) suggest that the probability of survival to age 85 years is as high as 69 percent with no risk factors and as low as 22 percent with 6 or more risk factors. The probability of exceptional (healthy) survival to age 85 years was 55 percent with no risk factors but decreased to 9 percent with 6 or more risk factors
“Anthropometric [measurement and study of the human body and its capacities] measures from this study, such as grip strength, suggest that it is important to be physically robust in midlife. This is consistent with theories of aging that suggest that better-built organisms last longer and that physiological reserve is an important determinant of survival,” the authors write. This may also be a marker of physical fitness.
“In summary, we have identified several potentially important risk factors for healthy survival in a large group of middle-aged men. These risk factors can be easily measured in clinical settings and are, for the most part, modifiable. This study suggests that common approaches that target multiple risk factors simultaneously, such as avoidance of smoking or hypertension, and approaches that enhance insulin sensitivity, such as maintaining a lean body weight, may improve the probability of better health at older ages. This may be especially important for men, few of whom survive to oldest-old age,” the researchers conclude.
(JAMA. 2006;296:2343-2350. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported by a contract from the National Heart, Lung, and Blood Institute, and contract and grants (including Hawaii Lifespan Study) from the National Institute on Aging, and a grant from the Hawaii Community Foundation. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 9:00 a.m. CT, Tuesday, November 14, 2006
Media Advisory: To contact Leonard S. Marks, M.D., call Rachel Champeau at 310-794-2270.
TESTOSTERONE REPLACEMENT THERAPY APPEARS SAFE FOR PROSTATE
NEW YORK—Preliminary research suggests that testosterone replacement therapy for men with low testosterone levels appears to have little effect on the prostate gland, contrary to some reports that this therapy may be harmful, according to a study in the November 15 issue of JAMA, a theme issue on men’s health.
Leonard S. Marks, M.D., of the Urological Sciences Research Foundation and University of California, Los Angeles, presented the findings of the study today at a JAMA media briefing on men’s health in New York.
Testosterone replacement therapy (TRT) in aging men is a widespread, growing practice. According to pharmaceutical industry estimates, more than 1.8 million prescriptions for testosterone products were written in the United States in 2002, a 30 percent increase over the previous year and a 170 percent increase over the previous 5 years. In 2005, a total of 2.3 million prescriptions were written for these products. Serum levels of testosterone decline with age, and many aging men with low levels of the hormone may experience depression, sexual dysfunction, diminished lean body mass, muscle volume and strength, and reduced bone mineral density, according to background information in the article. Such changes, in association with low testosterone levels, have been called “male menopause.”
Aspects of the syndrome may be improved with TRT, and most testosterone prescriptions are currently written for men older than 45 years, a demographic in which prostate disease is most common. Between 2 and 4 million men, nearly all in this “prostatic age group,” may be candidates for treatment, the authors write. In men with advanced prostate cancer, testosterone administration often worsens the disease. Thus, when aging men receive supplemental testosterone, a primary concern is prostate safety. Even in men with no sign of prostate cancer, the possibility of stimulating growth in subclinical disease exists. Instances of prostate cancer in men receiving testosterone supplementation have been reported. When TRT is prescribed, careful monitoring for prostate disease is considered mandatory. But there is little information regarding the effects of TRT on prostate tissue in men.
Dr. Marks and colleagues conducted a randomized controlled trial to assess the effects of TRT on prostate tissue of 44 men, age 44 to 78 years, with low serum testosterone levels. The study was conducted between February 2003 and November 2004. Participants were randomly assigned to receive by injection 150 mg of replacement testosterone or matching placebo every 2 weeks for 6 months. Of the 44 men randomized, 40 had prostate biopsies performed both at baseline and at the end of the study and were included in the final analysis (TRT, n = 21; placebo, n = 19).
Testosterone replacement therapy increased serum testosterone levels to the mid-normal range with no significant change in serum testosterone levels in matched, placebo-treated men. In prostate tissue, TRT increased median (midpoint) androgen (male sex hormone) concentrations only slightly compared with baseline levels or between the 2 groups. No treatment-related change was observed in prostate histology, tissue biomarkers, gene expression, or cancer incidence or severity. Treatment-related changes in prostate volume, serum prostate-specific antigen, voiding symptoms, and urinary flow were slight.
“… under the conditions herein, including the biopsy to detect cancer performed pretreatment, a degree of prostate safety is defined for men undergoing TRT,” the authors write. “The prostate risks to men undergoing TRT may not be as great as once believed, especially if the results of the pretreatment biopsy are negative. However, establishment of prostate safety for large populations of older men undergoing longer duration of TRT requires further study,” the researchers conclude.
