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Although early menopause is linked to increased risks in bone loss and fracture, new research indicates that, even among the majority of women who have menopause after age 45, the time since the final menstrual period can be a stronger predictor than chronological age for key risks in bone health and fracture.

Steve Debenport/Getty Images

In a large longitudinal cohort, the number of years since a woman’s final menstrual period specifically showed a stronger association with femoral neck bone mineral density (BMD) than chronological age, while an earlier age at menopause – even among those over 45 years, was linked to an increased risk of fracture.

“Most of our clinical tools to predict osteoporosis-related outcomes use chronological age,” first author Albert Shieh, MD, told this news organization.

“Our findings suggest that more research should be done to examine whether ovarian age (time since final menstrual period) should be used in these tools as well.”

An increased focus on the significance of age at the time of the final menstrual period, compared with chronological age, has gained interest in risk assessment because of the known acceleration in the decline of BMD that occurs 1 year prior to the final menstrual period and continues at a rapid pace for 3 years afterwards before slowing.

To further investigate the association with BMD, Dr. Shieh, an endocrinologist specializing in osteoporosis at the University of California, Los Angeles, and his colleagues turned to data from the Study of Women’s Health Across the Nation (SWAN), a longitudinal cohort study of ambulatory women with pre- or early perimenopausal baseline data and 15 annual follow-up assessments.

Outcomes regarding postmenopausal lumbar spine (LS) or femoral neck (FN) BMD were evaluated in 1,038 women, while the time to fracture in relation to the final menstrual period was separately evaluated in 1,554 women.

In both cohorts, the women had a known final menstrual period at age 45 or older, and on average, their final menstrual period occurred at age 52.

After a multivariate adjustment for age, body mass index, and various other factors, they found that each additional year after a woman’s final menstrual period was associated with a significant (0.006 g/cm²) reduction in postmenopausal lumbar spine BMD and a 0.004 g/cm² reduction femoral neck BMD (both P < .0001).

Conversely, chronological age was not associated with a change in femoral neck BMD when evaluated independently of years since the final menstrual period, the researchers reported in the Journal of Clinical Endocrinology and Metabolism.

Regarding lumbar spine BMD, chronological age was unexpectedly associated not just with change, but in fact with increases in lumbar spine BMD (P < .0001 per year). However, the authors speculate the change “is likely a reflection of age-associated degenerative changes causing false elevations in BMD measured by dual-energy x-ray absorptiometry.”

Fracture risk with earlier menopause

In terms of the fracture risk analysis, despite the women all being aged 45 or older, earlier age at menopause was still tied to an increased risk of incident fracture, with a 5% increase in risk for each earlier year in age at the time of the final menstrual period (P = .02).

Compared with women who had their final menstrual period at age 55, for instance, those who finished menstruating at age 47 had a 6.3% greater 20-year cumulative fracture risk, the authors note.

While previous findings from the Malmo Perimenopausal Study showed menopause prior to the age of 47 to be associated with an 83% and 59% greater risk of densitometric osteoporosis and fracture, respectively, by age 77, the authors note that the new study is unique in including only women who had a final menstrual period over the age of 45, therefore reducing the potential confounding of data on women under 45.

The new results “add to a growing body of literature suggesting that the endocrine changes that occur during the menopause transition trigger a pathophysiologic cascade that leads to organ dysfunction,” the authors note.

In terms of implications in risk assessment, “future studies should examine whether years since the final menstrual period predicts major osteoporotic fractures and hip fractures, specifically, and, if so, whether replacing chronological age with years since the final menstrual period improves the performance of clinical prediction tools, such as FRAX [Fracture Risk Assessment Tool],” they add.

Addition to guidelines?

Commenting on the findings, Peter Ebeling, MD, the current president of the American Society of Bone and Mineral Research, noted that the study importantly “confirms what we had previously anticipated, that in women with menopause who are 45 years of age or older a lower age of final menstrual period is associated with lower spine and hip BMD and more fractures.”

“We had already known this for women with premature ovarian insufficiency or an early menopause, and this extends the observation to the vast majority of women – more than 90% – with a normal menopause age,” said Dr. Ebeling, professor of medicine at Monash Health, Monash University, in Melbourne.

Despite the known importance of the time since final menstrual period, guidelines still focus on age in terms of chronology, rather than biology, emphasizing the risk among women over 50, in general, rather than the time since the last menstrual period, he noted.

“There is an important difference [between those two], as shown by this study,” he said. “Guidelines could be easily adapted to reflect this.”

Specifically, the association between lower age of final menstrual period and lower spine and hip BMD and more fractures requires “more formal assessment to determine whether adding age of final menstrual period to existing fracture risk calculator tools, like FRAX, can improve absolute fracture risk prediction,” Dr. Ebeling noted.

The authors and Dr. Ebeling had no disclosures to report.

Although early menopause is linked to increased risks in bone loss and fracture, new research indicates that, even among the majority of women who have menopause after age 45, the time since the final menstrual period can be a stronger predictor than chronological age for key risks in bone health and fracture.

Steve Debenport/Getty Images

In a large longitudinal cohort, the number of years since a woman’s final menstrual period specifically showed a stronger association with femoral neck bone mineral density (BMD) than chronological age, while an earlier age at menopause – even among those over 45 years, was linked to an increased risk of fracture.

“Most of our clinical tools to predict osteoporosis-related outcomes use chronological age,” first author Albert Shieh, MD, told this news organization.

“Our findings suggest that more research should be done to examine whether ovarian age (time since final menstrual period) should be used in these tools as well.”

An increased focus on the significance of age at the time of the final menstrual period, compared with chronological age, has gained interest in risk assessment because of the known acceleration in the decline of BMD that occurs 1 year prior to the final menstrual period and continues at a rapid pace for 3 years afterwards before slowing.

To further investigate the association with BMD, Dr. Shieh, an endocrinologist specializing in osteoporosis at the University of California, Los Angeles, and his colleagues turned to data from the Study of Women’s Health Across the Nation (SWAN), a longitudinal cohort study of ambulatory women with pre- or early perimenopausal baseline data and 15 annual follow-up assessments.

Outcomes regarding postmenopausal lumbar spine (LS) or femoral neck (FN) BMD were evaluated in 1,038 women, while the time to fracture in relation to the final menstrual period was separately evaluated in 1,554 women.

In both cohorts, the women had a known final menstrual period at age 45 or older, and on average, their final menstrual period occurred at age 52.

After a multivariate adjustment for age, body mass index, and various other factors, they found that each additional year after a woman’s final menstrual period was associated with a significant (0.006 g/cm²) reduction in postmenopausal lumbar spine BMD and a 0.004 g/cm² reduction femoral neck BMD (both P < .0001).

