Androgen Deprivation Does Not Improve Survival for
Seniors with Prostate Cancer
Conservative management of the disease does a better
job, says study
July
8, 2008 - A therapy that involves depriving the prostate gland of the
male hormone androgen does not improve survival for elderly men with
localized prostate cancer, compared to conservative management of the
disease, according to a study in the July 9 issue of JAMA. Which is good
news for researchers at Dana-Farber Cancer Institute that released a
study in February of 2007 warning this popular therapy may actually
increase the risk of death from heart disease for patients over age 65.
Prostate cancer is the most common nonskin cancer
and the second most common cause of cancer death among men.
“For the majority of men with incident prostate
cancer (approximately 85 percent), disease is diagnosed at localized
(T1-T2) stages, and standard treatment options include surgery,
radiation, or conservative management (i.e., deferral of treatment until
necessitated by disease signs or symptoms).
“Although not standard or sanctioned by major
groups or guidelines, an increasing number of clinicians and patients
have turned to primary androgen deprivation therapy (PADT) as an
alternative to surgery, radiation, or conservative management,
especially among older men,” the authors write.
In a 1999-2001 survey, PADT had become the second
most common treatment approach, after surgery, for localized prostate
cancer, despite a lack of data regarding PADT’s efficacy.
Grace L. Lu-Yao, M.P.H., Ph.D., of the Cancer
Institute of New Jersey, UMDNJ-Robert Wood Johnson Medical School,
Piscataway, N.J., and colleagues assessed the association between PADT
and disease-specific survival and overall survival in 19,271 men with
T1-T2 (localized) prostate cancer (diagnosed in 1992 – 2002).
The patients, age 66 years or older, did not
receive definitive local therapy (i.e., such as prostatectomy) for
prostate cancer.
Among the patients, 7,867 (41 percent) received
PADT, and 11,404 were treated with conservative management, not
including PADT.
During the follow-up period (through December 2006
for all-cause mortality and through December 2004 for prostate
cancer–specific mortality) there were 1,560 prostate cancer deaths and
11,045 deaths from all causes.
The researchers found that use of PADT for
localized prostate cancer was associated with lower 10-year prostate
cancer–specific survival (80.1 percent vs. 82.6 percent) and no increase
in 10-year overall survival compared with conservative management.
However, in a prespecified subset analysis, PADT
use in men with poorly differentiated cancer was associated with
improved 10-year prostate cancer–specific survival (59.8 percent vs.
54.3 percent) but not overall survival (17.3 percent vs. 15.3 percent).
“The significant adverse effects and costs
associated with PADT, along with our finding of a lack of overall
survival benefit, suggest that clinicians should carefully consider the
rationale for initiating PADT in elderly patients with T1-T2 prostate
cancer,” the authors conclude.
About Hormone (Androgen Deprivation)
Therapy
Hormone therapy is also called androgen deprivation
therapy (ADT) or androgen suppression therapy. The goal is to reduce
levels of the male hormones, called androgens, in the body. The main
androgens are testosterone and dihydrotestosterone (DHT). Androgens,
produced mainly in the testicles, stimulate prostate cancer cells to
grow. Lowering androgen levels often makes prostate cancers shrink or
grow more slowly. However, hormone therapy does not cure prostate
cancer.
Hormone therapy may be used in several situations:
● if you are not able to have surgery or
radiation or can't be cured by these treatments because the cancer has
already spread beyond the prostate gland
● if your cancer remains or comes back after
treatment with surgery or radiation therapy
● as an addition to radiation therapy as initial
treatment if you are at high risk for cancer recurrence
● before surgery or radiation to try and shrink
the cancer to make other treatments more effective
More at the American Cancer Society including more
on the various types of hormone therapy and the controversy –
click here.
Links to more SeniorJournal.com reports on
Prostate Cancer:
July
8, 2008 - A therapy that involves depriving the prostate gland of the
male hormone androgen does not improve survival for elderly men with
localized prostate cancer, compared to conservative management of the
disease, according to a study in the July 9 issue of JAMA. Which is good
news for researchers at Dana-Farber Cancer Institute that released a
study in February of 2007 warning this popular therapy may actually
increase the risk of death from heart disease for patients over age 65.