STAMPEDE: intensified hormone therapy showed no significant rise in cardiovascular events, but SCORE2 underestimated risk

The edition in brief

A post hoc analysis of 6,292 men in the STAMPEDE trial with linked English health records found five-year major adverse cardiovascular event rates of 9% in non-metastatic and 7% in metastatic disease with androgen receptor pathway inhibitor intensification, comparable to ADT alone. Abiraterone, abiraterone plus enzalutamide, docetaxel, zoledronic acid and prostate radiotherapy were not associated with a statistically significant rise in events, though confidence intervals allowed increases of up to about twofold. A history of cardiovascular disease was the strongest predictor. The SCORE2 risk tool discriminated poorly (AUC 0.61 to 0.63) and underestimated absolute risk. In 16,322 SEER patients with pT1b-2 N0M0 renal cell carcinoma, surgery more than three months after diagnosis was associated with higher five-year cancer-specific mortality (7.6% vs 5.9% after matching; about 1.3-fold), rising to 1.6-fold beyond six months, with no association in non-clear cell tumours. A network meta-analysis of 18 trials found vibegron added to an alpha-blocker reduced daytime frequency (by 0.81 per day) and urgency in men with BPH and persistent storage symptoms, with no established advantage over mirabegron. The pearl covers checking post-void residual before adding a bladder relaxant in men.