Conversely, chronological age was not associated with a change in femoral neck BMD when evaluated independently of years since the final menstrual period, the researchers reported in the Journal of Clinical Endocrinology and Metabolism.

Regarding lumbar spine BMD, chronological age was unexpectedly associated not just with change, but in fact with increases in lumbar spine BMD (P < .0001 per year). However, the authors speculate the change “is likely a reflection of age-associated degenerative changes causing false elevations in BMD measured by dual-energy x-ray absorptiometry.”

Fracture risk with earlier menopause

In terms of the fracture risk analysis, despite the women all being aged 45 or older, earlier age at menopause was still tied to an increased risk of incident fracture, with a 5% increase in risk for each earlier year in age at the time of the final menstrual period (P = .02).

Compared with women who had their final menstrual period at age 55, for instance, those who finished menstruating at age 47 had a 6.3% greater 20-year cumulative fracture risk, the authors note.

While previous findings from the Malmo Perimenopausal Study showed menopause prior to the age of 47 to be associated with an 83% and 59% greater risk of densitometric osteoporosis and fracture, respectively, by age 77, the authors note that the new study is unique in including only women who had a final menstrual period over the age of 45, therefore reducing the potential confounding of data on women under 45.

The new results “add to a growing body of literature suggesting that the endocrine changes that occur during the menopause transition trigger a pathophysiologic cascade that leads to organ dysfunction,” the authors note.

In terms of implications in risk assessment, “future studies should examine whether years since the final menstrual period predicts major osteoporotic fractures and hip fractures, specifically, and, if so, whether replacing chronological age with years since the final menstrual period improves the performance of clinical prediction tools, such as FRAX [Fracture Risk Assessment Tool],” they add.

Addition to guidelines?

Commenting on the findings, Peter Ebeling, MD, the current president of the American Society of Bone and Mineral Research, noted that the study importantly “confirms what we had previously anticipated, that in women with menopause who are 45 years of age or older a lower age of final menstrual period is associated with lower spine and hip BMD and more fractures.”

“We had already known this for women with premature ovarian insufficiency or an early menopause, and this extends the observation to the vast majority of women – more than 90% – with a normal menopause age,” said Dr. Ebeling, professor of medicine at Monash Health, Monash University, in Melbourne.

Despite the known importance of the time since final menstrual period, guidelines still focus on age in terms of chronology, rather than biology, emphasizing the risk among women over 50, in general, rather than the time since the last menstrual period, he noted.

“There is an important difference [between those two], as shown by this study,” he said. “Guidelines could be easily adapted to reflect this.”

Specifically, the association between lower age of final menstrual period and lower spine and hip BMD and more fractures requires “more formal assessment to determine whether adding age of final menstrual period to existing fracture risk calculator tools, like FRAX, can improve absolute fracture risk prediction,” Dr. Ebeling noted.

The authors and Dr. Ebeling had no disclosures to report.

Although early menopause is linked to increased risks in bone loss and fracture, new research indicates that, even among the majority of women who have menopause after age 45, the time since the final menstrual period can be a stronger predictor than chronological age for key risks in bone health and fracture.

Steve Debenport/Getty Images

In a large longitudinal cohort, the number of years since a woman’s final menstrual period specifically showed a stronger association with femoral neck bone mineral density (BMD) than chronological age, while an earlier age at menopause – even among those over 45 years, was linked to an increased risk of fracture.

“Most of our clinical tools to predict osteoporosis-related outcomes use chronological age,” first author Albert Shieh, MD, told this news organization.

“Our findings suggest that more research should be done to examine whether ovarian age (time since final menstrual period) should be used in these tools as well.”

An increased focus on the significance of age at the time of the final menstrual period, compared with chronological age, has gained interest in risk assessment because of the known acceleration in the decline of BMD that occurs 1 year prior to the final menstrual period and continues at a rapid pace for 3 years afterwards before slowing.

To further investigate the association with BMD, Dr. Shieh, an endocrinologist specializing in osteoporosis at the University of California, Los Angeles, and his colleagues turned to data from the Study of Women’s Health Across the Nation (SWAN), a longitudinal cohort study of ambulatory women with pre- or early perimenopausal baseline data and 15 annual follow-up assessments.

Outcomes regarding postmenopausal lumbar spine (LS) or femoral neck (FN) BMD were evaluated in 1,038 women, while the time to fracture in relation to the final menstrual period was separately evaluated in 1,554 women.

In both cohorts, the women had a known final menstrual period at age 45 or older, and on average, their final menstrual period occurred at age 52.

After a multivariate adjustment for age, body mass index, and various other factors, they found that each additional year after a woman’s final menstrual period was associated with a significant (0.006 g/cm²) reduction in postmenopausal lumbar spine BMD and a 0.004 g/cm² reduction femoral neck BMD (both P < .0001).

Conversely, chronological age was not associated with a change in femoral neck BMD when evaluated independently of years since the final menstrual period, the researchers reported in the Journal of Clinical Endocrinology and Metabolism.

Regarding lumbar spine BMD, chronological age was unexpectedly associated not just with change, but in fact with increases in lumbar spine BMD (P < .0001 per year). However, the authors speculate the change “is likely a reflection of age-associated degenerative changes causing false elevations in BMD measured by dual-energy x-ray absorptiometry.”

Fracture risk with earlier menopause

In terms of the fracture risk analysis, despite the women all being aged 45 or older, earlier age at menopause was still tied to an increased risk of incident fracture, with a 5% increase in risk for each earlier year in age at the time of the final menstrual period (P = .02).

Compared with women who had their final menstrual period at age 55, for instance, those who finished menstruating at age 47 had a 6.3% greater 20-year cumulative fracture risk, the authors note.

While previous findings from the Malmo Perimenopausal Study showed menopause prior to the age of 47 to be associated with an 83% and 59% greater risk of densitometric osteoporosis and fracture, respectively, by age 77, the authors note that the new study is unique in including only women who had a final menstrual period over the age of 45, therefore reducing the potential confounding of data on women under 45.

The new results “add to a growing body of literature suggesting that the endocrine changes that occur during the menopause transition trigger a pathophysiologic cascade that leads to organ dysfunction,” the authors note.

In terms of implications in risk assessment, “future studies should examine whether years since the final menstrual period predicts major osteoporotic fractures and hip fractures, specifically, and, if so, whether replacing chronological age with years since the final menstrual period improves the performance of clinical prediction tools, such as FRAX [Fracture Risk Assessment Tool],” they add.

Addition to guidelines?