(JAMA. 2006;296:2351-2361. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported by unrestricted educational grants from Watson Laboratories (Salt Lake City) and Solvay Pharmaceuticals (Marietta, Ga.); a National Institutes of Health/National Cancer Institute Spore grant (Drs. Epstein, Veltri, Makarov, and Partin); a National Institutes of Health grant (Dr. Hess); the Prostate Cancer Foundation (Dr. Nelson); a National Institutes of Health/National Cancer Institute Spore grant; and a National Institutes of Health grant (Drs. Mostaghel and Nelson). Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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JAMA REPORTS
VIDEO: Windows Media | Quicktime
STUDY IDENTIFIES MIDDLE-AGE RISK FACTORS THAT PREDICT LIFESPAN FOR MEN
VIDEO:
NAT SOT UP FULL FOR :03
Clinician talking to Mr. Shimizu/timing him standing up/sitting down
AUDIO:
“Ready, set, go.”
VIDEO:
B-ROLL
Clinician timing Mr. Shimizu standing up/sitting down
AUDIO:
JAMES SHIMIZU (shim-EE-zoo) IS EIGHTY-EIGHT YEARS OLD, AND IN REMARKABLY GOOD HEALTH.
VIDEO:
SOT/FULL
@ :11
Super: James Shimizu
88 years old
Runs :03
AUDIO:
“I don’t know reason why I live this long.”
VIDEO:
B-ROLL
Close up of Dr. Willcox looking at computer
With colleagues looking at computer until “five-thousand”
Mr. Shimizu being timed walking back and forth by clinician in exam room
GFX/JAMA COVER
AUDIO:
BUT THIS MAN MAY KNOW… HE’S DR. BRADLEY WILLCOX OF PACIFIC HEALTH RESEARCH INSTITUTE AND KUAKINI (koo-ah-KEE-nee) MEDICAL CENTER IN HONOLULU. HE AND HIS COLLEAGUES STUDIED HEALTH DATA ON MORE THAN FIVE-THOUSAND MEN LIKE MR. SHIMIZU – JAPANESE AMERICANS. THE DATA TRACKED THESE MEN FOR FORTY YEARS, BEGINNING IN MIDDLE AGE. THE FINDINGS APPEAR IN A MEN’S HEALTH THEME ISSUE OF JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.
VIDEO:
SOT/FULL
@ :36
Super: Bradley Willcox, M.D.
Pacific Health Research Institute
Runs :08
AUDIO:
“This kind of study can give us clues as to what are those important factors for having a healthy old age.”
VIDEO:
B-ROLL
Bite runs through “predict”
Elderly white man walking around exercise track
FULL SCREEN GRAPHIC
Title: Nine factors in middle age
Lean weight
Low blood pressure
Low blood sugar
Low bad cholesterol
Moderate alcohol consumption
No smoking
High hand grip strength
Higher education
Married
80% chance of living to age 80
AUDIO:
THEY FOUND THAT NINE FACTORS IN MIDDLE AGE PREDICT A LONG LIFE. THOSE MEN WHO LATER WENT ON TO LIVE THE LONGEST, AND THE HEALTHIEST, WERE NOT OVERWEIGHT, HAD LOW BLOOD PRESSURE, LOW BLOOD SUGAR, LOW BAD CHOLESTEROL, DRANK MODERATE AMOUNTS OF ALCOHOL, DIDN’T SMOKE, HAD HIGH HAND GRIP STRENGTH, HAD HIGHER EDUCATION LEVELS, AND WERE MARRIED. IF THIS DESCRIBES YOU AT MIDDLE AGE, YOU MAY HAVE AN EIGHTY PERCENT CHANCE OF LIVING TO AGE EIGHTY, AND A GOOD CHANCE OF DOING SO HEALTHFULLY.
VIDEO:
SOT/FULL
Bradley Willcox, M.D.
Pacific Health Research Institute
Runs :15
AUDIO:
“Your chances were more than 60% of being healthy at that age if you avoided these risk factors, yet if you had six or more of these risk factors you had less than a 10% chance of living into your mid 80s.”
VIDEO:
B-ROLL
Overweight middle-aged man talking to physician
AUDIO:
DR. WILLCOX HOPES PEOPLE WHO ARE MIDDLE-AGED WILL WORK ON THESE RISK FACTORS, SO THEY IMPROVE THEIR CHANCES OF A LONG, HEALTHY LIFE.
VIDEO:
SOT/FULL
Bradley Willcox, M.D.
Pacific Health Research Institute
Runs :11
AUDIO:
“The baby boomers are getting older and they need more information about how to age more healthfully, particularly male baby boomers who don’t do as good a job as female baby boomers at aging healthfully.”
VIDEO:
B-ROLL
Clinician timing Mr. Shimizu standing up/sitting down
AUDIO:
MR. SHIMIZU AVOIDED ALL THOSE RISK FACTORS, AND HE’S LIVING PROOF OF THE BENEFIT.
VIDEO:
NAT SOT UP FULL FOR :03
Clinician talking to Mr. Shimizu
AUDIO:
“Five, very good.”
VIDEO:
B-ROLL
Mr. Shimizu stays seated
AUDIO:
THIS IS MAVIS PRALL WITH THE JAMA REPORT.
