Prostate cancer

A series of PROSTVAC®-VF vaccinations has been shown to prolong the survival of men with metastatic, castration-resistant prostate cancer. The vaccine, which targets PSA, was well tolerated by 82 patients. After 3 years, one-third were alive, compared with 17% of the 40 controls. Median survival was prolonged by 8.5 months in the vaccinated group. There was no difference between the two groups, however, in the primary end point of progression-free survival. Confirmation in a larger, phase III trial is awaited.

Diagnosis of prostate cancer is associated with markedly increased risks of immediate fatal cardiovascular events and suicide. Men are particularly vulnerable in the week immediately following diagnosis, but risk remains elevated for the first year. These are the main findings of a prospective analysis of data from more than 168,000 men in Sweden collected over a 40-year period. The association was strongest amongst men aged less than 55 years. Data on disease severity at diagnosis were not available.

Surgery

Results of a small feasibility study support further investigation of laparoscopic nephrectomy using transvaginal natural orifice transluminal endoscopic surgery (NOTES) as an alternative management strategy for women with renal cancer. The procedure was completed in 100% of 14 patients (10 with renal cancer, 2 with lithiasis, and 2 with renal atrophy). Mean operative time was 133 min, and mean duration of hospitalization 4 days. One major complication—a colon injury—was reported.

Infectious disease

On the basis of cost-effectiveness modeling, a group of researchers in Rwanda have concluded that male circumcision programs for prevention of HIV infection should be scaled up in all age groups. At 3%, HIV prevalence is relatively low in Rwanda, and male circumcision is not a culturally ingrained practice. The team recommend incorporating circumcision of newborn boys into existing health services, as well as offering the procedure to adolescent and adult males.