Androgen deprivation therapy for localized prostate cancer not associated with improved survival

A therapy that involves depriving the prostate gland the male hormone androgen is not associated with improved 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.

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.

Source: JAMA and Archives Journals

Related stories:

New catheter-less technique may ease the pain and discomfort of prostate cancer recovery
To ease the pain of recovery following prostate cancer surgery, physician-scientists have developed an innovative and patient-friendly approach that eliminates the use of a penile urinary catheter. The new patentable technique, used in conjunction with robotic prostatectomy -- the surgical removal of the prostate -- eliminates the pain and discomfort associated with the standard catheter.
Raised risk of prostate cancer in Black men
(PhysOrg.com) -- Black men living in England are three times more likely to get prostate cancer than White men and tend to be diagnosed five years younger, researchers have found.
Disease diagnosis in just 15 minutes
Testing for diseases such as cancer and multiple sclerosis could soon be as simple as using a pregnancy testing kit.
Deactivating a cancer growth promoter
Three enzymes called phosphatases that shut down a molecule called SRC-3 (steroid receptor coactivator 3) could provide a new pathway for fighting cancer, particularly tumors of the breast and prostate, said researchers at Baylor College of Medicine in a report that appears in the current issue of the journal Molecular Cell.
Racial disparities decline for cancer in Missouri
Cancer death rates in the United States are highest among African Americans, but a new report shows that in Missouri the disparity in cancer incidence and death between African Americans and whites is declining. As a result, cancer incidence (the rate of newly diagnosed cases) between the races is equal, although the death rate will probably remain higher for African Americans for some time.
Study: When/if to start hormones for prostate cancer patients whose PSA rises after radiation
A new Fox Chase Cancer Center study suggests men with early stage prostate cancer treated with radiation therapy should begin hormone therapy immediately if their PSA level rises quickly and doubles within six months at any time after treatment. The study also supports foregoing hormones if the PSA doesn't rise as quickly. Both findings suggest a change in the practice of prescribing hormones is warranted.
Radiation added to hormone therapy increases survival for men with prostate cancer
For men with locally advanced prostate cancer the addition of radiation treatment to anti-androgen hormone therapy reduces the risk of dying of prostate cancer by 50 percent compared to those who have anti-androgen hormone treatment alone, according to a randomized study presented September 22, 2008, at the American Society for Therapeutic Radiology and Oncology's 50th Annual Meeting in Boston.
More parents ponder cancer gene tests for kids
(AP) -- Women are going for breast cancer gene testing in record numbers, forcing more parents to face a tough question: Should we test the kids? About 100,000 tests for breast cancer gene mutations were done last year, double the number in 2005. The trend may grow even more because of widening insurance coverage and a new law banning genetic discrimination.

News discussion:

Medicine & Health news