Gaziano et al report the results of a large randomized controlled trial in JAMA (2012). They studied more than 14,000 men with a median follow-up of 11 years. The subjects were physicians older than 50 years of age at the time of enrollment with the aim of seeing whether cancers could be prevented. They reported that prostate cancer made up nearly half of the cancers diagnosed, and that there was no difference in the incidence of prostate cancer found between men taking placebo or those taking multivitamins. The incidence of colon cancer was also the same in both groups. However, overall, there were fewer total numbers of cancers, excluding prostate cancer, in the group that received the daily multivitamin. Side effects were few but not very major.

According to the charity Prostate Cancer UK, research into prostate cancer is poorly funded in the UK. Of all cancers, research into Leukaemia is best funded with £3903 spent per case diagnosed. Breast cancer, the most common female cancer, which has a similar death rate to prostate cancer, received more than double the annual research spend at £853 per breast cancer case diagnosed, compared to £417 for prostate cancer. Approximately 10,000 men die from prostate cancer every year in the UK.

In an article by Schröder et al published in Europe Urol (2012) the authors show that Dutesteride can delay PSA rise in patients that have failed radical treatment for prostate cancer. The study, known as the ARTS trial, recruited 294 subjects that were randomised to either Dutesteride or placebo (147 in each treatment group). Only 187 (64%) completed 24 mo of treatment. In these patients Dutasteride significantly delayed the time to PSA doubling (p<0.001); the relative risk (RR) reduction was 66 % for the overall study period. Dutasteride also significantly delayed disease progression (p<0.001); the overall RR reduction in favour of dutasteride was 59%. The incidence of adverse events (AEs), serious AEs, and AEs leading to study withdrawal were similar between the treatment groups and in line with previously published data. A limitation of the study was that investigators were not blinded to PSA levels during the study.

In an article published in Human Reproduction (2012), the authors show that sperm concentration in semen of French men fell by 32% over a 17 year period. 26 609 partners of totally infertile women undergoing an assisted reproductive technology (ART) procedures in the whole of France were studied between 1989 and 2005. There was a continuous decline in concentration during this time.
This study adds to the debate about a global decrease in human sperm quality. Many small and sometimes methodologically flawed studies have reported similar temporal trends. There is growing biological, toxicological, experimental and human exposure data to support the endocrine disruptors’ hypothesis assuming that foetal exposure to endocrine disruptors could impair reproductive outcomes.

Using a population-based cohort study of over 50,000 patients who underwent radical cystectomy in USA between 2001-2008, the authors report no change in complication or mortality rates over this time period. The study, which was published in BJUI (2012), reports that about 29% and 2% of patients undergoing RC will experience a postoperative complication or die during hospitalisation, respectively. Results were better for high volume centres that performed 25 or more cystectomies per year.

In a double blind placebo controlled trial published in Ann Intern Med (2012) the authors investigate whether men with both erectile dysfunction and low serum testosterone should add testosterone gel to their regular treatment with sildenafil. They report that the extra testosterone made no difference to erectile function scores or any other measure of sexual wellbeing in middle aged men, despite serum concentrations of testosterone increasing to within normal limits.

In an article in BMJ (2012), the author discusses PSA screening for prostate cancer. Several studies have shown that a small number of prostate deaths could be avoided by screening for prostate cancer. However, a significant number of men may be harmed by treatment that they may never have needed. The authors believe that by using a genetic test looking for the presence of common prostate cancer genes, followed by a personalised use of PSA screening depending on genetic risk starting at the age of 45, would reduce the cost of screening and improve the pickup of significant prostate cancer compared to insignificant disease, thus reducing over treatment.

In an article in BMJ (2012), the author discusses the increasing numbers of NHS patients treated in Private Hospitals. Individuals in the UK with private medical insurance have reduced by 1.5 million (19%) since 2009, thought to be due to the recession. This has left capacity at private hospitals, which is being increasingly filled by the treatment of NHS patients.