Day: 12/07/2011

Androgen Deprivation in Prostate Cancer Doesn’t Increase Cardiovascular Death

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 Contrary to earlier findings, androgen-deprivation therapy for prostate cancer carries no apparent increased risk for cardiovascular mortality, according to a JAMA meta-analysis. Editorialists, however, express caution.

Researchers examined outcomes from eight randomized trials testing androgen deprivation against control therapy in some 4000 men with unfavorable-risk nonmetastatic prostate cancers.

Androgen deprivation was not associated with increased cardiovascular mortality during roughly 10 years’ follow-up. In fact, both prostate cancer–specific mortality and all-cause mortality were lower with androgen deprivation.

The editorialists point out that the meta-analysis focuses on mortality and does not take into account the possible effects of deprivation on “development or acceleration of cardiovascular disease.” They point to a Swedish registry study from 2010 that found elevated cardiovascular risks in all prostate cancers — and the risks increased with androgen deprivation. They recommend that men with cardiac disease undergoing androgen deprivation “should follow the appropriate secondary preventive measures.”

source:JAMA

Prenatal Steroids Improve Survival Among Very Preterm Infants

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Antenatal corticosteroids can improve morbidity and mortality among infants born at 23 weeks’ gestation or later, according to a JAMA study. (Current guidelines advise against treatment before 24 weeks.)

Researchers studied some 10,500 U.S. infants born at 22 to 25 weeks’ gestation, three quarters of whom were exposed to antenatal corticosteroids. They found that the primary outcome — death or neurodevelopmental impairment at 18 to 22 months’ corrected age — was significantly less common among exposed versus unexposed infants (64% vs. 82%). The benefits of steroid treatment were limited, however, to those born at 23 weeks or later.

The authors acknowledge several study limitations. Nonetheless, they conclude: “Initiation of antenatal corticosteroids may be considered starting at 23 weeks’ gestation and later if the infant will be given intensive care.”

source:JAMA