S5 E11: AF, Hypertension & Future Cardiac Disease; DRE and Prostate Cancer Screening: Is It Time to Stop? Interview with Amy Rylance & Sam Merriel
Apr 19, 2024
auto_awesome
Head of Improving Care at Prostate Cancer UK and a GP discuss the effectiveness of digital rectal exams for prostate cancer screening, along with the implications of atrial fibrillation and hypertension on future cardiac events. They explore the limitations of DRE in detecting prostate cancer and the shift towards MRI for more accurate diagnosis.
Lifetime risk of developing AF has increased over two decades, emphasizing the need for comprehensive management strategies.
Serum BMP can be a potential risk predictor for cardiovascular events in hypertensive patients, highlighting the importance of early detection and intervention.
Deep dives
The Study on Atrial Fibrillation Trends
A study in Denmark focusing on atrial fibrillation trends revealed that the lifetime risk of developing AF increased over two decades. The study involved 3.5 million individuals aged 45 plus, showing a higher prevalence of AF in recent years. The research highlighted a 28% lifetime risk of AF in the population, with a concerning rise to 33% in more recent cohorts. Additionally, the study found that the lifetime risk of complications such as heart failure with AF was at 41%, emphasizing the need for comprehensive management strategies.
Risk Stratification for Hypertensive Patients
In the Netherlands, a cohort study aimed to accurately predict cardiovascular events in older patients with hypertension. The study involved 530 participants aged 60 to 85 and explored the use of serum BMP as a biomarker for future cardiovascular events. Findings indicated that a raised BMP was associated with an increase in cardiovascular events such as heart failure. The study highlighted the potential use of BMP as a risk predictor for cardiovascular events in hypertensive patients.
Discussion on Digital Rectal Exam's Role in Prostate Cancer Screening
Experts Amy Rylance and Sam Merial discussed the effectiveness of the digital rectal exam (DRE) in prostate cancer screening. Their evaluation concluded that DRE as a standalone test or in conjunction with PSA does not significantly contribute to early detection of prostate cancer. The conversation emphasized that DRE may deter men from seeking medical advice due to discomfort, potentially leading to missed opportunities for early diagnosis. Additionally, the discussion highlighted the evolution of diagnostic pathways with technologies like MRI offering more accurate and less invasive methods for diagnosing prostate cancer.
Changing Approaches to Prostate Cancer Diagnosis
The podcast delved into the shifting landscape of prostate cancer diagnosis, moving towards the utilization of MRI as a primary diagnostic tool. With advancements in technology, such as multiparametric MRI, the standard of care now includes MRI as the initial test for suspected prostate cancer cases. This shift has enhanced diagnostic accuracy by targeting biopsies and reducing unnecessary invasive procedures. The discussion emphasized the role of MRI in providing a more precise evaluation of prostate health, leading to improved risk assessment and selective treatment approaches.
Welcome to the Hot Topics podcast from NB Medical with Dr Neal Tucker. To DRE or not to DRE? This is the question and the main event in this episode.
We have a fantastic interview with Amy Rylance, Head of Improving Care at Prostate Cancer UK, and Sam Merriel, GP and academic clinical lecturer, discussing their recent Clinical Practice paper in the BJGP: Is the digital rectal exam any good as a prostate cancer screening test?
In other research, we have two papers with a common theme. Firstly, a paper in the BMJ looking at long-term outcomes after diagnosis with atrial fibrillation, and secondly, a paper in the BJGP examining the role of BNP testing as a marker for future cardiovascular disease in patients with a new diagnosis of hypertension. Both show that while these conditions make us think of stroke and MI, we also should be thinking about heart failure.