Medical Bulletin 26/ March/ 2025 - Video

Almost half of people who died with inflammatory bowel disease (IBD) died prematurely, according to a study published in CMAJ (Canadian Medical Association Journal)

People with IBD have shorter life expectancy than people without such diseases, and they can develop other chronic health conditions related to their IBD. The study found that people with IBD are at risk for premature death (defined as death before age 75) when they develop other chronic health conditions earlier in life.

The clinical implication is that chronic conditions developed early in life may be more important in determining a patient’s health trajectory, although further causal research is needed to elucidate this relationship,” writes Dr. Eric Benchimol, a pediatric gastroenterologist and senior scientist at The Hospital for Sick Children (SickKids), professor of pediatrics and epidemiology at the Temerty Faculty of Medicine, University of Toronto, and a senior core scientist at ICES. “Although our insights are not causal insights, they identify patients potentially at higher risk of premature death, and therefore who might benefit from more coordinated care of their IBD and other chronic conditions,” he says

Of the total 9278 deaths in people with IBD between 2010 and 2020, almost half (47%) were premature, with higher rates in males than in females (50% v. 44%). The most common chronic conditions at death were various types of arthritis (77%), hypertension (73%), mood disorders (69%), kidney failure (50%) and cancer (46%). The researchers found that including chronic conditions diagnosed before age 60 and the age of diagnosis improved the models’ predictions.

“The use of premature death as the outcome more directly identifies opportunities for health system improvements, as premature deaths are considered avoidable through appropriate prevention or early and effective treatment,” write the authors.

“These findings provide scientific support for providing multidisciplinary and integrated health care across the lifespan (particularly during young and middle adulthood),” the authors conclude.

Ref: Machine learning prediction of premature death from multimorbidity among people with inflammatory bowel disease: a population-based retrospective cohort study, Canadian Medical Association Journal (2025). DOI: 10.1503/cmaj.241117

A simple urine test could accurately show the recurrence of kidney cancer at an early stage, potentially sparing patients invasive scans and enabling faster access to treatment, new research has shown.

The findings are presented at the European Association of Urology (EAU) Congress in Madrid . The test analyses the distinctive profiles of certain types of sugar molecules, called glycosaminoglycans which are found in urine. These profiles are known as the GAGome.

Currently, the only way to monitor patients is through a scan – usually a CT scan – every 6 to 12 months, with the frequency depending on their level of risk. The study’s initial cohort involved 134 patients treated at 23 hospitals across the UK, EU, USA and Canada. The patients were all diagnosed with ccRCC which had not spread beyond the kidney, and which was treated with surgery. Most had their kidney completely removed. All patients continued to have CT scans as standard monitoring after surgery, alongside a urine test every 3 months. Each urine sample was analysed using mass spectrometry to produce a score out of 100, called the GAGome score.

After up to 18 months of follow up, 15% of patients had seen their cancer return. The GAGome test was extremely sensitive in picking up recurrence, correctly identifying 90% of patients whose cancer had returned, while correctly ruling out just over half of those who remained cancer-free. These results were based on a GAGome score threshold optimised at 12/100. A score above 12 was counted as positive, and 12 or below as negative.

A positive result in the study yielded a 26% chance the patient actually had a recurrence. More importantly, a negative GAGome score resulted in a highly reliable 97% chance that the patient did not have a recurrence. The higher the GAGome score, the more likely the positive result correctly identified recurrence.

If you have a urine test that can accurately show whether the cancer has actually returned then you can better assess risk levels and reduce the frequency of the scans required, the authors said.

Based on the results the authors have so far, it’s likely that they could safely halve the number of scans that patients have to undergo.

Ref: European Association of Urology (EAU) Congress in Madrid, Monday 24 March 2025.

Biopsies guided by high resolution ultrasound are as effective as those using MRI in diagnosing prostate cancer, an international clinical trial has shown.

The technology, called micro-ultrasound, is cheaper and easier to use than MRI. It could significantly speed up diagnosis, reduce the need for multiple hospital visits and free up MRI for other uses, researchers say.

The results of the OPTIMUM trial are presented at the European Association of Urology Congress in Madrid and published in JAMA.

OPTIMUM is the first randomised trial to compare micro-ultrasound (microUS) guided biopsy with MRI-guided biopsy for prostate cancer. It involves 677 men who underwent biopsy at 19 hospitals across Canada, the USA and Europe. Of these, half underwent MRI-guided biopsy, a third received microUS-guided biopsy followed by MRI-guided biopsy and the remainder received microUS-guided biopsy alone.

MicroUS was able to identify prostate cancer as effectively as MRI-guided biopsy, with very similar rates of detection across all three arms of the trial. There was little difference even in the group who received both types of biopsies, with the microUS detecting the majority of significant cancers.

The results of the OPTIMUM trial could have a similar impact to the first introduction of MRI, according to lead researcher on the trial, When MRI first emerged and you could image prostate cancer accurately for the first time to do targeted biopsies, that was a gamechanger,” he recalls. “But MRI isn’t perfect. It’s expensive. It can be challenging to get access to it quickly. It requires a lot of experience to interpret properly. And it uses gadolinium which has some toxicity. Not all patients can have MRI, if they have replacement hips or pacemakers for example.

The ease and cost of micro-ultrasound means it could be an important tool for screening programmes as well, but further research would be needed to understand its potential role in that setting.

Ref: Kinnaird A, Luger F, Cash H, et al. Microultrasonography-Guided vs MRI-Guided Biopsy for Prostate Cancer Diagnosis: The OPTIMUM Randomized Clinical Trial. JAMA. Published online March 23, 2025. doi:10.1001/jama.2025.3579