Commenting on the findings, Peter Ebeling, MD, the current president of the American Society of Bone and Mineral Research, noted that the study importantly “confirms what we had previously anticipated, that in women with menopause who are 45 years of age or older a lower age of final menstrual period is associated with lower spine and hip BMD and more fractures.”

“We had already known this for women with premature ovarian insufficiency or an early menopause, and this extends the observation to the vast majority of women – more than 90% – with a normal menopause age,” said Dr. Ebeling, professor of medicine at Monash Health, Monash University, in Melbourne.

Despite the known importance of the time since final menstrual period, guidelines still focus on age in terms of chronology, rather than biology, emphasizing the risk among women over 50, in general, rather than the time since the last menstrual period, he noted.

“There is an important difference [between those two], as shown by this study,” he said. “Guidelines could be easily adapted to reflect this.”

Specifically, the association between lower age of final menstrual period and lower spine and hip BMD and more fractures requires “more formal assessment to determine whether adding age of final menstrual period to existing fracture risk calculator tools, like FRAX, can improve absolute fracture risk prediction,” Dr. Ebeling noted.

The authors and Dr. Ebeling had no disclosures to report.

In the first study of its kind, women with a breast cancer diagnosis who recalled eating nuts were found to have a significantly better disease-free survival over a 10-year study period, compared with those who said they had not eaten nuts.

PxHere

There was also an improvement in overall survival, but this was not statistically significant.

The finding comes from a study of more than 3,000 patients conducted in China, published online in the International Journal of Cancer. Patients were queried about nut consumption on only one occasion, 5 years after their breast cancer diagnosis. 

The investigators report a dose-response pattern between nut eating and the risk of both breast cancer recurrence and overall mortality, with those consuming the largest amounts having the lowest risks.

“Nuts are important components of healthy diets. Promoting this modifiable lifestyle factor should be emphasized in breast cancer survivor guidelines,” conclude Xiao-Ou Shu, MD, PhD, of Vanderbilt University, Nashville, Tenn., and colleagues in the study.

“The association for disease-free survival is quite strong and robust,” Dr. Shu told this news organization.

However, as with all observational studies, this report shows an association and not causation.

“Based upon this study alone, the evidence is weak,” said Wendy Chen, MD, MPH, a breast oncologist at Dana-Farber Cancer Institute in Boston, who was approached for comment.  

The people who consumed nuts generally had more education, higher income, lower body mass index, earlier-stage cancers, and more physically active lives – all factors associated with better breast cancer survival, she observed. “The authors tried to control for these factors,” Dr. Chen acknowledged. But it’s hard to know whether nut consumption was “truly” the difference maker, she said.

Furthermore, the study population is also “a bit unusual” because people had to survive 5 years after diagnosis to be included in the analysis – and thus is not representative of breast cancer survivors, she noted.

Erin Van Blarigan, PhD, an epidemiologist at the University of California, San Francisco, described the overall evidence of the beneficial relationship between nut eating and breast cancer – including this study – as “limited.” She previously led a study that observed benefits of nut intake for patients with colon cancer.

Dr. Van Blarigan also noted that nut intake in this study was “very low” – with the median intake less than one serving per week.

She also offered some general advice about eating nuts.  

“Nuts are an energy-dense food, so portion sizes should be kept small,” she said, explaining a portion should be about 1 ounce or 1/4 cup of nuts or 1-2 tablespoons of nut butter.

A little may go a long way, she suggested, as research to date “suggests only small amounts may be needed to gain potential benefits.”

The level of nut consumption was low in the Chinese study population (median = 17.3 grams/week) compared with the 42.5 grams/week recommended by the American Heart Association, the study authors acknowledge.

“Nuts, particularly tree nuts, are expensive in China. Traditionally, nut consumption level has been low among Chinese, particularly in the old generation,” commented Dr. Shu.
 

Study authors did an adjusted analysis

The new study was conducted among 3,449 participants of the Shanghai Breast Cancer Survival Study.

Nut consumption (including peanuts and tree nuts such as walnuts) was assessed with a food questionnaire at 5 years post-diagnosis.

An analysis was conducted at 10 years post-diagnosis (and 5 years after the diet questionnaire). At this 10-year mark, there were 252 breast cancer-specific deaths. Among 3,274 survivors without previous recurrence at the dietary assessment, 209 went on to develop breast cancer-specific events – either recurrence, metastasis, or breast cancer mortality.

Nut consumers had higher overall survival (93.7% vs. 89%; P = .003) and disease-free survival (94.1% vs. 86.2%; P <.001) rates than nonconsumers.

However, the two groups had many differences, as noted by the authors and outside experts.

The consumers had a younger age at diagnosis, lower BMI, higher total energy intake, higher diet quality score, and higher soy food intake. In addition, nut consumers were more likely to have a higher education, personal income, and physical activity level (≥7.5 metabolic equivalent of task-hour/week) as well as to have received immunotherapy.

So the investigators adjusted for many of those variables and found that nut consumption was associated with significantly better disease-free survival (hazard ratio, 0.52; 95% confidence interval, 0.35-0.75), but a nonsignificantly improved overall survival (HR, 0.90; 95% CI, 0.66-1.23), as noted above.

Analyses by amount of nut intake showed a dose-response relationship for both overall survival (P trend = .022) and disease-free survival (P trend = .003).

The authors say that “there has been no strong evidence to support individual food items in favor of breast cancer survival,” citing a 2018 report entitled “Diet, Nutrition, Physical Activity and Breast Cancer Survivors” from the World Cancer Research Fund/American Institute for Cancer Research.

The new study provides evidence that nuts may be such a food, they say, while also calling for studies to confirm their findings.

Study limitations include that fact that the statuses of recurrence and metastasis were self-reported. Misclassification, particularly regarding the event date, is likely, the team says.

The study authors and Dr. Van Blarigan and Dr. Chen have disclosed no relevant financial relationships.

A version of this article first appeared on Medscape.com.

In the first study of its kind, women with a breast cancer diagnosis who recalled eating nuts were found to have a significantly better disease-free survival over a 10-year study period, compared with those who said they had not eaten nuts.

PxHere

There was also an improvement in overall survival, but this was not statistically significant.

The finding comes from a study of more than 3,000 patients conducted in China, published online in the International Journal of Cancer. Patients were queried about nut consumption on only one occasion, 5 years after their breast cancer diagnosis. 

The investigators report a dose-response pattern between nut eating and the risk of both breast cancer recurrence and overall mortality, with those consuming the largest amounts having the lowest risks.

“Nuts are important components of healthy diets. Promoting this modifiable lifestyle factor should be emphasized in breast cancer survivor guidelines,” conclude Xiao-Ou Shu, MD, PhD, of Vanderbilt University, Nashville, Tenn., and colleagues in the study.

