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Published on 9 July 2008

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Hormone therapy unhelpful

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A therapy that involves depriving the prostate gland of the male hormone androgen is not associated with improved survival for elderly men with localised prostate cancer, compared to conservative management of the disease, according to a study in the 9 July issue of the Journal of the American Medical Association (JAMA).

In a 1999-2001 survey, primary androgen deprivation therapy (PADT) had become the second most common treatment approach, after surgery, for localised prostate cancer, despite a lack of data regarding PADT’s efficacy.

Grace L Lu-Yao MPH PhD of the Cancer Institute of New Jersey, UMDNJ-Robert Wood Johnson Medical School and colleagues assessed the association between PADT and disease-specific survival and overall survival in 19,271 men with T1-T2 (localised) prostate cancer (diagnosed in 1992 — 2002).

The patients, aged 66 years or older, did not receive definitive local therapy (such as prostatectomy) for prostate cancer.

Among the patients 7,867 (41%) 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 localised prostate cancer was associated with lower 10-year prostate cancer—specific survival (80.1%  vs 82.6%) 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% vs 54.3%) but not overall survival (17.3% vs 15.3%).

The authors conclude: “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.”

JAMA



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