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All you need to read in the other general journals

BMJ 2008; 337 doi: (Published 15 July 2008) Cite this as: BMJ 2008;337:a774

Androgen deprivation therapy may not work for men with early prostate cancer

Men with early prostate cancer can already choose between surgery, radiotherapy, or a simple wait and see policy as their primary treatment. Androgen deprivation therapy is another increasingly popular option, although there is precious little evidence that it works, say researchers from the US.

An analysis including more than 19 000 men with localised prostate cancer found no association between this treatment and a longer life or a reduced risk of death from prostate cancer. Men treated conservatively did just as well as—and on some measures they did slightly better than—men who had androgen deprivation therapy (orchidectomy or a luteinising hormone releasing hormone) as their primary treatment. For example, treatment was associated with a higher risk of death from prostate cancer over 10 years (hazard ratio 1.17, 95% CI 1.03 to 1.33). This result persisted through extensive adjustment of baseline differences between those who did and did not choose androgen deprivation therapy as their initial treatment.

Androgen deprivation therapy is far from harmless, say the researchers. It has been associated with gynaecomastia, impotence, hot flushes, fractures, diabetes, and heart attacks. It is also expensive. This observational study isn’t the final word, but it is probably big enough and convincing enough to justify caution with this treatment. All the men in the cohort were over 65 and diagnosed between 1992 and 2002.

Respiratory support improves symptoms not survival in patients with acute pulmonary oedema

Men and women with acute pulmonary oedema caused by heart failure got better slightly faster when treated with non-invasive ventilation in a large trial. But early improvements in breathlessness and metabolic state did not translate in to a lower risk of death during the first week.

After promising but inconsistent results from meta-analyses of small trials, researchers from the UK recruited more than 1000 patients into a three armed trial comparing two methods of non-invasive ventilation with supplementary oxygen alone. …

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