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Use of metformin did not reduce progression in male patients with low-risk prostate cancer on active surveillance, though the observed adverse effects (AEs) in patients with obesity may warrant further investigation, according to results from the randomized, double-blind phase 3 MAST trial (NCT01864096) published in the Journal of Clinical Oncology.

Among the 408 eligible patients who were enrolled in the trial and randomly assigned to either the metformin arm (n = 205) or the placebo arm (n = 203), 144 experienced either therapeutic or pathologic progression, with 70 cases of progression in the metformin arm and 74 in the placebo arm. In the metformin arm and placebo arm, the progression-free survival (PFS) probability was 94% (95% CI, 90%-97%) and 96% (95% CI, 93%-99%), respectively, at 12 months, 62% (95% CI, 54%-70%) and 69% (95% CI, 62%-76%) at 24 months, and 58% (95% CI, 51%-67%) and 60% (95% CI, 53%-68%) at 36 months. Per the Kaplan-Meier survival curves, there was no significant difference in time to progression between the treatment arms (P = .59). Notably, the HR for progression in the metformin group was 1.09 (95% CI, 0.79-1.52).

Overall, pathologic progression was observed in 136 patients, with 66 instances in the metformin arm and 70 in the placebo arm. In the metformin arm and placebo arm, the PFS probability was 94% (95% CI, 91%-98%) and 96% (95% CI, 94%-99%), respectively, at 12 months, 64% (95% CI, 57% to 72%) and 70% (95% CI, 63% to 77%) at 24 months, and 58% (95% CI, 51% to 67%) and 61% (95% CI, 54% to 69%) at 36 months. No statistically significant difference was observed (P = .66; HR, 0.77; 95% CI, 0.77-1.51).

A planned a priori analysis was stratified by body mass index (BMI). Patients with a BMI of 30 or greater who were assigned to the metformin group had a higher risk of pathologic progression per Kaplan-Meier survival curves.The HR for progression in the metformin group was 2.36 (95% CI, 1.21-4.59; P = .0092), highlighting the significantly increased risk associated with metformin use in this subgroup, whereas in patients with a BMI less than 30, the HR was 0.82 (95% CI, 0.55-1.23; P = .33). In the Cox proportional hazards model including the treatment group, BMI category, and interaction term, the interaction between BMI and treatment arm was significant (P = .0092).

Overall, the HR for progression in the metformin group was 1.09 (95% CI, 0.78-1.53; P = .60). In the BMI less than 30 and BMI of 30 or higher subgroups, the HRs were 0.86 (95% CI, 0.58-1.29; P = .48) and 2.19 (95% CI, 1.13-4.26; P = .021), respectively.

Further, therapeutic progression was observed in 45 patients, with 27 cases in the metformin arm and 18 in the placebo arm. In the metformin and placebo arms, the PFS probability was 97% (95% CI, 94% to 99%) and 98% (95% CI, 97% to 100%), respectively, at 12 months, 83% (95% CI, 77% to 89%) and 91% (95% CI, 87% to 95%) at 24 months, and 81% (95% CI, 75% to 88%) and 90% (95% CI, 86% to 95%) at 36 months. The difference between the 2 arms was not significant (HR, 1.73; 95% CI, 0.95-3.14; P = .068). The per-protocol sensitivity analysis revealed that the HR for the metformin group was 1.76 (95% CI, 0.97-3.20; P = .063).

“In conclusion, these findings demonstrate no benefit in adding metformin as a means of delaying progression among patients with low-risk [prostate cancer] on [active surveillance]. Furthermore, a potentially harmful effect was noted among obese men,” wrote lead study author Neil E Fleshner, MD, MPH, FRCSC, of the Division of Urologic Oncology at Princess Margaret Cancer Center of University Health Network in Toronto, Ontario, Canada.

A total of 408 patients were included in the analysis and randomly assigned, in a 1:1 ratio, to either receive metformin at 850 mg once daily, escalating to 850 mg twice daily over 1 month, or receive placebo. Eligible patients were between 18 and 80 years old with a biopsy-confirmed, low-risk, localized prostate cancer, and decided to undertake expectant management as their primary treatment. Those who received prior prostate cancer treatment, had any prior use of metformin, sulfonylureas, thiazolidinediones, or insulin, and a diagnosis of type 1 or 2 diabetes were excluded from participation.

The median age of patients was 62.0 years (IQR, 57.5-67.0), and 93.5% of patients were White. Most patients had clinical stage T1c disease (93.7%). The mean baseline BMI was 28.0 kg/m² (SD, 4.0), and 73.4% were considered nonobese and defined as having a BMI less than 30.