“The association for disease-free survival is quite strong and robust,” Dr. Shu told this news organization.

However, as with all observational studies, this report shows an association and not causation.

“Based upon this study alone, the evidence is weak,” said Wendy Chen, MD, MPH, a breast oncologist at Dana-Farber Cancer Institute in Boston, who was approached for comment.  

The people who consumed nuts generally had more education, higher income, lower body mass index, earlier-stage cancers, and more physically active lives – all factors associated with better breast cancer survival, she observed. “The authors tried to control for these factors,” Dr. Chen acknowledged. But it’s hard to know whether nut consumption was “truly” the difference maker, she said.

Furthermore, the study population is also “a bit unusual” because people had to survive 5 years after diagnosis to be included in the analysis – and thus is not representative of breast cancer survivors, she noted.

Erin Van Blarigan, PhD, an epidemiologist at the University of California, San Francisco, described the overall evidence of the beneficial relationship between nut eating and breast cancer – including this study – as “limited.” She previously led a study that observed benefits of nut intake for patients with colon cancer.

Dr. Van Blarigan also noted that nut intake in this study was “very low” – with the median intake less than one serving per week.

She also offered some general advice about eating nuts.  

“Nuts are an energy-dense food, so portion sizes should be kept small,” she said, explaining a portion should be about 1 ounce or 1/4 cup of nuts or 1-2 tablespoons of nut butter.

A little may go a long way, she suggested, as research to date “suggests only small amounts may be needed to gain potential benefits.”

The level of nut consumption was low in the Chinese study population (median = 17.3 grams/week) compared with the 42.5 grams/week recommended by the American Heart Association, the study authors acknowledge.

“Nuts, particularly tree nuts, are expensive in China. Traditionally, nut consumption level has been low among Chinese, particularly in the old generation,” commented Dr. Shu.
 

Study authors did an adjusted analysis

The new study was conducted among 3,449 participants of the Shanghai Breast Cancer Survival Study.

Nut consumption (including peanuts and tree nuts such as walnuts) was assessed with a food questionnaire at 5 years post-diagnosis.

An analysis was conducted at 10 years post-diagnosis (and 5 years after the diet questionnaire). At this 10-year mark, there were 252 breast cancer-specific deaths. Among 3,274 survivors without previous recurrence at the dietary assessment, 209 went on to develop breast cancer-specific events – either recurrence, metastasis, or breast cancer mortality.

Nut consumers had higher overall survival (93.7% vs. 89%; P = .003) and disease-free survival (94.1% vs. 86.2%; P <.001) rates than nonconsumers.

However, the two groups had many differences, as noted by the authors and outside experts.

The consumers had a younger age at diagnosis, lower BMI, higher total energy intake, higher diet quality score, and higher soy food intake. In addition, nut consumers were more likely to have a higher education, personal income, and physical activity level (≥7.5 metabolic equivalent of task-hour/week) as well as to have received immunotherapy.

So the investigators adjusted for many of those variables and found that nut consumption was associated with significantly better disease-free survival (hazard ratio, 0.52; 95% confidence interval, 0.35-0.75), but a nonsignificantly improved overall survival (HR, 0.90; 95% CI, 0.66-1.23), as noted above.

Analyses by amount of nut intake showed a dose-response relationship for both overall survival (P trend = .022) and disease-free survival (P trend = .003).

The authors say that “there has been no strong evidence to support individual food items in favor of breast cancer survival,” citing a 2018 report entitled “Diet, Nutrition, Physical Activity and Breast Cancer Survivors” from the World Cancer Research Fund/American Institute for Cancer Research.

The new study provides evidence that nuts may be such a food, they say, while also calling for studies to confirm their findings.

Study limitations include that fact that the statuses of recurrence and metastasis were self-reported. Misclassification, particularly regarding the event date, is likely, the team says.

The study authors and Dr. Van Blarigan and Dr. Chen have disclosed no relevant financial relationships.

A version of this article first appeared on Medscape.com.

In the first study of its kind, women with a breast cancer diagnosis who recalled eating nuts were found to have a significantly better disease-free survival over a 10-year study period, compared with those who said they had not eaten nuts.

PxHere

There was also an improvement in overall survival, but this was not statistically significant.

The finding comes from a study of more than 3,000 patients conducted in China, published online in the International Journal of Cancer. Patients were queried about nut consumption on only one occasion, 5 years after their breast cancer diagnosis. 

The investigators report a dose-response pattern between nut eating and the risk of both breast cancer recurrence and overall mortality, with those consuming the largest amounts having the lowest risks.

“Nuts are important components of healthy diets. Promoting this modifiable lifestyle factor should be emphasized in breast cancer survivor guidelines,” conclude Xiao-Ou Shu, MD, PhD, of Vanderbilt University, Nashville, Tenn., and colleagues in the study.

“The association for disease-free survival is quite strong and robust,” Dr. Shu told this news organization.

However, as with all observational studies, this report shows an association and not causation.

“Based upon this study alone, the evidence is weak,” said Wendy Chen, MD, MPH, a breast oncologist at Dana-Farber Cancer Institute in Boston, who was approached for comment.  

The people who consumed nuts generally had more education, higher income, lower body mass index, earlier-stage cancers, and more physically active lives – all factors associated with better breast cancer survival, she observed. “The authors tried to control for these factors,” Dr. Chen acknowledged. But it’s hard to know whether nut consumption was “truly” the difference maker, she said.

Furthermore, the study population is also “a bit unusual” because people had to survive 5 years after diagnosis to be included in the analysis – and thus is not representative of breast cancer survivors, she noted.

Erin Van Blarigan, PhD, an epidemiologist at the University of California, San Francisco, described the overall evidence of the beneficial relationship between nut eating and breast cancer – including this study – as “limited.” She previously led a study that observed benefits of nut intake for patients with colon cancer.

Dr. Van Blarigan also noted that nut intake in this study was “very low” – with the median intake less than one serving per week.

She also offered some general advice about eating nuts.  

“Nuts are an energy-dense food, so portion sizes should be kept small,” she said, explaining a portion should be about 1 ounce or 1/4 cup of nuts or 1-2 tablespoons of nut butter.

A little may go a long way, she suggested, as research to date “suggests only small amounts may be needed to gain potential benefits.”

The level of nut consumption was low in the Chinese study population (median = 17.3 grams/week) compared with the 42.5 grams/week recommended by the American Heart Association, the study authors acknowledge.

“Nuts, particularly tree nuts, are expensive in China. Traditionally, nut consumption level has been low among Chinese, particularly in the old generation,” commented Dr. Shu.
 

