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A study, published in tha journal cancer, has shown that the reliability of a prostate cancer-screening test may be compromised by lifestyle and demographic factors.

The study reveals the rate of change in concentration of prostate specific antigen ( PSA ) over time -- a calculation called PSA velocity -- can be significantly affected by age, race, and diet, leading to falsely lower or elevated values and possible misinterpretation by doctors.

Single determinations of PSA concentration, the most common use of the PSA screening test, were minimally but significantly affected by age and body mass index ( BMI ).

Studies have shown a decrease in prostate cancer mortality since 1992 and some researchers attribute a portion of that fall to the widespread adoption of the PSA test.

But some experts say that PSA concentration alone causes too many false positives and leads to many unnecessary tests, such as biopsies and transrectal ultrasounds.

Investigators continue to refine the test, including developing calculations such as PSA velocity, PSA density, and age-specific PSA, or other tests such as percent free PSA.

However, there is poor understanding of the effect of other factors, such as diet, race, and weight on PSA and its related measurements.

Alan R. Kristal, of the Fred Hutchinson Cancer Research Center in Seattle and colleagues reviewed PSA and PSA velocity data from 3,341 cancer-free men to determine relationships between PSA tests and demographic and lifestyle factors.

PSA velocity was significantly affected by age, race and diet, potentially affecting its clinical interpretation. PSA velocity decreased as men aged, and increased with higher total energy diets.

PSA velocity in African Americans was on average almost twice the level of Caucasians, and was lower among users of high-dose calcium supplements.

Large weight fluctuations also affected PSA velocity. Men who gained weight had lower PSA velocity and those who lost weight had higher PSA velocity.

As was found in other studies, single determinations of PSA concentration increase with age and decrease with obesity. These differences, while statistically significant, were considered minimal and would have little influence on clinical interpretation of PSA value.

While the authors considered the impact of demographic and lifestyle factors on the clinical interpretation of a single PSA concentration was negligible, the clinical impact on interpreting PSA velocity was considered significant. " Race, smoking, age, energy intake, calcium supplement use and weight change were associated with substantial differences in PSA velocity," they conclude, "and clinical interpretation of PSA velocity could be biased by these factors."

 

CREEK COUNTY, OKLA---Only one witness testified at the preliminary hearing of an Oklahoma judge, charged with four felony counts of indecent exposure for allegedly using a "penis pump" under his judicial robes while adjudicating two murder trials and a civil trial in 2003.

Former Creek County District Judge Donald Thompson, 59, was ordered to stand trial after Lisa Foster, Thompson's court reporter for nearly 15 years, testified for nearly three hours before Associate District Judge James D. Bland who found that there was sufficient cause to proceed to trial.

Foster testified that she had marked her notes every time she witnessed Thompson masturbating with the "penis pump" while he was presiding at trials between 2001 and 2003.

Thompson will be arraigned on Jan. 26 for four counts of indecent exposure and one count of misuse of a state computer. It is alleged that Thompson kept explicit photos of himself on his office computer. A trial date will be set at Thompson's arraignment.

If he is found guilty at jury trial, he could face a maximum of 41 years in prison.

During the hearing. Foster testified that she saw Thompson shave his pubic area during closing arguments in a murder case. She said she didn't report him because she was afraid of losing her job.

She took several Polaroid pictures of the device used by Thompson in March 2001 to show her husband because she wanted people to know "that I was not crazy".

The court reporter said she was afraid to go to police. Only after she was subpoenaed by the state judicial review board did she relate what she had seen and heard in the courtroom and after a penis pump was found in the courtroom by police in September 2003 during an investigation of Thompson.

She was fired in 2004.

Thompson was arrested last year. A judge for over 22 years prior to his resignation, Thompson could face up to 10 years in prison and a $20,000 fine on each felony count and would have to register as a sex offender.

Thompson is collecting his $88,000 annual pension but if convicted, the pension would be revoked.

DNA samples have reportedly been taken and processed by the Oklahoma State Bureau of Investigation. However, according to test results, there were no signs of Thompson's DNA on any of the materials seized from around the judge's bench including the carpet.

