EvidenceProstate cancer

Veterinary paste is dosed for animals by weight, and 'one squirt' is not a human dose. Liver injury of this severity can be fatal and this patient was fortunate to present in time.

For men with low- or intermediate-risk prostate cancer, protons and modern IMRT give the same excellent quality of life and cancer control, so the choice can rest on access, cost and convenience rather than on an expected sparing of bowel or bladder. The result removes prostate cancer from the list of adult indications where a proton advantage was assumed but untested.

This series is the standard reference for US cancer numbers and the source of most headlines about cancer in younger adults. The gap between falling mortality and rising incidence is the argument for both continued treatment advances and stronger prevention and screening.

This edition supplied two widely quoted signals: the first population-level evidence of HPV vaccination preventing cervical cancer in the United States, and the warning that reduced PSA screening was shifting prostate cancer towards later diagnosis.

This academic programme is what the FDA approved 68Ga-PSMA-11 on in December 2020, and the Illuccix and Locametz kits rest on it for the staging indication. Its message for a man being staged before surgery is that a positive PSMA PET node is very likely real, but a negative scan does not rule out small nodal deposits, so the lymph node dissection still matters.

Men with metastatic castration-resistant prostate cancer that has progressed after hormonal therapy and chemotherapy, and whose tumours show PSMA on a PET scan, can now receive lutetium-PSMA, which extends life, controls pain and is usually better tolerated than further chemotherapy. It has established a new treatment class in which a scan decides who gets the matching radioactive drug, and it is now being tested earlier in the disease (PSMAfore, PSMAddition).

This was the most cited description of the global cancer burden until the 2020 release and is the reference behind many national cancer plans of the late 2010s. Its country-level comparisons showed where prevention, such as HPV and hepatitis B vaccination and tobacco control, would have the largest effect.

Complementary approaches used alongside treatment are one thing; substituting an alternative therapy for surgery, chemotherapy, radiotherapy or hormone therapy in a curable cancer is associated with a large increase in the risk of dying. The finding is the evidence base for offering complementary therapies inside cancer centres and for asking every patient, without judgement, what else they are using.

Men diagnosed with prostate cancer that has already spread, or that is locally advanced and high risk, should start abiraterone (or another androgen-receptor pathway inhibitor) at the same time as testosterone suppression rather than waiting for resistance. This roughly halves the risk of death over several years. The same platform later showed that docetaxel chemotherapy and, in high-volume metastatic disease, triple therapy also help, and that abiraterone benefits men with high-risk disease treated with radiotherapy.

Founder mutations make population-level testing feasible because a three-variant panel finds most carriers; the BRCA1 founder variants in particular predispose to basal-like, triple-negative tumours, so ancestry shapes who gets this disease and who is eligible for PARP inhibitors.