Biomedical subjects

M A Moyad

Publications and source records attributed to M A Moyad.

17 recordsLinked to original sources

PubMed2001

Fat reduction to prevent prostate cancer: waiting for more evidence?

Complementary medicine has become an important area of interest for patients and researchers around the world. The utilization of some of these therapies by many individuals makes it imperative to understand whether they have any role in treatment of cancer or other diseases. Some of such therapies may play a role in the prevention of prostate cancer. Clinical trials are addressing this issue, and whether these products could also improve prognosis of prostate cancer. That dietary fat reduction may help to prevent prostate cancer is supported by numerous case-control studies reported over the past several decades, but recent prospective studies suggest that the impact of fat reduction in this regard may not be great. Clinicians should be careful not to suggest such a benefit until more research provides a better picture of the situation. Breast cancer is probably the best example of why more research into dietary changes for reduction in cancer risk is needed. Once believed to play a significant role, recent prospective studies suggest that dietary fat reduction may have little effect on breast cancer prevention, although some interesting insights have been gained with regard to the method of meat preparation and the influence of genetics. Fat reduction, together with soy products or other plant estrogen foods, may have a symbiotic relationship. Numerous healthy lifestyle changes incorporated and practiced at one time (healthy diet, attainment and maintenance of normal weight, soy consumption, among others) may hold some promise in the area of cancer prevention. In the meantime any healthy lifestyle or dietary change should be encouraged, because it may reduce the risk of cardiovascular disease, which is still the number one cause of mortality. It is also an important cause of morbidity and mortality in cancer patients. Regardless, complementary medicine should probably be discussed with any patient who is initiating or undergoing conventional treatment, because of the cardiovascular benefits and overall potential impact on all-cause mortality. Whether such therapies impact on prostate carcinoma remains to be determined through additional prospective investigations.

Animals↗

PubMed2001

Results and lessons from clinical trials using dietary supplements for cancer: direct and indirect investigations.

Randomized controlled trials are generally regarded as the standard of study designs to determine potential causality. The inclusion of a placebo group in these trials, when appropriate, is generally needed to access the efficacy of a drug or dietary supplement. The recent increasing use of dietary supplements and herbal medications by patients makes it imperative to reevaluate the past findings of clinical studies. Several large-scale trials of dietary supplements have been tested in various populations to determine their effect on cancer prevention. Other trials have focused on patients already diagnosed with cancer. In the latter case, it is difficult to involve a placebo because of the serious nature of the disease. Nevertheless, much has been gleaned from these trials directly and indirectly. Overall, when analyzing primary endpoints in these trials, the results have been discouraging and even support the nonuse of certain supplements because of potential adverse effects. Other secondary endpoints in these same trials have revealed some potential encouraging and discouraging data. Individuals who currently qualify for the potential use of dietary supplements for cancer may be restricted to those who have a deficiency in a certain compound despite adequate dietary sources or lifestyle changes. Those individuals with a smoking history or other unhealthy lifestyle seem to have the most to gain or lose from taking certain dietary supplements for cancer. The time seems more than ripe to evaluate past adequate trials with supplements, such as beta-carotene, N-acetyl-cysteine, selenium, shark cartilage, vitamin C, vitamin E, and others. Again, these studies have been disappointing, but they provide insight for the clinician and patient of what to potentially expect when using these supplements for cancer. In addition, indirect trials for other conditions (cardiovascular) may provide future insight into possible results for future cancer prevention trials.

Acetylcysteine↗

PubMed2001

Current methods used for defining, measuring, and treating obesity.