Thompson has denied the accusations and says that the pump seized was a gag gift from a friend. The sex toy and another one found under the bench will be admitted as evidence at trial and jurors will be allowed to see the sex toy.

Jurors told police that they heard whooshing noises coming from the bench during the trial proceedings.
 

When Julian Cousins was told that the cancer that had cost him one testicle at the age of 24 had recurred in the other 13 years later, he saw the future as a stark choice between castration and death.

Julian Cousins: 'I wanted to lead a normal life. Every man has his pride'

"The hospital wanted to book me in for the following Monday, but, at 37, I was not prepared to be a human being with no gender identity," says the south London tennis coach. "They told me I could have prosthetic testicles and wear patches to replace my testosterone, but that wasn't an acceptable solution for me. My view was, 'If that's all you can offer, I would rather die on my terms than live on yours'."

Four years later, Mr Cousins is alive on his own terms. In what turned out to be an inspired decision, he sought out Tim Oliver, professor of oncology at Barts and the London Hospital medical school, who had treated his first bout of cancer.

Prof Oliver has pioneered alternatives to orchidectomy - removal of the testicle - for patients who have already had one operation. He believes that, in time, we may see the same kind of revolution in the treatment of testicular cancer that has been seen in breast cancer care. Wherever possible, women are now offered a lumpectomy rather than a mastectomy. In future, lumpectomy may be available to men with small tumours, who today would lose a testicle.

After two courses of powerful chemotherapy, which "felt like being plugged into the National Grid" and left him feeling shattered, Mr Cousins's tumour had disappeared without the need for surgery. Next March, he is getting married. "Children are very important to my fiancée, and our relationship would have been extremely difficult - if not impossible - had I been unable to have a family," he says.

Each year, about 2,000 people are given a diagnosis of testicular cancer; those aged 18 to 32 are most at risk. For reasons that are not understood, the incidence of the disease has risen by 84 per cent in the past 25 years, and is still increasing. The good news is that the vast majority of those diagnosed can be cured. Because more men now carry out self-examination, doctors are seeing tumours earlier, when they are smaller and less likely to have spread. Survival rates for men whose cancer is confined to the testicle are now 99 per cent. Where the disease has spread, survival rates have leapt from five per cent in the Sixties to more than 90 per cent today - thanks, mainly, to highly effective chemotherapy.

Treatment for cancer of one testicle almost always involves its removal, sometimes accompanied by chemotherapy or radiotherapy; potency and fertility are normally unaffected. An unlucky two to three per cent of these patients will have cancer in both testicles, some simultaneously, and others years apart.

For them, castration used to be the only option - followed by hormone replacement therapy to supply testosterone, without which patients suffer hot flushes, are unable to have an erection and are at risk of osteoporosis. Castrated men cannot, of course, father children naturally and usually bank their sperm before treatment.

Prof Oliver has long been determined to find a less radical solution, particularly for young men who have their lives ahead of them and have not had any children.

"Surgeons operating on women with breast cancer used to remove part of the chest wall, the lymph glands and the whole breast - until research showed that this was no more effective than just removing the cancerous lump," says Prof Oliver. "Now that chemotherapy is so successful in curing testicular cancer, why should we waste all these testicles?"

For the past 10 years, he has offered men with small cancers of the second testicle the opportunity to have chemotherapy followed by a lumpectomy, where necessary. The advantages of such an approach are obvious, but according to the Orchid Cancer Appeal - a charity that Prof Oliver helped to found, and which helps to fund his research in this field - 99 per cent of men in Britain who could benefit are not offered the opportunity and end up being castrated.

"The risk with the less invasive treatment is that you turn out to be wrong and the cancer returns," says Prof Oliver, who believes that fear of recurrence prevents more oncologists from recommending this option. "Of the 28 patients we have treated, about 18 per cent have developed another tumour. But we have operated on those men at that point and they have all been fine."

Chris Demetriades, a civil servant from Essex, decided to take the risk when he developed cancer in his second testicle, 12 years after losing his first. "Being diagnosed with another lump sent me to the ends of the earth. I was 36, I hadn't had kids and my life was over.