The primary end point of the trial was time to progression, defined as the earliest occurrence of therapeutic or pathologic progression.

The B0 rate at 18 months was 27.3% in the metformin group and 28.1% in the placebo group (P = .880); at 36 months, it was 41.0% vs 31.1%, respectively (P = .181).

Regarding safety, the most reported adverse effects (AEs) were gastrointestinal, which occurred more frequently in the metformin group. Diarrhea occurred in 19% of the metformin group vs 8% of the placebo group, and nausea, dyspepsia, or abdominal pain occurred in 9% of the metformin group vs 1% of the placebo group. These AEs were typically mild or moderate in severity, and no significant differences were observed in serious AEs between the 2 groups.

Reference

Fleshner NE, Bernardino RM, Izawa J, et al. Metformin active surveillance trial in low-risk prostate cancer. J Clin Oncol. 2025;43(34):3662-3671. doi:10.1200/JCO-25-01070

The Australian dollar has been on a slow march down from a peak of 109 US cents achieved in July 2011.

The local currency approached 80 US cents during the depths of the COVID-19 emergency in February 2021.

Five years on, it has fallen roughly 12 per cent from that level, now at around 70 US cents.

The depreciation has been significant enough to benefit exporters, while providing a headwind for importers and travellers.

The local currency now sits at a crossroads, especially considering recent geopolitical events.

The key question now is, as it evolves, who will be the winners and losers?

What’s driving the dollar?

The value of the Australian dollar, or the “Aussie” as it’s known in market circles, is driven by several forces. 

They include the interest rate differential between the United States and Australia, the prices of commodities, geopolitical factors, and overall market sentiment.

And when looking specifically at the Australian-US dollar cross rate, the value of the greenback is also important.

While the Australian dollar has been in a steady decline over the past five years, it found strength in 2025, gaining roughly 8 per cent.

In trade-weighted terms, it has also moved from a low of 58.8 US cents in April 2025 to 62.3 in December 2025.

This has largely been driven by firming commodity prices and a weakening US dollar.

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Weaker greenback

It is the weaker greenback that has been central to the Australian dollar’s gradual increase over the past year.

Indeed, the US dollar index, which tracks the value of the greenback, fell from around 110 in January to as low as 96 in July.

But analysts say further Australian dollar strength will require more than weakness in the US dollar.

“The Aussie dollar is up about 8 per cent for the year while the US dollar index is down about 9 per cent, which highlights that global investors looking for an alternative to the greenback are not enthused by the Aussie, notwithstanding the RBA’s hawkishness,” InTouch Capital Markets senior currency strategist Sean Callow said.

After bottoming again in September, the Australian dollar found further strength for a few months, but since mid-November, a clear narrative has emerged: US interest rates could fall further still, while Australian interest rates may increase.

There’s a positive correlation between a nation’s interest rates and the value of its currency.

The potential for easier US monetary policy and tighter Australian monetary policy is pushing the value of the Aussie dollar higher.

“The Aussie dollar would likely appreciate, especially against low-yield peers, should the RBA remain hawkish amid inflation challenges,” RSM Australia economist Devika Shivadekar said.

But Mr Callow is not expecting the Australian dollar to surge past 70 US cents, for example.

“But a lacklustre global economy should limit Aussie dollar gains to around 0.69 to 0.70 [US cents].”

Mr Shivadekar thinks China’s economy, which is key to global economic growth, will be front and centre in contributing to that “lacklustre” performance.

“Key risks … stem from a China slowdown hurting commodity demand, global risk-off shocks, and a widening rate gap if the Fed/others stay tighter for longer,” she said.

Commodities rising

The Australian dollar’s value also shifts with commodity markets.

While the price of iron ore has been steadily increasing since July, it’s the price of gold and silver that seem to be providing support for the local currency.

While the prices of precious metals have consolidated over the past couple of weeks, their years-long bull run has been impressive.

Gold has surged about 65 per cent in 2025.

Gold is a traditional haven asset that performs well during periods of economic and geopolitical uncertainty and can fall in price when the opposite is true.

Silver rocketed up 182 per cent last calendar year, driven by its critical mineral status, supply shortages and rising industrial and investor demand.

Winners and losers

Businesses that import inventory will be hoping the recent ascent of the Australian dollar will continue.

The rising Aussie reduces their costs.

Exporters, however, will likely want to see the Australian dollar remain firmly under 70 US cents.

The sweet spot for exporters, analysts say, is roughly 65 US cents.

Meanwhile, Australians heading overseas will be keen to see the Australian dollar appreciate further.

The Australian dollar performed very well for Australians in the wake of the global financial crisis of 2008/2009 by rising beyond parity with the US dollar.

