Timing of Radiotherapy (RT) after Radical Prostatectomy (RP): Long-term outcomes in the RADICALS-RT trial [NCT00541047]

Background The optimal timing of radiotherapy (RT) after radical prostatectomy for prostate cancer has been uncertain. RADICALS-RT compared efficacy and safety of adjuvant RT versus an observation policy with salvage RT for PSA failure. Methods RADICALS-RT was a randomised controlled trial enrolling patients with ≥1 risk factor (pT3/4, Gleason 7-10, positive margins, pre-op PSA≥10ng/ml) for recurrence after radical prostatectomy. Patients were randomised 1:1 to adjuvant RT (“Adjuvant-RT”) or an observation policy with salvage RT for PSA failure (“Salvage-RT”) defined as PSA≥0.1ng/ml or 3 consecutive rises. Stratification factors were Gleason score, margin status, planned RT schedule (52.5Gy/20 fractions or 66Gy/33 fractions) and treatment centre. The primary outcome measure was freedom-from-distant metastasis, designed with 80% power to detect an improvement from 90% with Salvage-RT (control) to 95% at 10yr with Adjuvant-RT. Secondary outcome measures were bPFS, freedom-from-non-protocol hormone therapy, safety and patient-reported outcomes. Standard survival analysis methods were used; HR<1 favours Adjuvant-RT. Findings Between Oct-2007 and Dec-2016, 1396 participants from UK, Denmark, Canada and Ireland were randomised: 699 Salvage-RT, 697 Adjuvant-RT. Allocated groups were balanced with median age 65yr. 93% (649/697) Adjuvant-RT reported RT within 6m after randomisation; 39% (270/699) Salvage-RT reported RT during follow-up. Median follow-up was 7.8 years. With 80 distant metastasis events, 10yr FFDM was 93% for Adjuvant-RT and 90% for Salvage-RT: HR=0.68 (95%CI 0·43–1·07, p=0·095). Of 109 deaths, 17 were due to prostate cancer. Overall survival was not improved (HR=0.980, 95%CI 0.667–1.440, p=0.917). Adjuvant-RT reported worse urinary and faecal incontinence one year after randomisation (p=0.001); faecal incontinence remained significant after ten years (p=0.017). Interpretation Long-term results from RADICALS-RT confirm adjuvant RT after radical prostatectomy increases the risk of urinary and bowel morbidity, but does not meaningfully improve disease control. An observation policy with salvage RT for PSA failure should be the current standard after radical prostatectomy

Personal life satisfaction as a measure of societal happiness is an individualistic presumption: Evidence from fifty countries

Numerous studies document that societal happiness is correlated with individualism, but the nature of this phenomenon remains understudied. In the current paper, we address this gap and test the reasoning that individualism correlates with societal happiness because the most common measure of societal happiness (i.e., country-level aggregates of personal life satisfaction) is individualism-themed. With the data collected from 13,009 participants across fifty countries, we compare associations of four types of happiness (out of which three are more collectivism-themed than personal life satisfaction) with two different measures of individualism. We replicated previous findings by demonstrating that societal happiness measured as country-level aggregate of personal life satisfaction is correlated with individualism. Importantly though, we also found that the country-level aggregates of the collectivism-themed measures of happiness do not tend to be significantly correlated with individualism. Implications for happiness studies and for policy makers are signaled

The intergenerational transmission of parenting: introduction to the special section

Long-standing interest in the intergenerational transmission of parenting has stimulated work focused on child maltreatment, harsh parenting, and warm–supportive rearing. In addition to documenting significant, even if modest, continuity in parenting across generations, research in this area has addressed questions of mediation and moderation. This special section extends work in this general area, with 2 studies further chronicling intergenerational transmission and 3 further illuminating mechanisms through which parenting in 1 generation is repeated in a subsequent generation. Lacking, however, is high-quality work highlighting the conditions under which parenting is not transmitted across generations

The intergenerational transmission of parenting: closing comments for the special section

The 5 studies in this special section both confirm prior findings regarding the intergenerational transmission of parenting and provide important new evidence regarding the intergenerational transmission of positive parenting and the developmental mediators that seem involved in that transmission. Consistent with earlier research, the findings suggest that harsh parenting in the 1st generation (G1) predicts similar behavior in the 2nd generation (G2) primarily through the exacerbation of G2 conduct problems. In contrast, replicated findings in this set of articles indicate that intergenerational continuities in positive parenting likely stem from the social and academic competencies such parenting engenders in the next generation. In addition, these 5 studies demonstrate that the evidence for intergenerational continuity in parenting is robust across diverse study samples, different types of measurement, different lengths of time, and after the introduction of a variety of control variables. Important next steps in this area of inquiry should include the study of moderator variables that will explain discontinuities as well as continuities in G1 and G2 parenting. Also important will be research on genetic and epigenetic processes that contribute to similarities and dissimilarities in parenting across generations