Endocrinology

Baseline testosterone modifies docetaxel mortality benefit in nonmetastatic high-risk prostate cancer.

In two randomized-trial cohorts, adding docetaxel to RT and ADT reduced all-cause mortality only in men with baseline normal testosterone. A significant treatment-by-testosterone interaction was present in both discovery and validation cohorts (p=.048 and p=.042). Patients with PSA >20 ng/mL, T3/4 disease, or Gleason 9/10 and normal testosterone derived most benefit. These data support considering baseline testosterone as a predictive biomarker when selecting docetaxel for otherwise healthy high-risk nonmetastatic prostate cancer. 1

High prevalence of low testosterone among evaluated infertile men with normal sperm concentration; obesity predicts deficiency.

In 3,147 infertile men with sperm ≥15 million/mL, 77.2% lacked hormonal evaluation, and 24.1% of tested men had low testosterone (<300 ng/dL). Higher BMI and lower estradiol independently predicted low testosterone (BMI OR 1.083 per unit; obesity OR 1.725). Endocrine assessment rates varied by provider specialty, suggesting missed opportunities for diagnosis. Consider routine hormonal screening in infertile men, particularly those with obesity or metabolic risk factors, because low testosterone was common and treatable. 2

CHW-led, tablet-assisted diabetes care modestly improved HbA1c and engagement versus facility referral in rural Lesotho.

In a cluster-RCT of 103 participants, CHWs using tablet decision support achieved mean HbA1c 6.5% versus 7.1% with facility referral at 12 months (adjusted difference -0.46%, 95% CI -1.14 to 0.22). Engagement in care was higher with the CHW-led model and no important safety differences were reported. The effect was modest and CIs include small or null effects, so findings require confirmation in larger trials. In similar low-resource settings, supervised CHW programs with digital guidance may be a pragmatic option to improve diabetes access and control. 3