Obesity, despite becoming a recognized epidemic in the United States and many countries around the world cannot be necessarily defined, measured, and treated in a simplified fashion. Numerous organizations have classified overweight and obesity using different anthropometric parameters. Older methods to determine the extent of obesity, such as crude weight and skin calipers, contain serious limitations. For example, measuring abdominal obesity cannot be determined using calipers. Other methods such as lean body mass, body mass index (BMI), and waist-to-hip ratio (WHR) are more commonly used in epidemiologic studies but also contain inherent errors. More expensive and technologically advanced methods, such as densitometry, dual-energy x-ray absorptiometry (DEXA), and bioelectrical impedance analysis are also helpful, but the time and cost of using these methods in large-scale studies are a concern. Numerous options for treating obesity exist, and the clinician should be made aware of their strengths and limitations. Lifestyle changes are not only cost effective, but may be the best approach for individuals who desire to lose weight or to maintain their weight while becoming more fit. The addition of drug therapy is also a possibility. A variety of pharmacotherapy interventions are available to the patient on a short-term basis. In addition, two drugs have Food and Drug Administration approval for the long-term treatment of obesity. Drug therapy should be viewed as adjunctive treatment to lifestyle changes for the individuals who qualify based on their BMI and other comorbidities. Drug therapy carries several adverse effects, and the potential for indefinite treatment continues to be an area of controversy. Therefore, a multidisciplinary approach to treating obesity must be considered in any patient who is obese. These treatments in combination with drug therapy in some cases have provided some of the best results in randomized trials. Obesity needs to be considered a chronic disease that requires long-term commitment and multidisciplinary treatment to achieve the desired results. Unless therapy is individualized, it may be difficult to reverse the dramatic trends in obesity rates that have been observed over the past several decades.

Absorptiometry, Photon↗

PubMed2001

The prevalence and effectiveness of complementary and alternative medicine: what has been learned and what it may be telling us about our patients, ourselves, and conventional medical treatment.

Complementary and alternative medicine (CAM) has been popular in numerous countries around the world. The fairly large range of prevalence may be partially due to different definitions of CAM from a variety of researchers, patients, and the general public. Beyond prevalence issues, few studies have specifically explored the reasons for the use of CAM. Studies that have attempted to answer this question have found that issues such as distress and quality of life issues are some partial reasons for its use. Despite the fact that few, if any, CAM therapies have prolonged survival, encouraging future research into potential benefits seems warranted because some CAM therapies have preliminary encouraging results, and overall, CAM therapies are just in need of more randomized trials. Perhaps, at this time, the central focus of studies should revolve around potential improvements in quality of life issues. Some therapies have been found to potentially improve this parameter. However, during the course of certain conventional medical treatments, many CAM therapies, such as dietary supplements, should be discouraged. These could theoretically reduce the oxidative stress caused by effective treatments, such as radiation or chemotherapy, thus reducing their efficacy. Other basic lifestyle changes, such as simple dietary changes and exercise, should be encouraged during the course of treatment because of the potential benefits already demonstrated. In addition, these simple lifestyle changes may improve overall health, which is a serious issue for many patients. The prevalence of CAM should provide a challenge to health care professionals as a call to improve already existing services and communication between patients. Rather than perceiving CAM as a potential hindrance to proper conventional treatment, the reality could be that CAM is providing a unique opportunity and insight to health care professionals on how to make our current system that much better.

Acquired Immunodeficiency Syndrome↗

PubMed2001

Obesity, interrelated mechanisms, and exposures and kidney cancer.

Obesity has been shown to increase the risk or be associated with numerous conditions from cardiovascular disease and type II diabetes to erectile dysfunction and osteoarthritis. Obesity may also be associated with numerous cancers, and kidney cancer or renal-cell cancer (RCC) may have one of the strongest correlations to obesity compared with cancer at any other site. Almost every epidemiologic investigation has demonstrated an association that tends to affect women more than men, but both genders are impacted. In general, past studies suggest that with increasing weight, a threshold point exists whereby a certain range of body mass index dramatically changes risk. Men and women at the most extreme ends of obesity tend to have the highest risk or only risk in past studies. Individuals at the more extreme ends of obesity may be affected by an almost indefinite number of mechanisms and exposures that could determine incidence and possibly prognosis. For example, higher estrogen levels, elevated insulin levels, a greater concentration of growth factors in adipose tissue, hypertension, cholesterol metabolism abnormalities, and immune malfunction are just some of the potential mechanisms that may increase kidney cancer risk. Obese individuals may also have lower serum levels of vitamin D and engage in less physical activity. Smoking or genetic predisposition to RCC may synergistically contribute to the effect of obesity on risk. The potential mechanisms and associations are numerous and complex. Regardless of the actual cancer risk now and in the future, the overall effect of obesity on general health is clear, and this should be kept in mind in the discussion between health professional and patient.