"I made my choice not just because I wanted to have children naturally - I wanted to lead a normal life without pills and injections. Every man has his pride." Chris had two courses of chemotherapy, one of which made him very ill, and a lumpectomy.

He is now married with a two-year-old son, Aaron Oliver (named after the doctor who helped make his birth possible). "I know that there is a 30 per cent chance the cancer will recur and I do worry about that. I would like the chance to see my son grow up but, whatever happens, I have no regrets about my decision."

Few disagree that this approach should be offered routinely to men who have already lost one testicle. The next step is to offer it to young men with both testicles who have small tumours. "The fact that 23 per cent of tumours are now smaller than 2 cm raises the possibility of carrying out testis-preserving surgery, rather than orchidectomies, in young patients who have an excellent prognosis, and for whom long-term psychological and fertility issues assume greater importance," says Prof Oliver. "We need a randomised controlled trial to evaluate these issues."

"This option would apply only to men with very small tumours," says Prof Alan Horwich, head of the testicular tumour unit at the Royal Marsden Hospital in London, who supports the idea of a partial orchidectomy, if appropriate, for patients with only one testicle. "Where the cancer is in different sites in the testis, there is a chance that you may not remove it properly. Or you may remove the cancer, but leave pre-cancerous cells which would be likely to cause a new tumour later."

Prof Horwich believes that the emphasis in treating primary testicular cancer should focus on ensuring that no pre-cancerous changes have taken place in the remaining testicle, and on treating them early when they have, usually with low dose radiotherapy.

On the morning of his 42nd birthday, Stephen Harrell was arrested outside a liquor store on Century Boulevard in Inglewood, handcuffed, and hauled off to face the screwiest charge ever leveled at him in his admittedly checkered career with the criminal justice system. He was accused of concealing four rocks of cocaine in his foreskin.

To be more precise, he was accused of wrapping the rocks in individual clear plastic bags, placing them all in another black bag, shoving them halfway up his penis and then keeping them snugly in place for at least an hour between the time of his arrest and the time that three Inglewood cops strip-searched him. The whole package was variously described by the arresting officer as being “bigger than a marble” and having roughly the same diameter as a dime.

Let me point out to those of you unendowed with male genitalia that we are talking about an almost unfathomable world of pain here, not to mention physical elasticity of a truly extraordinary kind. (Those of you with male genitalia have probably crossed your legs already.) Nothing in Harrell’s long resume as a petty criminal and drug user suggests he was ever in serious contention for the cast of Puppetry of the Penis. Or, as Harrell himself put it in one of his first interviews with his defense attorney: “I may be big, but I ain’t no horse.”

So far, just a funny story. But it only gets more bizarre on closer examination. The arresting officer, Patrick Manning, claims he saw Harrell drop a crack pipe from his waistband as soon as he became aware of his patrol car. That, at least, was the pretext for the arrest. But Harrell didn’t apparently think of dumping the cocaine – assuming he ever had it in the first place. Officer Manning noticed nothing unusual about the way Harrell was walking, and once he had cuffed him and put him in the patrol car he didn’t report any wriggling or gasps of pain.

The public defender eventually assigned to Harrell, Eleanor Schneir, had the bright idea of downloading some penis diagrams off the Internet and asked Officer Manning and the two colleagues he took with him into the strip-search room to show the trial jury where exactly the bulge had been. Curiously, each policeman put it in a different place. One said it was at the top, beneath the foreskin proper, while the other two put it further down and to the side. In one diagram the package was almost all the way to the base of the penis – which makes one wonder just how endowed with male genitalia the police officers themselves can have been.

Schneir had great fun buying up gourmet gumballs from her local grocery store and waving them at the jury, with a dime taped to the side for size-comparison purposes, just to emphasize the preposterousness of the allegation. She cited no less an authority than Seinfeld to question whether any penis could withstand the cold of the strip-search room without succumbing to the dreaded male problem of shrinkage, which would surely have shaken the incriminating package loose all by itself.

