An article published in the July 9 issue of JAMA finds that elderly men with localized prostate cancer had no improvement in survival when treated with a therapy that deprives the prostate gland of androgen (a male hormone) compared to conservative management of the disease.
Among men, prostate cancer is the most common cancer after skin cancer and is the second leading cause of cancer deaths after lung cancer. “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,” write Grace L. Lu-Yao, M.P.H., Ph.D. (Cancer Institute of New Jersey, UMDNJ-Robert Wood Johnson Medical School, Piscataway, N.J.) and colleagues, authors of the study. Although there is a lack of evidence that clearly shows the efficacy of PADT, the procedure was the second most common treatment, after surgery, for localized prostate cancer according to a 1999-2001 survey.
To add to the small body of extant research, Lu-Yao and colleagues studied 19,271 men (age 66 or older) who were diagnosed between 1992 and 2002 with localized (stages T1-T2) prostate cancer. The focus of the research was to analyze the potential association between PADT and prostate cancer-specific survival and overall survival. None of the patients received a prostatectomy or other definitive local therapy, but 7,867 (41%) received PADT and 11,404 received conservative management treatment that did not include PADT. Patients were followed up through December 2006 for all-cause mortality (11,045 deaths) and through December 2004 for prostate cancer-specific mortality (1,560 deaths).
Lu-Yao and colleagues found that the 10-year prostate cancer-specific survival for receivers of PADT was 80.1%, compared to 82.6% for those who were treated with conservative managements. That is, PADT was associated with a lower 10-year prostate cancer-specific survival compared to conservative management. In addition, the hormone depriving therapy was not associated with a better 10-year overall survival compared to conservative management. A subgroup analysis that focused on men with poorly differentiated cancer resulted in an association between PADT and an improved 10-year prostate cancer-specific survival (59.8% for PADT vs. 54.3%) but not an association between PADT and overall survival (17.3% for PADT vs.15.3%).
The authors conclude that, “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.”
Survival Following Primary Androgen Deprivation Therapy Among Men With Localized Prostate Cancer
Grace L. Lu-Yao; Peter C. Albertsen; Dirk F. Moore; Weichung Shih; Yong Lin; Robert S. DiPaola; Siu-Long Yao
JAMA (2008). 300: pp. 173 – 181.
Written by: Peter M Crosta