Blood Pressure↗

PubMed2001

Review of potential risk factors for kidney (renal cell) cancer.

Renal cell cancer (RCC) is responsible for a small percentage of total cancer cases and deaths throughout the world, but the incidence rates of RCC have been steadily increasing over the past decade, whereas numerous other cancers have stabilized or even decreased in number. Even in countries that were observed to have a lower incidence of this disease many are now experiencing large increases in the rates of this cancer. Most kidney cancers are RCC, and blacks are currently experiencing RCC rates that are higher than any other race. Older individuals are also at a higher risk compared with young individuals, but this observation may also be changing. The reasons for these potential increases are not understood beyond the partial impact and greater use of newer diagnostic procedures. Other reasons for higher rates of RCC and a better understanding of which individuals may be at the highest risk need to be examined to provide the clinician with possible clues as to who should be tested and what prevention measures should be offered. Most of the past investigations into risk factors have been case-control or retrospective studies, but some generalizations can still be made. Family history and genetics seem to increase risk, but overall are responsible for a small number of the total cases. Smoking, obesity, and even hypertension seem to be risk factors for RCC. Reducing these behaviors and conditions may also reduce the risk of RCC. Healthier eating habits (fruits and vegetables, and a lower caloric intake) and more physical activity may also reduce the risk of RCC. Therefore, it is possible that the increases in RCC may also be due, in part, to unhealthy lifestyle factors that have been on the increase over the past several decades. Recommendations for cardiovascular disease prevention should also be applied to patients or clinicians concerned about RCC risk. Finally, numerous occupations, occupational exposures, reproductive and hormonal changes or manipulations, and a variety of other factors may impact risk, but overall their contribution seems small compared with other more consistent risk factors.

Age Factors↗

PubMed2001

An introduction to aspirin, NSAIDs, and COX-2 inhibitors for the primary prevention of cardiovascular events and cancer and their potential preventive role in bladder carcinogenesis: part I.

Aspirin and the nonsteroidal anti-inflammatory drugs (NSAIDs) have been commercially available for decades, and their ability to reduce pain and inflammation are well known. The ability of these agents to cause adverse effects are also known, and the search for newer NSAIDs with less side effects accelerated after the two isoforms of cyclooxygenase (COX) (COX-1 and COX-2) were discovered. The selective COX-2 inhibitors seem to have equivalent efficacy, but potentially less gastrointestinal adverse effects than the traditional NSAIDs. Recent concern that the selective COX-2 inhibitors could increase cardiovascular events requires more investigation. In the meantime, aspirin continues to receive attention as a potential primary cardiovascular agent because of its antiplatelet effects and past and current clinical trials. Several trials have demonstrated that low-dose aspirin may significantly reduce the risk of myocardial infarction and other cardiovascular events. However, the benefits of aspirin need to be weighed against its primary side effect in these situations (hemorrhagic stroke). Patients at low risk for future cardiovascular events are probably not good candidates for this therapy; however, those individuals with a high risk of a future cardiovascular event may qualify for this therapy. Aspirin has also demonstrated a potential ability to reduce the risk of deep venous thrombosis and pulmonary embolism. A recent large trial of low-dose aspirin after major surgery revealed that this agent could also have some activity in the venous component of the human body. Aspirin may also have some applicability for reducing side effects of oral estrogens in men with advanced prostate cancer. Thus, it seems as if aspirin, NSAIDS, and even the selective COX-2 inhibitors may have therapeutic potential far beyond reducing pain and general inflammation. These overall observations and effects provided some of the impetus to investigate their potential ability to reduce the risk and possibly progression of a number of cancers. A few already available over-the-counter products and prescriptions seem to be receiving attention as possible anticancer agents.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed2001

An introduction to aspirin, NSAids, and COX-2 inhibitors for the primary prevention of cardiovascular events and cancer and their potential preventive role in bladder carcinogenesis: part II.

