The edition · Urology
Cardiology referral at the start of ADT improved cholesterol, not heart events
A 2,487-man trial over almost six years won on risk factors but showed no difference in heart attack, stroke or heart failure. Plus how much high-grade tumour matters in Ta bladder cancer, and a US abiraterone recall.
The edition in brief
A randomised trial at 55 sites in eight countries assigned 2,487 men starting androgen deprivation therapy for prostate cancer to usual care or routine referral to an internist or cardiologist, who aimed for systolic pressure of 130 mmHg or lower and prescribed a statin regardless of cholesterol. Over a median 5.8 years the intervention won on a hierarchical composite (win ratio 1.60), driven mainly by cholesterol 12 mg/dL lower; cardiovascular death, myocardial infarction, stroke and heart failure did not differ (sHR 1.08, 0.79–1.49). A Canadian cohort of 321 high-grade pTa bladder cancers with central pathology review found the proportion of high-grade tumour did not predict recurrence, but thresholds of 10% or more were associated with worse progression-free survival, while the current 5% WHO threshold did not discriminate. The FDA lists a Class II recall of one US-distributed abiraterone acetate 250 mg product for failed tablet weight uniformity; it is ongoing and is a quality action, not a safety signal for the drug. A small Nigerian trial found no difference in pain or bleeding between a biopsy gun and a semi-automatic needle for transrectal biopsy. The pearl is the baseline checks before starting ADT.
In Ta bladder cancer, the share of high-grade tumour tracked with progression
Request the high-grade percentage in Ta bladder tumours; a larger share signals higher progression risk.
FDA Class II recall of one US abiraterone 250 mg product for tablet weight
This is a quality recall of one US abiraterone product, not a safety signal for the drug; check supply rather than stopping treatment.
Biopsy gun and semi-automatic needle caused similar pain and bleeding
Device choice did not change pain or bleeding after transrectal biopsy in this small trial.
Four baseline checks before starting androgen deprivation
Check blood pressure, lipids, glucose and fracture risk before starting ADT, and hand cardiovascular care to primary care.
Routine cardiology referral on ADT lowered cholesterol but not cardiovascular events
Check and hand over cardiovascular risk at the start of ADT; routine specialist referral improved cholesterol but not events.
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