Study authors did an adjusted analysis

The new study was conducted among 3,449 participants of the Shanghai Breast Cancer Survival Study.

Nut consumption (including peanuts and tree nuts such as walnuts) was assessed with a food questionnaire at 5 years post-diagnosis.

An analysis was conducted at 10 years post-diagnosis (and 5 years after the diet questionnaire). At this 10-year mark, there were 252 breast cancer-specific deaths. Among 3,274 survivors without previous recurrence at the dietary assessment, 209 went on to develop breast cancer-specific events – either recurrence, metastasis, or breast cancer mortality.

Nut consumers had higher overall survival (93.7% vs. 89%; P = .003) and disease-free survival (94.1% vs. 86.2%; P <.001) rates than nonconsumers.

However, the two groups had many differences, as noted by the authors and outside experts.

The consumers had a younger age at diagnosis, lower BMI, higher total energy intake, higher diet quality score, and higher soy food intake. In addition, nut consumers were more likely to have a higher education, personal income, and physical activity level (≥7.5 metabolic equivalent of task-hour/week) as well as to have received immunotherapy.

So the investigators adjusted for many of those variables and found that nut consumption was associated with significantly better disease-free survival (hazard ratio, 0.52; 95% confidence interval, 0.35-0.75), but a nonsignificantly improved overall survival (HR, 0.90; 95% CI, 0.66-1.23), as noted above.

Analyses by amount of nut intake showed a dose-response relationship for both overall survival (P trend = .022) and disease-free survival (P trend = .003).

The authors say that “there has been no strong evidence to support individual food items in favor of breast cancer survival,” citing a 2018 report entitled “Diet, Nutrition, Physical Activity and Breast Cancer Survivors” from the World Cancer Research Fund/American Institute for Cancer Research.

The new study provides evidence that nuts may be such a food, they say, while also calling for studies to confirm their findings.

Study limitations include that fact that the statuses of recurrence and metastasis were self-reported. Misclassification, particularly regarding the event date, is likely, the team says.

The study authors and Dr. Van Blarigan and Dr. Chen have disclosed no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Key clinical point: Stereotactic body radiation therapy (SBRT) is safe and shows low incidence of high-grade bleeding in older patients with localized prostate cancer who received anticoagulant or antiplatelet treatment.

Major finding: Overall, 18.2% of patients reported hematuria with a median time of 10.5 months and 38.6% experienced hematochezia with a median time of 6 months. Rates of grade 2 or more hematuria and hematochezia were 4.6% and 2.5%, respectively. No grade 4 or 5 toxicities were reported.

Study details: A retrospective study of 44 patients with localized prostate cancer (median age, 72 years) who were treated with SBRT between 2007 and 2017 and received anticoagulant or antiplatelet at baseline. Patients with rectal spacer were not included.

Disclosures: The study was funded by Accuray, National Institute on Minority Health and Health Disparities and The James and Theodore Pedas Family Foundation. The authors did not declare any conflict of interests.

Source: Pepin A et al. Front Oncol. 2021 Sep 17. doi: 10.3389/fonc.2021.722852.

Key clinical point: Stereotactic body radiation therapy (SBRT) is safe and shows low incidence of high-grade bleeding in older patients with localized prostate cancer who received anticoagulant or antiplatelet treatment.

Major finding: Overall, 18.2% of patients reported hematuria with a median time of 10.5 months and 38.6% experienced hematochezia with a median time of 6 months. Rates of grade 2 or more hematuria and hematochezia were 4.6% and 2.5%, respectively. No grade 4 or 5 toxicities were reported.

Study details: A retrospective study of 44 patients with localized prostate cancer (median age, 72 years) who were treated with SBRT between 2007 and 2017 and received anticoagulant or antiplatelet at baseline. Patients with rectal spacer were not included.

Disclosures: The study was funded by Accuray, National Institute on Minority Health and Health Disparities and The James and Theodore Pedas Family Foundation. The authors did not declare any conflict of interests.

Source: Pepin A et al. Front Oncol. 2021 Sep 17. doi: 10.3389/fonc.2021.722852.

Key clinical point: Stereotactic body radiation therapy (SBRT) is safe and shows low incidence of high-grade bleeding in older patients with localized prostate cancer who received anticoagulant or antiplatelet treatment.

Major finding: Overall, 18.2% of patients reported hematuria with a median time of 10.5 months and 38.6% experienced hematochezia with a median time of 6 months. Rates of grade 2 or more hematuria and hematochezia were 4.6% and 2.5%, respectively. No grade 4 or 5 toxicities were reported.

Study details: A retrospective study of 44 patients with localized prostate cancer (median age, 72 years) who were treated with SBRT between 2007 and 2017 and received anticoagulant or antiplatelet at baseline. Patients with rectal spacer were not included.

Disclosures: The study was funded by Accuray, National Institute on Minority Health and Health Disparities and The James and Theodore Pedas Family Foundation. The authors did not declare any conflict of interests.

Source: Pepin A et al. Front Oncol. 2021 Sep 17. doi: 10.3389/fonc.2021.722852.

Key clinical point: A single-fraction high-dose-rate (HDR) brachytherapy boost followed by ultra-hypofractionated stereotactic body radiation therapy (SBRT) to the prostate and/or pelvic lymph nodes shows a low rate of early toxicity in patients with higher-risk prostate cancer.

Major finding: The median follow-up was 24.1 months. No grade 3 or worse genitourinary or gastrointestinal toxicities were reported. Acute and late grade 2 gastrointestinal adverse events (AEs) were 0.99% each. Acute and late grade 2 genitourinary AEs were 5.9% and 9.9%, respectively. The median time to a grade 2 genitourinary toxicity was 6 months.

Study details: A retrospective study of 101 patients with high-risk prostate cancer who received HDR brachytherapy combined with ultra-hypofractionated radiotherapy.

Disclosures: This work was supported by the National Institutes of Health. The authors received research funding, consulting fees, and/or honoraria and/or served as editor-in-chief.

Source: Gorovets D et al. Brachytherapy. 2021 Sep 26. doi: 10.1016/j.brachy.2021.08.006.

Key clinical point: A single-fraction high-dose-rate (HDR) brachytherapy boost followed by ultra-hypofractionated stereotactic body radiation therapy (SBRT) to the prostate and/or pelvic lymph nodes shows a low rate of early toxicity in patients with higher-risk prostate cancer.

Major finding: The median follow-up was 24.1 months. No grade 3 or worse genitourinary or gastrointestinal toxicities were reported. Acute and late grade 2 gastrointestinal adverse events (AEs) were 0.99% each. Acute and late grade 2 genitourinary AEs were 5.9% and 9.9%, respectively. The median time to a grade 2 genitourinary toxicity was 6 months.