Aspirin and the nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) have been commercially available for decades, and their ability to reduce pain and inflammation are well known. The ability of some of these agents to also reduce a primary or secondary cardiovascular event or to potentially reduce the risk of colorectal cancer has also been documented. These observations collectively have initiated a wide variety of investigations to determine whether or not these agents may have an ability to reduce the risk or progression of numerous cancers. Some urologic cancers have been included in these recent studies. For example, prostate cancer may be sensitive to these compounds based on a small number of preliminary studies. Bladder cancer may also be sensitive to the effects of these agents. Older patients and those with more aggressive tumors may benefit most from these initial studies. Many cancers also demonstrate a greater upregulation of cyclooxygenase-2 (COX-2), and this has lead to recent interest, especially in colorectal cancer, to test the ability of these selective agents against the development of precancerous colon polyps. High-risk patients for colorectal cancer may have benefited by taking a selective COX-2 inhibitor in a recent randomized trial, but whether or not this benefit continues to occur after the COX-2 inhibitor is removed remains controversial and needs further study. Prostate and bladder cancer also seem to demonstrate an upregulation of COX-2, and laboratory studies suggest that these selective NSAIDs may have a greater effect on reducing the development of these tumors. Randomized clinical trials are needed, but because numerous individuals are currently using COX-2 inhibitors, a large volume of data should make at least retrospective studies more plausible in the near future. The challenge for researchers and clinicians is to further understand which NSAIDs and what dosage and duration may provide the optimal benefit (if any), and to accurately construe the available current data on these agents for patients inquiring about these compounds.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed2001

Complementary medicine for prostate cancer: effects of soy and fat consumption.

Complementary medicine has become an increasing area of interest for patients and researchers around the world. The utilization of some of these therapies by many individuals makes it imperative to understand if they have a role in cancer or other disease treatment. Soy products have generated a large interest because a variety of laboratory and epidemiologic research suggests these items may play a role in the prevention of prostate cancer. Clinical trials are addressing this issue and whether or not these products could also improve prognosis of prostate cancer. Additionally, other soy-based capsules (ipriflavone) have received some research, but the largest clinical study to date does not support the use of these supplements to reduce hot flashes and/or osteoporosis risk. Dietary fat reduction to prevent prostate cancer is supported by numerous case-control studies over the past 25 years. However, recent prospective studies suggest that fat reduction may not play a strong role in prevention of prostate carcinoma. Soy products and fat reduction may have a symbiotic relationship. Any healthy lifestyle or dietary change should be encouraged, because it may reduce the risk of cardiovascular disease, which is still the number one cause of mortality.

Journal Article↗

PubMed1999

Use of PC-SPES, a commercially available supplement for prostate cancer, in a patient with hormone-naive disease.

OBJECTIVES: PC-SPES, an over-the-counter supplement, is actually a combination of eight different herbs. It is being used by patients to treat cancer of the prostate at different stages of the disease and has been commercially available since November 1996. It has been observed to dramatically decrease prostate-specific antigen (PSA) values in several patients; however, its out-of-pocket cost ($162 to $486/mo) and potential side effects must be weighed against its potential objective benefits. We reviewed its use in 1 patient. METHODS: A patient with clinically localized prostate cancer (T1c) with a PSA of 8.8 ng/mL, who decided to delay any conventional treatment, began treatment with 9 PC-SPES capsules/day. RESULTS: After 3 weeks, his PSA dropped to 1.4 ng/mL and after a total of 8 weeks, his PSA was less than 0.1 ng/mL (undetectable). He has continued on a maintenance dose of 6 capsules per day, decreasing to 4 capsules per day, with a continuing undetectable PSA. During this time the patient also experienced a number of strong estrogenic effects: loss of libido, erectile dysfunction, extreme breast enlargement and tenderness, reduction in overall body hair, pitting edema, and a significant drop in his lipoprotein (a) level (from 46 to 11 mg/dL). CONCLUSIONS: PC-SPES may provide additive advantages (or disadvantages) over prescribed hormonal treatments but must be compared with other hormonal and nonhormonal treatments in clinical trials with hormone-sensitive and -insensitive patients with prostate cancer to determine its future use or nonuse.

