JAMA 13 Dec 2006

This observational study takes a careful look at 44 630 men diagnosed with localised prostate cancer between the ages of 65 and 80. Over 30,000 of them had radical prostatectomy or radiotherapy, and in this group, mortality was 30% less than in those who were simply observed. Sounds impressive, doesn’t it? But of course this also tells us something about the patients that surgeons and radiotherapists don’t want to treat, since this was not a randomised trial. And to put it in a truer perspective, prostate cancer itself was responsible for 6.8% of deaths in the treatment group and 8% of deaths in the observation group. The old saying that you’re more likely to die with your prostate cancer than from your prostate cancer proved true in more than nine cases out of ten, whatever the treatment.

As markers of cardiovascular risk go, C-reactive protein is something of a bit-player, but has aroused a lot of interest as a potential causal link between inflammation and cardiovascular events. This study looks at common polymorphisms of one of the genes that governs CRP production – conveniently called the CRP gene. Over a 13 year period, variation in this gene shows the expected correlation with variation in CRP levels, and at the same time a correlation with cardiovascular risk.

2720 Another circulating chemical associated with cardiovascular risk is homocysteine (HCy), and many people have assumed that this association is causal too. Elevated HCy is a marker for deficiency of folic acid, pyridoxine or cobalamin, and the most popular therapeutic intervention is to increase intake of folic acid. In fact many countries now enrich all bread flour with folate, more to prevent neural tube defects than vascular disease. This meta-analysis of all RCTs shows that it may be vain to hope for the latter: eleven studies show no overall effect.