Prescrire international
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Prescrire international · Feb 2013
ReviewFirst-line treatment of metastatic prostate cancer. Androgen suppression for symptomatic disease.
Prostate cancer sometimes metastasizes, especially to bone, which may cause pain, fractures and spinal cord compression. What are the best first-line treatment options for patients with metastatic prostate cancer? To answer this question, we conducted a review of the literature, using the standard Prescrire methodology. Suppressing androgen secretion by surgically removing the testicles (orchiectomy) or by administering a gonadorelin agonist relieves the pain associated with bone metastases in about 80% of patients. ⋯ First-line hormonal treatments are initially very effective in relieving symptoms of metastatic prostate cancer. Our analysis of the available data suggests that the best treatment option is androgen suppression with goserelin. Flutamide monotherapy is an alternative for some patients.
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Prescrire international · Jan 2013
ReviewLocally advanced prostate cancer: effective treatments, but many adverse effects.
Locally advanced prostate tumours, i.e. those that extend beyond the prostate gland but are not metastatic, often carry a poor prognosis: between 10% and 40% of patients die within 5 years after diagnosis. Various treatments are proposed to improve their prognosis. Which treatments have a proven survival benefit, and what are their adverse effects? To answer these questions, we reviewed the literature using the standard Prescrire methodology. ⋯ The adverse effects of gonadorelin agonists often undermine patients' quality of life, due to hot flushes, loss of libido, erectile dysfunction, gynaecomastia, osteoporosis, weight gain, cardiovascular events, and diabetes. In mid-2012, European clinical practice guidelines recommend a combination of radiation therapy and androgen suppression for 2 to 3 years for most patients with locally advanced prostate cancer. Before choosing between therapeutic options, it is crucial to take into account the patient's priorities in terms of treatment efficacy and adverse effects, and reversibility of adverse effects.
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Prescrire international · Oct 2012
ReviewManagement of localised prostate cancer: watchful waiting, surgery or radiation therapy, depending on the natural course, which is often relatively slow.
Localised prostate cancer, confined to the prostate gland, occurs mainly in men over 65 years of age. The principal management options are watchful waiting, prostatectomy and radiation therapy. Which of these options has the best harm-benefit balance for patients with localised prostate cancer? To answer this question, we conducted a review of the literature using the standard Prescrire methodology. ⋯ Patients should be informed of the risks associated with each of these options and should be actively involved in the choice of treatment. Treatment is often warranted for patients with high-risk localised prostate cancer. The main options are either radical prostatectomy or external beam radiation therapy combined with hormone therapy.
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Prescrire international · Sep 2012
ReviewYaws, a non-venereal treponemal infection. Still endemic in some parts of the world.
Yaws is an infection that mainly affects the poorest populations living in humid tropical areas. We reviewed the literature on yaws, the most common non-venereal treponemal infection, using the standard Prescrire methodology. Yaws is often transmitted directly from person to person. ⋯ Curative treatment consists of a single injection of benzathine benzylpenicillin. The results of a randomised trial suggest that a single oral dose of azithromycin is as effective as penicillin. In India, yaws was successfully eradicated through a programme based on providing information to the population at risk, screening and treatment.