At a certain point, it seemed Harrell was home free, and Schneir was confident enough to berate the prosecution for subjecting him to an embarrassing public spectacle. As she told the jury: “He has to sit here and hear me, his lawyer, his advocate, a woman, argue to a jury of 12 strangers that his penis is too small for this to be possible – what could possibly be more humiliating than that?”

Things took an unexpected turn, however, as a batch of photographs of Harrell’s genitalia was released to the court and appeared to show that he was circumcised. From Harrell’s point of view, this might have looked like a pretty good defense – how, after all, can anyone conceal drugs in their foreskin if they don’t have one? In reality, though, the photographs unleashed a furor in the courtroom and changed the terms of the debate entirely. Suddenly, it was not the Inglewood PD whose honesty was under scrutiny but rather Harrell’s, as the defendant was accused of yanking his foreskin back for the camera in an attempt to conceal it.

In the single most surreal sequence of the trial, Officer Manning bragged that he knew all about the flexibility of uncircumcised penises because he used to play baseball for the Atlanta Braves (he was a 1999 draft pick later sidelined by a knee injury) and frequently showered with players from Colombia and Central America who not only had foreskins but were frequently “silly” with them. Manning told the prosecutor he saw players pull down their foreskins and dance around for as long as 20 minutes.

Schneir wasn’t going to let this one go. “I’m a little confused,” she said disingenuously. “I was always led to believe that men in showers go to great lengths not to look at each other’s penises, and you’re telling me you looked for 20 minutes?”

Members of the jury started guffawing. Manning said sheepishly that he hadn’t exactly looked for 20 minutes. So Schneir asked him how long he had looked for – 15 minutes, 10 minutes, 5 minutes? Eventually, Manning said he’d looked at one penis for one minute. Schneir deadpanned: “Okay, we’re all dying to know: whose penis was it?”

For all the courtroom humor, from here on out the trial started slipping out of the grasp of the defense. The deputy district attorney suggested the only way to resolve the circumcision question was to have Harrell re-examined by a medical professional. Harrell told the court he’d had quite enough people looking at his penis and refused. The judge, Deirdre Hill, then instructed the jury that they were free to interpret this refusal as a form of self-incrimination.

Schneir tried valiantly to argue that the circumcision question made no difference to the plausibility of the police’s story. But the damage was done, and the jury came back with a guilty verdict.

That, of course, is the way so many petty crime cases go. Given the choice between a defendant of dubious character and the testimony of uniformed police officers, juries will almost always side with the police. The Harrell case reflects many of the uglier aspects of law enforcement in Los Angeles: a poor, black, relatively harmless delinquent picked up, handcuffed and stripped by white officers, and lumbered with a serious felony charge for which he has just been sentenced to six years and six months behind bars. Without the allegation of cocaine in his penis, he would have been looking at a misdemeanor and a $100 fine.

There is some evidence to suggest that Officer Manning, for one, finds escapades like the apprehension of Stephen Harrell to be a bit of a hoot. Interviewed by a Myrtle Beach, South Carolina newspaper when he first made the leap from baseball to policing, he said patrolling the streets of Inglewood was not entirely unlike competitive sports. “To me, it’s almost like a game,” he said. “I’ve had a great time so far.”

Judge Hill also appears to have taken Harrell less than seriously. At one point during the sentencing phase, when one of the fingerprints from his conviction record failed to match, she ruled that his priors should be disregarded and that he was therefore eligible for drug treatment under the terms of Proposition 36. When the court next convened, however, she simply reversed herself – for reasons possibly connected to the fact that the district attorney’s office was in a separate dispute with her and threatening to have her removed from felony cases — and she ended up imposing the maximum sentence.

“She’d already told my client she would release him,” a frustrated Schneir said. “That seems to me cruel and unusual punishment on some level.” Stephen Harrell is now stuck behind bars until 2010 at the earliest – and it’s far from clear who is better off for it.


 

Once a routine procedure for newborn boys, circumcision is falling rapidly out of favor in the United States - even as some new evidence suggests that the surgery may reduce the transmission of HIV and other sexually transmitted diseases.

In recent years, many doctors and medical groups, including the influential American Academy of Pediatrics, have stopped recommending routine circumcisions because they believed there wasn't enough evidence that it's medically necessary.

