Infection

New guidelines pertaining to catheter-associated urinary tract infections have been issued by the Infectious Diseases Society of America. Recommendations based on good evidence from at least two randomized controlled trials encompass prevention, diagnosis and management. Emphasis is placed on reducing inappropriate catheterization, which is currently widespread. Timely catheter removal, prompted by electronic reminders or automatic stop orders, is also recommended.

Prostate cancer

The American Cancer Society has updated its guidelines for early detection of prostate cancer, stressing the importance of informed decision-making. Men without symptoms whose life expectancy exceeds 10 years should be offered screening after receiving information about risks, benefits and uncertainties. Information should be provided before the age of 50 years to men at high risk of developing the disease.

An Italian team has used bone scan data from 853 men newly diagnosed with prostate cancer to validate guidelines issued by four organizations. Area under the curve (AUC) approximated 80% for criteria on which to base ordering of a staging bone scan issued by the European Association of Urology, the American Urological Association, the National Comprehensive Cancer Network, and the American Joint Committee on Cancer. The AUC of the authors' own risk stratification tool—which incorporates PSA, clinical stage and biopsy Gleason sum—was 88%.

The CYP17 inhibitor abiraterone acetate exerts meaningful antitumor effects in men with castration-resistant prostate cancer who have received docetaxel. Almost 50 participants received daily 1,000 mg doses of abiraterone for a median of 24 weeks. The well-tolerated drug elicited PSA declines of at least 30% in 70% of patients. The same proportion of participants experienced an at least 30% drop in number of circulating tumor cells. Data from phase III trials are awaited.