And in July 2024, the Australian dollar hit a peak against the Japanese yen, which saw many flock to the country.

The dollar is now down roughly 4 per cent from those levels.

Where to from here?

So how is the Australian dollar expected to perform against the major currencies in the months ahead?

Movements against the yen will depend on Japan’s fiscal and monetary policies, while changes against the Chinese yuan may depend on Australian, US and Chinese trade policies.

The Reserve Bank and the US Federal Reserve’s interest rate decisions will move the Australian dollar against the US dollar.

“It’s easy to see further appreciation, as [a] hawkish RBA vs [a] more dovish US Federal Reserve and downward USD pressure could see the Australian dollar even get up to 70 US cents,” AMP deputy chief economist Diana Mousina said.

“Fair value is more like 72 US cents but it’s hard to see significant upside beyond 70 US as euro and yen benefit more from lower USD and [we need to see] stronger global growth, and China to see [a] higher Australian dollar.”

If US interest rates fall significantly from here and Australian interest rates rise, the dollar, analysts say, will likely move convincingly above 70 US cents.

And US President Donald Trump’s foray into Venezuela puts another spanner in the works of the currency market.

Brace for big moves in commodities prices and currencies in the coming days and months.

A lawsuit filed late last month took Chicago-based McDonald’s to task over the McRib sandwich, calling its name a form of false advertising.

The lawsuit was filed Dec. 23 in U.S. District Court in Chicago. Plaintiffs Peter Le of Baldwin Park, California; Charles Lynch of Poughkeepsie, New York; Dorien Baker of Chicago; and Darrick Wilson of Washington, D.C., sought class-action status in the lawsuit.

McDonald’s offers the McRib during limited windows with ad campaigns to announce their return each time, most recently starting this past November.

The lawsuit said McDonald’s has “cultivated a sense of anticipation around the McRib, leveraging its scarcity to drive sales across its many locations.”

As CBS News has reported before, the notorious 520-calorie sandwich contains just five simple ingredients: seasoned boneless pork dipped in BBQ sauce, sliced onions, and dill pickles in a toasted homestyle bun.

“When everything combines, you have BBQ pork sandwich perfection,” McDonald’s has said.

But the lawsuit alleged that fans of the sandwich assume they’re biting into pork rib meat, but the McRib does not really contain any.

Despite its name and distinctive shape — its meat patty has been deliberately crafted to resemble a rack of pork ribs—the McRib does not contain any actual pork rib meat at all,” the lawsuit said. “Instead, its meat patty is reconstructed using ground-up portions of lower-grade pork products such as, inter alia, pork shoulder, heart, tripe, and scalded stomach.”

The lawsuit said actual pork rib meat cuts — spareribs and baby back ribs — are premium cuts of pork that are more valuable than lower-quality cuts. Despite not containing any rib meat, the McRib is among the most expensive single-item options offered on the menu at McDonald’s, the lawsuit said.

“The name ‘McRib’ is a deliberate sleight of hand. By including the word “Rib” in the name of the sandwich, McDonald’s knowingly markets the sandwich in a way that deceives reasonable consumers, who reasonably (but mistakenly) believe that a product named the ‘McRib’ will include at least some meaningful quantity of actual pork rib meat, which commands a premium price on the market,” the lawsuit said. “McDonald’s does this despite knowing that the sandwich in fact does not contain any meaningful quantity of actual pork rib meat — indeed, none at all.”

The lawsuit said consumers are led to believe they’re eating rib meat when they’re eating a McRib, but are actually eating “a lower-quality restructured meat product that did not contain any actual pork rib meat.”

“Put simply: consumers have been materially misled en masse as a result of McDonald’s deceptive labeling and marketing into purchasing sandwiches that they would not otherwise have purchased, or would only have paid less for, had they known the truth,” the lawsuit said.

The lawsuit further alleged McDonald’s knows or should know that customers are being misled, given the name “McRib” and the way the sandwich’s patty is shaped to look like a pork rib.

The lawsuit accused McDonald’s of fraudulent omission or concealment, fraudulent misrepresentation, negligent misrepresentation, and other counts. It demanded an order “enjoining McDonald’s to desist from further deceptive naming, marketing and advertising practices with respect to the McRib and such other injunctive relief that the Court deems just and proper,” and an award of damages to the plaintiffs.

A response from McDonald’s was not immediately available.

McDonald’s first added the McRib to menus in Kansas City in 1981, according to CBS News Austin. 

The chain pulled it from its menu four years later, but the sandwich has become a cult favorite among McDonald’s loyalists in recent years. It was previously sold regionally before expanding to all of its U.S. restaurants in 2020, CBS News Austin reported.