The choice of treatment for localized prostate cancer depends on the risk of progression; competing risks of mortality; baseline urinary, sexual, and bowel function; and patient preferences. To compare the harms of treatment strategies, Barocas and colleagues analyzed data from a prospective, population-based cohort study of 2550 men diagnosed with localized prostate cancer and found that radical prostatectomy was associated with a larger decline in sexual function and with worse urinary incontinence than radiation therapy or active surveillance after 3 years. However, there were no meaningful differences in bowel or hormonal function beyond 12 months and no meaningful differences in global quality of life. In an Editorial on this and another article in this issue, Hamdy and Donovan suggest that physicians should discuss in detail the risks and benefits of treatment and active surveillance with patients who have prostate cancer.
Editorial and Related Article
In men with prostate cancer, adverse effects of treatment may affect quality of life. In a population-based prospective cohort of 1141 men with newly diagnosed prostate cancer followed up for 2 years by Chen and colleagues, radical prostatectomy, external beam radiotherapy, and brachytherapy were associated with patterns of adverse effects including sexual dysfunction, urinary tract obstruction and irritation, urinary incontinence, and bowel problems. However, by 24 months, mean scores for treatment groups and active surveillance were not significantly different in most domains.
The oral anticoagulants warfarin and dabigatran are both effective for the prevention of stroke in patients with nonvalvular atrial fibrillation, but the use of warfarin is associated with an increased risk of osteoporotic fracture. In a retrospective cohort study of 51 496 patients newly diagnosed with nonvalvular atrial fibrillation, Lau and colleagues observed a lower risk of osteoporotic fracture in patients treated with dabigatran than in patients treated with warfarin.
Direct-to-consumer advertising may steer consumers to beneficial treatments for high-priority illnesses but can also contribute to escalating drug prices and reduced patient safety. In an ecologic study of advertising ratings and commercial insurance claims, Layton and colleagues found that regional exposure to televised direct-to-consumer advertising was associated with increased testing for serum testosterone and initiation of testosterone treatment. In an Editorial, Kravitz notes that direct-to-consumer advertising is designed to influence physician behavior and that clinical judgment is imperative when indications for prescribing are uncertain and patient demand is strong.
An article in JAMA Surgery presented the American Association of Endocrine Surgeons Guidelines for Definitive Management of Primary Hyperparathyroidism, which have expanded the indications for parathyroidectomy to include patients with neurocognitive and neuropsychiatric symptoms as well as some patients with cardiovascular disease. In a From The JAMA Network article, Campbell discusses the risks and benefits of this potentially curative surgery.
This JAMA Clinical Challenge article by Vangipuram and colleagues presents an afebrile patient with a tender, vesicular eruption at the base of his left thumb. What would you do next?
This Medical Letter on Drugs and Therapeutics article discusses the evidence that the onset of type 2 diabetes can be delayed or possibly prevented by treatment with metformin—or with an intensive lifestyle intervention focusing on weight loss and exercise.
Highlights. JAMA. 2017;317(11):1093–1095. doi:10.1001/jama.2016.13042