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BMJ 2012; 345 doi: (Published 25 July 2012) Cite this as: BMJ 2012;345:e4981

Who needs radical prostatectomy for localised prostate cancer?

A trial comparing radical prostactectomy with simple observation for men with localised prostate cancer has once more tipped the balance of evidence away from surgery for many men. Radical prostatectomy did not significantly reduce mortality during 10 years of follow-up (171/364 (47%) v 183/367 (49.9%), hazard ratio 0.88 (95% CI 0.71 to 1.08)) and made no significant difference to risk of death from prostate cancer or its treatment. The men had localised disease (half the tumours were impalpable) and a median prostate specific antigen concentration of 7.8 μg/L. Four fifths of the men who had surgery were unable to have erections afterwards (231/285 (81%) v 124/281 (44%), P<0.001), and one in six was incontinent (49/287 (17%) v 18/284 (6%), P<0.001)

The trial was too small to be conclusive, says a linked editorial (doi:10.1056/NEJMe1205012), but radical prostatectomy is beginning to look like the wrong choice for many men, particularly those with low risk disease (early stage, low grade tumours and low concentrations of prostate specific antigen). Radical prostatectomy will be the right choice for others, however, and the task ahead is to find out exactly who they are. These are the men with lethal cancers, who need definitive treatment. Current diagnostic strategies still aren’t good enough to differentiate cancers that could kill from those that probably won’t, and researchers are working on smarter biomarkers to replace or complement prostate specific antigen. The ultimate goal is to biopsy fewer men and treat aggressively only those who need it. Active surveillance is another option for men who don’t.

Oral immunotherapy helps some children with egg allergy

Children with egg allergies face a lifetime of trying to avoid a ubiquitous and often hidden ingredient. Treatment options are limited, but a preliminary trial suggests that …

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