Androgen suppression improves survival in some men with localised prostate cancer
External beam radiotherapy is an established option for men with localised prostate cancer. A short burst (for four months) of androgen suppression given at the same time prolonged survival for some but not all men in a trial from the US. The benefit, which was modest, was confined to men who had localised cancers of “intermediate risk,” defined using a combination of stage, Gleason score, and baseline concentration of prostate specific antigen. In this subgroup, antiandrogen treatment prolonged overall survival at 10 years compared with radiotherapy alone (61% v 54%; hazard ratio 1.23, 95% CI 1.02 to 1.49).
These men began the trial with a mean age of 70, tumours staged T1 or T2, and prostate specific antigen concentrations no higher than 20 ng/ml. Antiandrogen treatment reduced deaths from prostate cancer (4% v 8%; 1.87, 1.27 to 2.74), but again, the benefit was greatest for men with intermediate risk tumours.
Erectile dysfunction was a problem for both groups of men in this trial. It was significantly more of a problem for those given short term antiandrogen treatment. US regulators already warn prescribers that gonadotrophin releasing hormone agonists increase the risk of heart attack, stroke, diabetes, and even sudden death in vulnerable adults, says an editorial (p 169). The benefits are unlikely to outweigh the risks for men with low risk localised prostate cancer.
Unpicking the placebo effect in adults with asthma
The power of the placebo is well known, particularly in medical conditions with subjective symptoms such as asthma. In one experiment, adults with mild to moderate asthma reported the same improvement in symptoms after inhaled albuterol, an inhaled placebo, and sham acupuncture (50%, 45%, and 46% improvement). Participants did not notice the significant improvement in objective lung …