Study details: A retrospective study of 101 patients with high-risk prostate cancer who received HDR brachytherapy combined with ultra-hypofractionated radiotherapy.

Disclosures: This work was supported by the National Institutes of Health. The authors received research funding, consulting fees, and/or honoraria and/or served as editor-in-chief.

Source: Gorovets D et al. Brachytherapy. 2021 Sep 26. doi: 10.1016/j.brachy.2021.08.006.

Key clinical point: A single-fraction high-dose-rate (HDR) brachytherapy boost followed by ultra-hypofractionated stereotactic body radiation therapy (SBRT) to the prostate and/or pelvic lymph nodes shows a low rate of early toxicity in patients with higher-risk prostate cancer.

Major finding: The median follow-up was 24.1 months. No grade 3 or worse genitourinary or gastrointestinal toxicities were reported. Acute and late grade 2 gastrointestinal adverse events (AEs) were 0.99% each. Acute and late grade 2 genitourinary AEs were 5.9% and 9.9%, respectively. The median time to a grade 2 genitourinary toxicity was 6 months.

Study details: A retrospective study of 101 patients with high-risk prostate cancer who received HDR brachytherapy combined with ultra-hypofractionated radiotherapy.

Disclosures: This work was supported by the National Institutes of Health. The authors received research funding, consulting fees, and/or honoraria and/or served as editor-in-chief.

Source: Gorovets D et al. Brachytherapy. 2021 Sep 26. doi: 10.1016/j.brachy.2021.08.006.

Key clinical point: Use of chemotherapy and survival has increased in contemporary patients with de novo metastatic prostate cancer vs historical patients.

Major finding: The rates of chemotherapy were not significantly different between 2004 and 2013 (P = .3). The chemotherapy rates increased from 17.2% to 24.7% between 2014 and 2016 (P = .04). After propensity score matching, the median overall survival was significantly longer in contemporary vs. historical patients (not reached vs 25 months; adjusted hazard ratio [aHR], 0.55; P < .001). Cancer-specific mortality also improved in contemporary patients (not reached vs. 26 months; aHR, 0.55; P < .001).

Study details: A retrospective study of 19,913 patients who had de novo metastatic prostate cancer between 2004 and 2016, divided between historical (2004-2013) and contemporary (2014-2016).

Disclosures: No funding source was identified for this work. The authors had no competing interests.

Source: Hoeh B et al. Prostate. 2021 Sep 15. doi: 10.1002/pros.24235.

Key clinical point: Use of chemotherapy and survival has increased in contemporary patients with de novo metastatic prostate cancer vs historical patients.

Major finding: The rates of chemotherapy were not significantly different between 2004 and 2013 (P = .3). The chemotherapy rates increased from 17.2% to 24.7% between 2014 and 2016 (P = .04). After propensity score matching, the median overall survival was significantly longer in contemporary vs. historical patients (not reached vs 25 months; adjusted hazard ratio [aHR], 0.55; P < .001). Cancer-specific mortality also improved in contemporary patients (not reached vs. 26 months; aHR, 0.55; P < .001).

Study details: A retrospective study of 19,913 patients who had de novo metastatic prostate cancer between 2004 and 2016, divided between historical (2004-2013) and contemporary (2014-2016).

Disclosures: No funding source was identified for this work. The authors had no competing interests.

Source: Hoeh B et al. Prostate. 2021 Sep 15. doi: 10.1002/pros.24235.

Key clinical point: Use of chemotherapy and survival has increased in contemporary patients with de novo metastatic prostate cancer vs historical patients.

Major finding: The rates of chemotherapy were not significantly different between 2004 and 2013 (P = .3). The chemotherapy rates increased from 17.2% to 24.7% between 2014 and 2016 (P = .04). After propensity score matching, the median overall survival was significantly longer in contemporary vs. historical patients (not reached vs 25 months; adjusted hazard ratio [aHR], 0.55; P < .001). Cancer-specific mortality also improved in contemporary patients (not reached vs. 26 months; aHR, 0.55; P < .001).

Study details: A retrospective study of 19,913 patients who had de novo metastatic prostate cancer between 2004 and 2016, divided between historical (2004-2013) and contemporary (2014-2016).

Disclosures: No funding source was identified for this work. The authors had no competing interests.

Source: Hoeh B et al. Prostate. 2021 Sep 15. doi: 10.1002/pros.24235.

Key clinical point: Bone-modifying agents (BMAs) are overused in the real world in patients with metastatic castration-sensitive prostate cancer (mCSPC).

Major finding: Receipt of BMAs was reported in 23.6% of patients within 180 days of diagnosis. The proportion of patients receiving BMAs within 180 days increased from 17.3% during 2007-2009 to 28.1% during 2012-2015.

Study details: A retrospective study of 2,627 patients with stage IV prostate cancer from the Surveillance, Epidemiology, and End Results-Medicare database, diagnosed between 2007 and 2015. Patients receiving BMAs before the diagnosis or with a history of hypercalcemia, osteoporosis, osteopenia, or bone fracture were not included.

Disclosures: This study was supported by the National Cancer Institute at the National Institutes of Health. The authors received awards, personal/consulting/advisory fees, grants, nonfinancial support, and/or research funding from various sources. Some authors reported stock ownerships in various companies.

Source: Mitchell AP et al. J Natl Cancer Inst. 2021 Oct 1. doi: 10.1093/jnci/djab196.

Key clinical point: Bone-modifying agents (BMAs) are overused in the real world in patients with metastatic castration-sensitive prostate cancer (mCSPC).

Major finding: Receipt of BMAs was reported in 23.6% of patients within 180 days of diagnosis. The proportion of patients receiving BMAs within 180 days increased from 17.3% during 2007-2009 to 28.1% during 2012-2015.

Study details: A retrospective study of 2,627 patients with stage IV prostate cancer from the Surveillance, Epidemiology, and End Results-Medicare database, diagnosed between 2007 and 2015. Patients receiving BMAs before the diagnosis or with a history of hypercalcemia, osteoporosis, osteopenia, or bone fracture were not included.

Disclosures: This study was supported by the National Cancer Institute at the National Institutes of Health. The authors received awards, personal/consulting/advisory fees, grants, nonfinancial support, and/or research funding from various sources. Some authors reported stock ownerships in various companies.

Source: Mitchell AP et al. J Natl Cancer Inst. 2021 Oct 1. doi: 10.1093/jnci/djab196.

Key clinical point: Bone-modifying agents (BMAs) are overused in the real world in patients with metastatic castration-sensitive prostate cancer (mCSPC).