Antineoplastic Agents, Phytogenic↗

PubMed1999

Alternative therapies for advanced prostate cancer. What should I tell my patients?

Alternative medicine use in the general population has continued to dramatically increase in this decade. The research supporting the use of acupuncture treatment in other areas of medicine is compelling. In addition, herbal therapies, such as PC-SPES and St. John's Wort, may play important roles in this disease. Clinicians dealing with advanced prostate cancer need to be introduced to some of these newer treatments so they can be discussed objectively with patients.

Acupuncture Therapy↗

PubMed1999

Nontraditional treatments for localized prostate cancer: ten rules to know before talking to my patients.

There is accumulating evidence that nontraditional treatments used by the general population are experiencing a dramatic increase. The use of these treatments by prostate cancer patients seems to at least parallel or exceed that of recent surveys for other groups. Unfortunately, much of the attention of nontraditional treatments has focused on "what to take and not to take," rather then "how to approach" the use of these therapies. One of the most widely used nontraditional treatments is the use of supplements. Outlined here are 10 general rules that the clinician should know before consulting on these treatments. Recording supplement use as a part of the general medical history, knowing the general behavior of supplement users, instructing individuals on the proper time to use supplements, and focusing on more than prostate cancer for our example patient are just some of the rules that will enable the health professional to be better equipped for handling this unique area of medicine.

Advertising↗

PubMed1999

Vitamin E, alpha- and gamma-tocopherol, and prostate cancer.

Vitamin E is one of the most researched compounds in medicine. Vitamin E is actually a general name for potentially eight different compounds, so supplements can contain several forms and vitamin E in the diet also differs from the form found over the counter. There has been a strong interest in this supplement in the prostate cancer arena primarily because of a Finnish study that demonstrated a lower morbidity and mortality from this disease in men taking 50 mg of synthetic (alpha-tocopherol) vitamin E daily. In addition, observations from laboratory and clinical studies dealing with heart disease have found that gamma-tocopherol may also play a significant role in prevention; therefore, we decided to test the ability of this compound (versus synthetic vitamin E) to control the growth of a human prostate cancer cell line. Gamma-tocopherol was found to be superior to alpha-tocopherol in terms of cell inhibition in vitro. Both forms of vitamin E (and others) should be thoroughly evaluated in the future to provide the most effective chemoprevention information to the patient.

Dietary Fats↗

PubMed1999

Soy, disease prevention, and prostate cancer.

Population-based studies from around the world support the theory that soy products and their constituents, primarily the isoflavones or phytoestrogens, are partly responsible for the lower rates of certain chronic diseases in different areas of the world. Cardiovascular disease and hormonally induced cancers are just a few of the conditions lower in Asian countries that consume large quantities of soy per average person. Genistein, one of soy's individual phytoestrogens, has been found to inhibit numerous breast and prostate cancer cell lines. A limited amount of clinical evidence also points to a beneficial role of soy in reducing hormonal levels and exhibiting weak estrogen and antiestrogen-like qualities. Other phytoestrogens found in nature, such as lignans, may also have a future role in cancer. Collectively, these phytoestrogens, like genistein, have enough evidence to warrant their use in a number of clinical trials as a potential chemopreventive agent or adjunct to prostate cancer treatment.

Breast Neoplasms↗

PubMed1999

Traditional Chinese medicine, acupuncture, and other alternative medicines for prostate cancer: an introduction and the need for more research.

