geoffrey modest medical blogs

  A Swedish study found that following men with a high PSA with an MRI seemed to be a reasonable approach for risk-stratifying patients, decreasing false positive results and without leading to significant delays in diagnosis of significantprostate cancer, in the Gothenburg-2 trial, a large, population-based, screening trial (see psa MRI followup NEJM2024  in dropbox, or DOI:10.1056/NEJMoa2406050). Special thanks to Brittany Berk (a really smart urologist and, it just so happens, my daughter-in-law) for some comments and suggestions.....   Details: -- about 80,000 men who were 50 to 60 years of age in Gothenburg (aka “Goteborg”), Sweden were eligible for participation in the trial, from which 38,316 men were randomly selected and invited for screening, a population-based trial that started in 2015 -- those who accepted the invitation were assigned in a 1:1:1 manner to 1 of 3 groups:     -- those with low PSA levels of 1.8-3.0 ng/mL....

  A recent study assessed the outcomes of adults with Nonalcoholic Fatty Liver Disease (NAFLD) across the histologic spectrum (see   nafld prospective outcome study nejm2021  in dropbox, or DOI: 10.1056/NEJMoa2029349 )    Details:   -- 1773 adults with NAFLD in a perspective cohort study, from the NAFLD Database Study Phase 2 non-interventional registry of the NASH Clinical Research Network (NASH = Non-Alcoholic Steatohepatitis) -- all had liver biopsies that found NAFLD and had at least one follow-up visit after 48 weeks  -- to differentiate NAFLD from Alcoholic Fatty Liver Disease, a questionnaire was used to establish consumption of less than 20 g of alcohol daily for women and less than 30 g for men [biopsy analysis of NAFLD vs alcoholic fatty liver disease can be indistinguishable] -- median age 52,  36% male, 85% white, 12% Latinx, BMI 33, mean time since NAFLD diagnosis 2.7 years --75% of those with NAFLD had NASH --mean ALT 51 , ...