Oral 5-aminolevulinic acid induced photodynamic diagnostic ureterorenoscopy - does the blood pressure require monitoring?

Background: Photodynamic Diagnosis has been proven to improve detection of superficial bladder cancer and improve visualisation of resection margins. The use of 5-aminolevulinic acid as the photosensitising agent has been associated with side effects, specifically hypotension. We aimed to evaluate the effect of oral 5-ALA on the blood pressure in a group of patient who underwent Photodynamic Diagnostic Ureterorenoscopy. Methods: We carried out an observational study on all patients who underwent PDD-Ureterorenoscopy with oral 5-ALA between July 2009 and September 2011. Pre-administration, hourly post-administration and hourly post-operative blood pressures were noted. Mean arterial blood pressure and the threshold for cerebral ischaemia were calculated as well. Results: The study includes thirty-eight procedures which involved twenty-four patients with a mean age of 74 (SD ± 16.95). Hypotension was defined a

There are calls for a national screening programme for prostate cancer: what is the evidence to justify such a national screening programme?

INTRODUCTION: Prostate cancer is the commonest cancer in men and a major health issue worldwide. Screening for early disease has been available for many years, but there is still no national screening programme established in the United Kingdom.OBJECTIVE: To assess the latest evidence regarding prostate cancer screening and whether it meets the necessary requirements to be established as a national programme for all men.METHODS: Electronic databases and library catalogues were searched electronically and manual retrieval was performed. Only primary research results were used for the analysis.RESULTS: In recent years, several important randomised controlled trials have produced varied outcomes. In Europe the largest study thus far concluded that screening reduced prostate cancer mortality by 20%. On the contrary, a large American trial found no reduction in mortality after 7-10 years follow-up. Most studies comment on the adverse effects of screening - principally those of overdiagnosis and subsequent overtreatment.DISCUSSION: Further information about the natural history of prostate cancer and accuracy of screening is needed before a screening programme can be truly justified. In the interim, doctors and patients should discuss the risks, benefits and sequelae of taking part in voluntary screening for prostate cancer.</p