Major finding: Receipt of BMAs was reported in 23.6% of patients within 180 days of diagnosis. The proportion of patients receiving BMAs within 180 days increased from 17.3% during 2007-2009 to 28.1% during 2012-2015.

Study details: A retrospective study of 2,627 patients with stage IV prostate cancer from the Surveillance, Epidemiology, and End Results-Medicare database, diagnosed between 2007 and 2015. Patients receiving BMAs before the diagnosis or with a history of hypercalcemia, osteoporosis, osteopenia, or bone fracture were not included.

Disclosures: This study was supported by the National Cancer Institute at the National Institutes of Health. The authors received awards, personal/consulting/advisory fees, grants, nonfinancial support, and/or research funding from various sources. Some authors reported stock ownerships in various companies.

Source: Mitchell AP et al. J Natl Cancer Inst. 2021 Oct 1. doi: 10.1093/jnci/djab196.

Key clinical point: Androgen-signaling inhibitors (ASIs) are associated with significant survival benefits in patients with metastatic castration-resistant prostate cancer (mCRPC) with luminal tumor subtype.

Major finding: ASI treatment was associated with an improved overall survival in patients with luminal tumors (hazard ratio [HR], 0.27; P < .001), but not in those with basal tumors (HR, 0.62; P = .07).

Study details: A retrospective study of 4 patient cohorts (n=634) with mCRPC.

Disclosures: This study was funded by grants from the Department of Defense, Stand Up To Cancer-Prostate Cancer Foundation, Prostate Cancer Foundation, Movember Foundation, UCSF Benioff, Swedish Research Council, National Cancer Institute, and University of Wisconsin Carbone Cancer Center. The authors received consulting/advisory fees, research funding, and grants outside this work. Some authors reported pending patents and/or being employed with pharmaceutical companies.

Source: Aggarwal R et al. JAMA Oncol. 2021 Sep 23. doi: 10.1001/jamaoncol.2021.3987.

Key clinical point: Androgen-signaling inhibitors (ASIs) are associated with significant survival benefits in patients with metastatic castration-resistant prostate cancer (mCRPC) with luminal tumor subtype.

Major finding: ASI treatment was associated with an improved overall survival in patients with luminal tumors (hazard ratio [HR], 0.27; P < .001), but not in those with basal tumors (HR, 0.62; P = .07).

Study details: A retrospective study of 4 patient cohorts (n=634) with mCRPC.

Disclosures: This study was funded by grants from the Department of Defense, Stand Up To Cancer-Prostate Cancer Foundation, Prostate Cancer Foundation, Movember Foundation, UCSF Benioff, Swedish Research Council, National Cancer Institute, and University of Wisconsin Carbone Cancer Center. The authors received consulting/advisory fees, research funding, and grants outside this work. Some authors reported pending patents and/or being employed with pharmaceutical companies.

Source: Aggarwal R et al. JAMA Oncol. 2021 Sep 23. doi: 10.1001/jamaoncol.2021.3987.

Key clinical point: Androgen-signaling inhibitors (ASIs) are associated with significant survival benefits in patients with metastatic castration-resistant prostate cancer (mCRPC) with luminal tumor subtype.

Major finding: ASI treatment was associated with an improved overall survival in patients with luminal tumors (hazard ratio [HR], 0.27; P < .001), but not in those with basal tumors (HR, 0.62; P = .07).

Study details: A retrospective study of 4 patient cohorts (n=634) with mCRPC.

Disclosures: This study was funded by grants from the Department of Defense, Stand Up To Cancer-Prostate Cancer Foundation, Prostate Cancer Foundation, Movember Foundation, UCSF Benioff, Swedish Research Council, National Cancer Institute, and University of Wisconsin Carbone Cancer Center. The authors received consulting/advisory fees, research funding, and grants outside this work. Some authors reported pending patents and/or being employed with pharmaceutical companies.

Source: Aggarwal R et al. JAMA Oncol. 2021 Sep 23. doi: 10.1001/jamaoncol.2021.3987.

Key clinical point: External beam radiation therapy (EBRT) does not show a survival benefit in newly diagnosed elderly patients with metastatic prostate cancer.

Major finding: Patients who received EBRT vs. those who did not showed similar overall survival (hazard ratio [HR], 0.97; P = .6) and cancer-specific survival (HR, 1.04; P = .4).

Study details: A retrospective study of 6,556 patients, aged 75 years and above, with metastatic prostate cancer identified from the Surveillance, Epidemiology and End Results database between 2004 and 2016, of which 1,105 received EBRT.

Disclosures: No study source was identified for this work. The authors declared no conflict of interests.

Source: Wenzel M et al. Prostate. 2021 Oct 11. doi: 10.1002/pros.24249.

Key clinical point: External beam radiation therapy (EBRT) does not show a survival benefit in newly diagnosed elderly patients with metastatic prostate cancer.

Major finding: Patients who received EBRT vs. those who did not showed similar overall survival (hazard ratio [HR], 0.97; P = .6) and cancer-specific survival (HR, 1.04; P = .4).

Study details: A retrospective study of 6,556 patients, aged 75 years and above, with metastatic prostate cancer identified from the Surveillance, Epidemiology and End Results database between 2004 and 2016, of which 1,105 received EBRT.

Disclosures: No study source was identified for this work. The authors declared no conflict of interests.

Source: Wenzel M et al. Prostate. 2021 Oct 11. doi: 10.1002/pros.24249.

Key clinical point: External beam radiation therapy (EBRT) does not show a survival benefit in newly diagnosed elderly patients with metastatic prostate cancer.

Major finding: Patients who received EBRT vs. those who did not showed similar overall survival (hazard ratio [HR], 0.97; P = .6) and cancer-specific survival (HR, 1.04; P = .4).

Study details: A retrospective study of 6,556 patients, aged 75 years and above, with metastatic prostate cancer identified from the Surveillance, Epidemiology and End Results database between 2004 and 2016, of which 1,105 received EBRT.

Disclosures: No study source was identified for this work. The authors declared no conflict of interests.

Source: Wenzel M et al. Prostate. 2021 Oct 11. doi: 10.1002/pros.24249.

Key clinical point: In patients with localized prostate cancer, robot-assisted laparoscopic prostatectomy (RALP) vs open retropubic radical prostatectomy (RRP) has similar prostate cancer-specific mortality (PCSM) and lower risk for erectile dysfunction in the long term.

Major finding: At 8 years, urinary incontinence was not significantly different between RALP and RRP groups. Erectile dysfunction was significantly lower in the RALP group (66% vs 70%; adjusted risk ratio, 0.93; 95% confidence interval [CI], 0.87-0.99). PCSM was significantly lower in the RALP group (adjusted hazard ratio, 0.56; 95% CI, 0.34-0.93).

