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The results of those studies were contradictory; however, now, they can be explained given the results of the current study, in which we demonstrated that there was increased mortality with ADT only among older men, consistent with an earlier study by Beyer et al in which the median age was 73 years.5 Also revealed in the current study and consistent with the previous study by Merrick et al, we did not observe an association between ACM and NHT among men of similar age in the study by Merrick http://www.selleckchem.com/products/lgk-974.html et al, who had a median age of 67 years.6 The separation in the survival curves for the older men occurred after 8 years. This suggests that the impact on mortality may be secondary to the adverse effect of ADT on cardiovascular risk factors. If this is true, then it would take time for the effect of ADT to manifest as a cardiovascular mortality-related event.2 A few points require further discussion. First, it is important to note that, in this exploratory, retrospective analysis, although we observed an association between hormone therapy use and an increased risk of ACM in elderly men, this does not prove causality. Specifically, http://www.selleckchem.com/products/17-AAG(Geldanamycin).html these results are hypothesis generating; and, to prove causation, it would be necessary to perform a prospective study designed specifically to examine hormone therapy use and its impact on ACM. Second, data on testosterone recovery were not available for the patients in this study. However, in older men, generally, there is a longer time to testosterone recovery, and this may have influenced our results.12 Third, causes of death were not available for all patients in this study. Therefore, we chose to report on overall survival status. Because an increase in ACM was noted only for men aged >73 years, in whom increased comorbid illness would be expected compared with men aged http://www.selleck.cn/products/VX-809.html severe comorbidity did not benefit in terms of overall survival for the addition of ADT to radiotherapy, also may explain the current results.13 Specifically, ADT may accentuate underlying comorbidity, which probably is cardiovascular based on previous reports.2-4, 13 Finally, prior randomized studies have demonstrated an overall and/or cancer-specific survival benefit with the addition of hormone therapy to external-beam radiation in men with high-risk disease.13-17 In the current study, 12% of patients had high-risk disease; however, hormone therapy was used in conjunction with brachytherapy, and a survival benefit has not been demonstrated with the addition of hormone therapy in that setting.