More states also have been cutting Medicaid funding for circumcisions, which typically pays for about a third of all circumcisions each year. Sixteen states no longer cover the surgery. A number of private insurers also have stopped paying for the procedure.

As a result, overall circumcision rates in the U.S. have fallen to the lowest level in more than half a century, from 63.5 percent in 1993 to 55.9 percent in 2003, the last year for which federal data are available.

That isn't the case around Racine, as best as local health groups can determine. Although All Saints Healthcare doesn't keep statistics, its staff has seen no change in the patterns of circumcision, said Sue Kolberg, spokeswoman for All Saints.

There is a segment of the population which doesn't want circumcisions done, and in particular they are not popular among Hispanics, said Dr. Fernando Rustia, a pediatrician at the Aurora Health Care clinic in Mount Pleasant. "And realistically, there are no medical reasons for circumcision."

Past studies have found no difference between circumcised and uncircumcised men in the rate of sexually transmitted diseases or urinary tract infections, Rustia said.

"But overall, parents still can be property taught how to properlty clean the area so that infection doesn't spread," Kolberg said.

Removing the foreskin from the penis can't prevent transmission of sexually transmitted diseases. The best prevention techniques remain reducing the number of sexual partners and using condoms.

But as new HIV cases remain at a stubborn 40,000 a year and infections continue to disproportionately affect minorities (especially minority women) and the poor, some prevention experts again have begun urging doctors to recommend circumcision for newborns. A small number are even advising uncircumcised adult men at high-risk for HIV to undergo the procedure.

In the first random trial on the topic, published this month in the Public Library of Science Medicine, researchers tracked for nearly two years more than 3,200 men in South Africa who were randomly assigned either to be circumcised or not. Only 20 men in the first group became infected whereas 49 in the second did. Researchers halted the experiment early because the results were so convincing.

Other, smaller studies done over the last several years strongly suggest that circumcision also protects against gonorrhea and syphilis. In 2003, a review of 2,000 men who visited an inner-city STD clinic during a one-year period found that uncircumcised men were as much as twice as likely to have either or both infections.

For parents of newborn boys, the question ultimately comes down to this: Do they believe their child will ever be at high enough risk of contracting a sexually transmitted disease to warrant having him circumcised? For many the answer may be no, but for others it's a clear possibility.

"Other than condoms and antiretroviral drugs that block transmission during childbirth, circumcision is the next best tool we have to (slow) infections," said Dr. Thomas Coates, a professor of infectious diseases at the University of California, Los Angeles' David Geffen School of Medicine and a well-known HIV prevention expert.

Although circumcision is not routine in most countries, the procedure to remove the foreskin from the penis has been popular here since the late 19th century. At that time, a number of well-known physicians and religious activists said the surgery promoted hygiene and was a possible cure for sexual "perversions." By the 1960s, nearly 9 of 10 U.S. boys were circumcised.

Nonetheless, it's unclear just what medical benefit circumcision brings. There's evidence that it helps reduce urinary tract infections in infants and penile cancer in adults, but both conditions are relatively rare.

There also have been numerous studies in recent decades on the role circumcision plays in STD transmission, but they were either too small or not rigorous enough to sway doctors that all young men should be circumcised.

The American Academy of Pediatrics declared circumcision an "elective" surgery more than a decade ago and has reiterated its position several times, including earlier this year. Dr. Alan Fleischman, a member of the American Academy of Pediatrics task force that makes recommendations on circumcisions, said the committee probably wouldn't change its position.

The reason: Rates of HIV and other STDs remain relatively low in the United States, making routine circumcisions for everyone in this country unnecessary.

Still, said Fleischman, a clinical professor at Albert Einstein College of Medicine in New York, "parents have to assess their own situations and decide if they believe their child would be at risk and if this surgery is worthwhile."

Some researchers say they know why circumcision may help protect men from contracting some STDs. A 2002 study done at the University of Illinois-Chicago found a male's foreskin is packed with cells that are highly susceptible to the HIV virus.

They say the foreskin also traps fluids, allowing HIV and other pathogens more time to infect.

