Episode Details

Episode 60: Variety of Topics.  

Gabrielle Robinson (MS3) discusses with Dr Arreaza these topics: IsoPSA, 3HP for LTBI, shingles vaccine, and DELC.

Introduction: You will hear a conversation between Gabrielle Robinson, a 3rd year medical student, and Hector Arreaza. They discussed 4 articles about topics that are relevant to current clinical practice in family medicine.

This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it’s sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home.

Variety of Topics. 

By Gabrielle Robinson, MS3, Ross University School of Medicine, and Hector Arreaza, MD.  

The IsoPSA test

H: Cleveland Clinic published this article in July 2020[1]. 

G: According to that article, the IsoPSA test is a new clinically relevant screen for prostate cancer. The data suggests that ISoPSA can potentially decrease unnecessary prostate biopsies by 45%. The IsoPSA evaluates changes in the structure of PSA rather than measuring the concentration of PSA.  

G: IsoPSA is meant to be used in patients who are over 50 years old with PSA > 4ng/mL that have not had a previous diagnosis for prostate cancer or are under surveillance.

H: Is PSA a bad screening test?
G: Measuring the concentration of PSA has proven to be a less sensitive screening tool because PSA is specific for tissues and nonspecific for cancer. This means that a high PSA does not necessarily mean cancer is present.  The PSA can be elevated due to a multitude of reasons including but not limited to prostatitis, benign prostatic hyperplasia, etc.  Unfortunately, this has led to the overdiagnosis of low-grade cancers that were in fact benign conditions. However, PSA is an effective tool for monitoring of recurrence of prostate cancer and it reduces the need for treatment of metastatic disease.

H: As a reminder, screening for prostate cancer in asymptomatic individuals by using PSA is a grade D recommendation from the USPSTF. D means “Do not do it!” However, IsoPSA is not included in that recommendation. We’ll see if evidence suggests IsoPSA as an alternative in the future. 

3HP for latent TB infection treatment

H: This information was published by CDC on June 28, 2018. 

G: Previously, the treatment for latent TB included 3–9 months of DAILY Isoniazid (INH) or Rifampin (RIF), either alone or combined.  Now, new data according to CDC recommends that INH-RPT (isoniazid-rifaPENtine) treatment once a week for 12 weeks (AKA 3HP regimen) is adequate in controlling the reactivation of latent TB[2].

H: RifaPEntine is not Rifampin.

G: It is also worth mentioning that this treatment is also approved for patients 2-11 years of age as well as patients who have HIV/AIDS who are currently taking anti-retroviral.

H: Currently, the regimens for LTBI treatment are: 
-Monotherapy with INH for 6-9 months
-Monotherapy with Rifampin daily for 4 months
-Combinations: INH-Rifampin daily for 3 months (3HR therapy), and INH-RifaPENTINE weekly for 3 months (3HP therapy).

Shingles vaccine may reduce risk of stroke

G: Why do we think having shingles increases risk of stroke in the first place? The mechanism is not well understood but there is a strong index of suspicion that the inflammation resulting from the outbreak plays a significant role.  

H: So, you read a study, a chart review published by the American Heart Association, tell us about it.

In this study, patients who received the shingles vaccine (live vaccine) were compared to patient who did NOT receive the vaccine. The results showed that getting the shingles vaccine decreased the ris