There are several other alternative medicines apart from vitamins and minerals that the clinician should be aware of because they have grown in popularity in other fields of medicine. In time, these therapies should impact the arena of urologic oncology. Traditional Chinese Medicine, which includes acupuncture, is an area that has received some attention. The theory behind it can be quite daunting because it is so different from the theory behind Western Medical Science. In addition, exactly how acupuncture can be applied to a patient and its potential use in prostate cancer need to be addressed. Other herbal therapies for the patient experiencing symptoms related to a localized cancer diagnosis also need to be evaluated. St John's Wort for depression and Kava for anxiety are two examples of herbal alternatives that some prostate patients are inquiring about. Finally, Ginkgo biloba has received a great deal of attention in the media for erectile dysfunction, but there is a dearth of evidence in this area and the information that already exists can be misleading until further studies are conducted. Also, it is imperative that additional studies be performed in all of the above subjects as they relate to prostate cancer, but a general survey on alternative medicine use in urologic diseases is needed first before an adequate review of the most popular therapies can be published.

Acupuncture Therapy↗

PubMed1999

Emphasizing and promoting overall health and nontraditional treatments after a prostate cancer diagnosis.

Although prostate cancer is the number one diagnosed cancer in men, the importance of emphasizing and preventing other common diseases after diagnosis is essential. For example, heart disease still remains the number one cause of mortality in men, accounting for 50% of the deaths in Western countries. Therefore, promoting overall healthy behaviors also seems essential, especially in light of past and recent evidence that an individual can maintain proper health by following some simple guidelines. The increased consumption of healthy foods, greater intakes of B-vitamins and minerals such as potassium can significantly reduce the risk of heart disease, stroke, and possibly cancer in a patient with a prior or current malignancy. Overall dietary change as observed from the Mediterranean diet, light exercise, and improved mental health should also be stressed to the patient because of recent studies.

Cardiovascular Diseases↗

PubMed1995

An analytical comparison of the three most commonly used prostate-specific antigen assays: Tandem-R, Tandem-E, and IMx.

OBJECTIVES: To compare the similarity of individual prostate-specific antigen (PSA) results when using the Tandem-R PSA assay, the Tandem-E PSA assay, or the IMx PSA assay; to assess the lot-to-lot variation within (intra-assay interlot) and between (interassay interlot) the Tandem-R, Tandem-E, and IMx PSA assays; and to evaluate the individual and overall potential lot-to-lot bias of the Tandem-R, Tandem-E, and IMx PSA assays. METHODS: Forty-nine serum samples (PSA values from 0 to 85 ng/mL) were each tested by three separate lots (manufacturer's reagent materials) of Tandem-R, Tandem-E, and IMx PSA assays. Therefore, a total of nine different lots were utilized per patient sample in this investigation. Analyses primarily focused on three ranges: 0 to 10 ng/mL (low), 10 to 85 ng/mL (high), and 0 to 85 ng/mL (overall). RESULTS: In the 0 to 10 ng/mL range, 93% of the assay comparisons yielded an actual difference of less than 1 ng/mL. All three assays demonstrated excellent correlation within and between their three respective lots, within all three ranges. The 95% confidence intervals around the percent coefficient of variation (CV) demonstrated similar results for each assay (CV range, 3.2% to 6.0%). All lots demonstrated an average actual PSA bias of less than +/- 1 ng/mL. The average percent PSA bias was also similar between all three assay systems. All lots demonstrated a less than +/- 4% bias. CONCLUSIONS: Overall, the Tandem-R and IMx PSA assays yielded slightly lower results than the Tandem-E PSA assay. However, these differences were not statistically significant. In addition, the overall lot-to-lot variation (intra-assay and interassay) was not statistically significant, and the actual or percent PSA bias was minimal with these three assays. Therefore, a clinician can feel confident that a patient's serum sample should yield a similar and interchangeable result, whether it is determined by the Tandem-R, Tandem-E, or IMx PSA assay system.

Blood Chemical Analysis↗