Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial

Background Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain. Methods RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov , NCT00541047 . Findings Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths. Interpretation Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy. Funding Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society

Communicating for Aquatic Conservation in Cambodia and Beyond: Lessons Learned from In-Person and Media-Based Environmental Education and Outreach Strategies

Communication and outreach efforts are essential for raising awareness about conservation issues among the general public. This paper reviews three in-person approaches (environmental education, outreach events, and field trips), as well as four types of media (print products, news media, visual media, and social media) for communicating about environmental topics, with a focus on highlighting conservation issues in Cambodia. Strengths and weaknesses are considered for each communication tool, along with lessons from a case study example of the Wonders of the Mekong, an interdisciplinary project based in Cambodia that aims to study, protect, and raise awareness about the Mekong River system. We also describe a cross-cutting initiative to share inspiring stories of local conservation practitioners that incorporates both in-person and media-based approaches. In terms of required resources and effort, there is an inherent tradeoff between the depth of in-person engagement and overall reach. While media-based approaches are valuable for reaching large numbers of people with a moderate amount of effort, in-person approaches may create a deeper connection and longer-term impact on an individual level. Ultimately, a diverse communication strategy that utilizes multiple tools to reach different audiences will be most effective. The interdisciplinary Wonders of the Mekong project has successfully communicated the values of the Mekong ecosystem to a broad audience in Cambodia using a variety of strategies, and further evaluation could help illuminate whether and how these communication approaches are shifting attitudes or promoting conservation behaviors.</jats:p

Communicating for Aquatic Conservation in Cambodia and Beyond: Lessons Learned from In-Person and Media-Based Environmental Education and Outreach Strategies

Communication and outreach efforts are essential for raising awareness about conservation issues among the general public. This paper reviews three in-person approaches (environmental education, outreach events, and field trips), as well as four types of media (print products, news media, visual media, and social media) for communicating about environmental topics, with a focus on highlighting conservation issues in Cambodia. Strengths and weaknesses are considered for each communication tool, along with lessons from a case study example of the Wonders of the Mekong, an interdisciplinary project based in Cambodia that aims to study, protect, and raise awareness about the Mekong River system. We also describe a cross-cutting initiative to share inspiring stories of local conservation practitioners that incorporates both in-person and media-based approaches. In terms of required resources and effort, there is an inherent tradeoff between the depth of in-person engagement and overall reach. While media-based approaches are valuable for reaching large numbers of people with a moderate amount of effort, in-person approaches may create a deeper connection and longer-term impact on an individual level. Ultimately, a diverse communication strategy that utilizes multiple tools to reach different audiences will be most effective. The interdisciplinary Wonders of the Mekong project has successfully communicated the values of the Mekong ecosystem to a broad audience in Cambodia using a variety of strategies, and further evaluation could help illuminate whether and how these communication approaches are shifting attitudes or promoting conservation behaviors

Schooling and Citizenship in a Young Democracy: Evidence from Postwar Germany

This paper examines whether schooling has a causal impact on individuals' political behavior. Between 1949 and 1969, the number of compulsory years of schooling in the Federal Republic of Germany was gradually increased across all federal states. These legislative changes provide an opportunity to investigate the causal impact of schooling on political behavior. Years of schooling are found to be positively correlated with several political outcomes. However, there is little evidence of a causal effect. This study conjectures that there is ample historical evidence to support the hypothesis that the fundamentals of democracy were already learned earlier in school, potentially outweighing the political returns of schooling in Germany. Copyright © The editors of the "Scandinavian Journal of Economics" 2010 .