Study details: A prospective, controlled, nonrandomized trial of 4,003 patients with localized prostate cancer who were randomly assigned to either RALP and RRP between 2008 and 2011.

Disclosures: This work was supported by the Swedish Cancer Society, Swedish Research Council, Region Västra Götaland, Sahlgrenska University Hospital, Mrs. Mary von Sydow Foundation, Anna and Edwin Berger Foundation, Stockholm County Council, and Swedish Medical Association. The authors declared no competing interests.

Source: Lantz A et al. Eur Urol. 2021 Sep 15. doi: 10.1016/j.eururo.2021.07.025.

Key clinical point: In patients with localized prostate cancer, robot-assisted laparoscopic prostatectomy (RALP) vs open retropubic radical prostatectomy (RRP) has similar prostate cancer-specific mortality (PCSM) and lower risk for erectile dysfunction in the long term.

Major finding: At 8 years, urinary incontinence was not significantly different between RALP and RRP groups. Erectile dysfunction was significantly lower in the RALP group (66% vs 70%; adjusted risk ratio, 0.93; 95% confidence interval [CI], 0.87-0.99). PCSM was significantly lower in the RALP group (adjusted hazard ratio, 0.56; 95% CI, 0.34-0.93).

Study details: A prospective, controlled, nonrandomized trial of 4,003 patients with localized prostate cancer who were randomly assigned to either RALP and RRP between 2008 and 2011.

Disclosures: This work was supported by the Swedish Cancer Society, Swedish Research Council, Region Västra Götaland, Sahlgrenska University Hospital, Mrs. Mary von Sydow Foundation, Anna and Edwin Berger Foundation, Stockholm County Council, and Swedish Medical Association. The authors declared no competing interests.

Source: Lantz A et al. Eur Urol. 2021 Sep 15. doi: 10.1016/j.eururo.2021.07.025.

Key clinical point: In patients with localized prostate cancer, robot-assisted laparoscopic prostatectomy (RALP) vs open retropubic radical prostatectomy (RRP) has similar prostate cancer-specific mortality (PCSM) and lower risk for erectile dysfunction in the long term.

Major finding: At 8 years, urinary incontinence was not significantly different between RALP and RRP groups. Erectile dysfunction was significantly lower in the RALP group (66% vs 70%; adjusted risk ratio, 0.93; 95% confidence interval [CI], 0.87-0.99). PCSM was significantly lower in the RALP group (adjusted hazard ratio, 0.56; 95% CI, 0.34-0.93).

Study details: A prospective, controlled, nonrandomized trial of 4,003 patients with localized prostate cancer who were randomly assigned to either RALP and RRP between 2008 and 2011.

Disclosures: This work was supported by the Swedish Cancer Society, Swedish Research Council, Region Västra Götaland, Sahlgrenska University Hospital, Mrs. Mary von Sydow Foundation, Anna and Edwin Berger Foundation, Stockholm County Council, and Swedish Medical Association. The authors declared no competing interests.

Source: Lantz A et al. Eur Urol. 2021 Sep 15. doi: 10.1016/j.eururo.2021.07.025.

Key clinical point: Adding abiraterone plus prednisone to androgen deprivation therapy (ADT) following definitive treatment in patients with biochemically recurrent castration-naïve prostate cancer prolongs prostate-specific antigen (PSA)-free survival (PSA less than 0.2 ng/mL).

Major finding: Abiraterone and prednisone plus ADT vs ADT alone significantly improved PSA-free survival (27.0 months vs 19.9 months; hazard ratio, 0.64; 95% confidence interval, 0.47-0.87).

Study details: A phase 2, randomized, open-label trial of 200 patients with nonmetastatic biochemically recurrent castration-naïve prostate cancer who were randomly assigned to either abiraterone plus prednisone to ADT or ADT alone following definitive treatment.

Disclosures: This study was funded by the Prostate Cancer Foundation, Janssen Research, Koch Center for Applied Biology, and Alexander & Eckstein Labs. The authors received research grant/funding, honoraria, advisory/consulting fees, and travel expenses. Dr. Subudhi SK declared ownership interest with Apricity Health.

Source: Spetsieri N et al. Eur J Cancer. 2021 Sep 15. doi: 10.1016/j.ejca.2021.06.017.

Key clinical point: Adding abiraterone plus prednisone to androgen deprivation therapy (ADT) following definitive treatment in patients with biochemically recurrent castration-naïve prostate cancer prolongs prostate-specific antigen (PSA)-free survival (PSA less than 0.2 ng/mL).

Major finding: Abiraterone and prednisone plus ADT vs ADT alone significantly improved PSA-free survival (27.0 months vs 19.9 months; hazard ratio, 0.64; 95% confidence interval, 0.47-0.87).

Study details: A phase 2, randomized, open-label trial of 200 patients with nonmetastatic biochemically recurrent castration-naïve prostate cancer who were randomly assigned to either abiraterone plus prednisone to ADT or ADT alone following definitive treatment.

Disclosures: This study was funded by the Prostate Cancer Foundation, Janssen Research, Koch Center for Applied Biology, and Alexander & Eckstein Labs. The authors received research grant/funding, honoraria, advisory/consulting fees, and travel expenses. Dr. Subudhi SK declared ownership interest with Apricity Health.

Source: Spetsieri N et al. Eur J Cancer. 2021 Sep 15. doi: 10.1016/j.ejca.2021.06.017.

Key clinical point: Adding abiraterone plus prednisone to androgen deprivation therapy (ADT) following definitive treatment in patients with biochemically recurrent castration-naïve prostate cancer prolongs prostate-specific antigen (PSA)-free survival (PSA less than 0.2 ng/mL).

Major finding: Abiraterone and prednisone plus ADT vs ADT alone significantly improved PSA-free survival (27.0 months vs 19.9 months; hazard ratio, 0.64; 95% confidence interval, 0.47-0.87).

Study details: A phase 2, randomized, open-label trial of 200 patients with nonmetastatic biochemically recurrent castration-naïve prostate cancer who were randomly assigned to either abiraterone plus prednisone to ADT or ADT alone following definitive treatment.

Disclosures: This study was funded by the Prostate Cancer Foundation, Janssen Research, Koch Center for Applied Biology, and Alexander & Eckstein Labs. The authors received research grant/funding, honoraria, advisory/consulting fees, and travel expenses. Dr. Subudhi SK declared ownership interest with Apricity Health.

Source: Spetsieri N et al. Eur J Cancer. 2021 Sep 15. doi: 10.1016/j.ejca.2021.06.017.