Duration of androgen suppression in the treatment of prostate cancer.

International audienceBACKGROUND: The combination of radiotherapy plus long-term medical suppression of androgens (> or = 2 years) improves overall survival in patients with locally advanced prostate cancer. We compared the use of radiotherapy plus short-term androgen suppression with the use of radiotherapy plus long-term androgen suppression in the treatment of locally advanced prostate cancer. METHODS: We randomly assigned patients with locally advanced prostate cancer who had received external-beam radiotherapy plus 6 months of androgen suppression to two groups, one to receive no further treatment (short-term suppression) and the other to receive 2.5 years of further treatment with a luteinizing hormone-releasing hormone agonist (long-term suppression). An outcome of noninferiority of short-term androgen suppression as compared with long-term suppression required a hazard ratio of more than 1.35 for overall survival, with a one-sided alpha level of 0.05. An interim analysis showed futility, and the results are presented with an adjusted one-sided alpha level of 0.0429. RESULTS: A total of 1113 men were registered, of whom 970 were randomly assigned, 483 to short-term suppression and 487 to long-term suppression. After a median follow-up of 6.4 years, 132 patients in the short-term group and 98 in the long-term group had died; the number of deaths due to prostate cancer was 47 in the short-term group and 29 in the long-term group. The 5-year overall mortality for short-term and long-term suppression was 19.0% and 15.2%, respectively; the observed hazard ratio was 1.42 (upper 95.71% confidence limit, 1.79; P=0.65 for noninferiority). Adverse events in both groups included fatigue, diminished sexual function, and hot flushes. CONCLUSIONS: The combination of radiotherapy plus 6 months of androgen suppression provides inferior survival as compared with radiotherapy plus 3 years of androgen suppression in the treatment of locally advanced prostate cancer. (ClinicalTrials.gov number, NCT00003026.

Individual differences in children's pragmatic ability: a review of associations with formal language, social cognition, and executive functions

Children vary in their ability to use language in social contexts and this has important consequences for wellbeing. We review studies that test whether individual differences in pragmatic skill are associated with formal language ability, mentalising and executive functions in both typical and atypical development. The strongest and most consistent associations found were between pragmatic and formal language. Additional associations with mentalising were observed, particularly with discourse contingency and irony understanding. Fewer studies considered executive function and evidence is mixed. To make progress, high-quality studies of specific pragmatic skills are needed to test mechanistic models of development. We propose 6 goals for future research: 1) developing an empirically-based taxonomy of pragmatic skills; 2) establishing which skills matter most for everyday functioning; 3) testing specific hypotheses about information processing; 4) augmenting measures of individual differences; 5) considering a broader set of psychological associates; 6) employing statistical tools that model the nested structure of pragmatics and cognition