"One of the benefits (circumcision) has is that it is permanent and protects every time," said Robert Bailey, professor of epidemiology at the University of Illinois-Chicago and the lead researcher on the 2002 study.

Coates, of UCLA, is most concerned that reduced Medicaid funding for the procedure could lead to even greater HIV and other STD rates among minorities and the poor, who already have disproportionately higher infection rates. In some communities, rates are as high as 30 percent in some populations, such as gay black men.

Said Coates: "When these children grow up, and start having sex, we are guaranteeing they will be at a greater risk. Why would we want to do that?"


 

TRADITIONAL leaders have been urged to play a direct and leading role in preventing the continued deaths of initiates in the Eastern Cape.

The renewed call by the province’s House of Traditional Leaders follows the death of an initiate who hanged himself at Bolothwa in the Queenstown area on New Year’s day. This took the death toll in the province this circumcision season to 22.

Health spokesman Sizwe Kupelo said the initiate suspected he had a sexually transmitted disease.

Among the reasons for initiates’ deaths were 16 cases of botched circumcision, four assaults, one struck by lighting, and one suicide.

"The reason for many of these deaths is negligence on the side of parents and traditional helpers,” said Kupelo.

Parents and community members waited until the 11th hour to inform the department about the problem.

"We can deploy as many officials as we can but they are not the holy ghosts. They depend on information from parents. If parents came forward on time, many lives could have been saved,” Kupelo said.

Contrary to Chief Mwelo Nonkonyana, who blamed the department’s interference as the cause of these deaths, Kupelo said the intervention by the department in saving lives had been successful.

Some 400 boys had been rescued from illegal initiation schools outside Matatiele, he said.

Eight circumcision supervisors were also arrested for allowing underage boys to be circumcised without parental consent.

Chief Langa Mavuso, who is HIV/Aids co-ordinator in the House of Traditional Leaders in the province, echoed Kupelo’s views.

He also rejected calls for the abolition of the custom.

"The irresponsibility of parents cannot force us to do away with the custom which is the only custom that unites us as the Xhosa nation.”

He said there was a tendency to confuse the custom with actual surgery. "This is about discipline.”

Mavuso also criticised the chiefs for not playing an active role in guarding and monitoring the custom. "This has allowed fly-by-night traditional surgeons to hijack it for their selfish ends,” Mavuso said.

The chief also asked that the custom be practised in such a way that allowed would-be initiates to be checked by modern doctors before going to the bush.

"There is also nothing wrong with the boy being taken to hospital to get some treatment and antibiotics. Even in the bush they should be allowed to take antiretrovirals for HIV or any other medical treatment,” Mavuso said.

He called for the training of traditional surgeons in health matters.

An expert in African tradition, Dr Mathole Motshekga, of Kara Foundation, said "critics of circumcision focused on circumcision and the deaths but not on the administration of these initiation schools by unqualified and unaccountable persons who fail or neglect to observe minimum health standards”.

The traditional chiefs and healers were the main role-players in the custom, Motshekga said.


 

Ordering a judge to stand trial for allegedly masturbating under his robes while on the bench during court hearings, even during jury trials, is only right.

Former Creek County Judge Donald Thompson, 59, was ordered Jan. 3 to stand trial on indecent exposure charges.

This saga began with allegations in June 2004. Thompson resigned from the bench the following August, and in February last year, when charges were filed, Thompson’s attorney said he thought the retirement deal meant no criminal charges would be filed.

Thompson says the charges are false and his court clerk and others, are out to embarrass him.

But, according to news reports, investigators say semen was found after testing the judge’s robe and the carpet behind the bench.

As embarrassing to the state as this might be — and it is very embarrassing — it should be settled.

Judges hold a respected position in our society. Like anyone, they are not perfect, but we should expect those who apportion the law to obey it, and at the least, to give justice full attention while on the bench.

People’s lives depend on a judge’s ability to be fair and intent on the matters before him or her. If Thompson did what he is accused of, he broke not only the trust of the public, but also the law.

http://www.muskogeephoenix.com/apps/pbcs.dll/article?AID=/20060107/OPINION/60106029/1014