Intermittent androgen deprivation for asymptomatic prostate cancer?

N Engl J Med2012;367:895-903OpenUrlCrossRefMedline

Androgen deprivation therapy was introduced for men with painful metastatic prostate cancer⇑. Treatment soon shifted to asymptomatic men with rising concentrations of prostate specific antigen (PSA) who would have more to lose from serious side effects. So, in 1999 researchers launched a trial to test intermittent therapy—eight months of treatment with a luteinising hormone releasing hormone agonist, followed by a variable length of time off until PSA concentrations reached an upper threshold. Treatment breaks made no discernible difference to overall survival during nearly seven years of follow-up when compared with continuous treatment or orchidectomy (estimated median survival 8.8 v 9.1 years; hazard ratio for death during intermittent treatment 1.02, 95% CI 0.86 to 1.21). Results for quality of life were harder to interpret, although intermittent treatment was associated with improved libido, fewer hot flushes, and better control of urinary symptoms.

Researchers recruited 1386 men with rising concentrations of PSA but no metastases after definitive radiotherapy for prostate cancer. Participants had a mean age of 74 years, and almost three quarters had a prostate gland that felt normal on rectal examination. Just over one third (524/1386) died during follow-up. Only 197 men died from prostate cancer, however, and a linked editorial questions how many asymptomatic men with this kind of profile need androgen deprivation at all? We don’t yet know, and this trial can’t tell us, writes the editorial’s author (p 945).

Childhood budesonide has a small but lasting effect on height

N Engl J Med2012; doi:10.1056/NEJMoa1203229

Between 1993 and 1995, 1041 children with asthma began a randomised trial that compared inhaled glucocorticoids with nedocromil or placebo⇑. More than a decade after the end of the trial, the authors measured their adult height and found that those given inhaled budesonide were slightly but significantly …