Overused Prostate Cancer Treatment Appeared Ineffective

Androgen deprivation therapy for prostate cancer did not improve long term survival rates

(RxWiki News) Prostate cancer is a sensitive subject for men. Some of the common treatment options come with very personal potential side effects like loss of sexual desire or impotence.

A new long-term study has questioned the effectiveness of a common hormone therapy that suppresses male hormones like testosterone.

The researchers found that hormone suppression therapy had virtually no effect on 15-year prostate cancer survival rates.

Further, an accompanying editorial suggested that physicians are overusing hormone therapy in prostate cancer, which will likely affect one in six men.

"Discuss prostate cancer treatment options with your oncologist."

Grace Lu-Yao, MPH, PhD, of the Rutgers Cancer Institute of New Jersey and Robert Wood Johnson Medical School in New Brunswick, New Jersey, was the lead author of this study.

Dr. Lu-Yao and her research team set out to analyze how the use of androgen-deprivation therapy in treatment of localized, early-stage prostate cancer affected patient outcomes.

The prostate is a walnut-sized gland that makes fluid for semen, which carries sperm in men. Prostate cancer is a slow-growing and common form of cancer that can spread to other parts of the body.

Androgen-deprivation therapy (ADT) is a prostate cancer treatment that reduces the level of male hormones called androgens in the body. Androgens, including testosterone, are targeted because they foster growth of prostate cancer cells. Side effects of ADT may include reduced libido, impotence, hot flashes, fatigue and depression among other issues.

Dr. Lu-Yao and colleagues used Surveillance, Epidemiology and End Results (SEER) Program data to link ADT to long-term survival rates in American patients.

The study groups included 66,717 Medicare patients, 66 years of age and older, who were diagnosed between 1992 and 2009 in several geographic areas.

Those patients did not receive surgery or therapy within 180 days of initial diagnosis.

In patients with moderately differentiated cancer, an intermediate tumor medical classification, the 15-year prostate cancer survival rate was 90.6 percent in areas with both high and low ADT use.

In patients with more severe prostate cancer, the 15-year prostate cancer survival rate was 78.6 percent in high ADT use areas and 78.5 percent in low use areas.

The researchers found that the very minimal impact on long-term prostate cancer survival called into question the effectiveness of ADT.

"Health care providers and their older patients should carefully weigh our findings against the considerable adverse effects and costs associated with primary ADT before initiating this therapy in men with clinically localized prostate cancer," Dr. Lue-Yao and colleagues wrote.

This study was published July 14 in the JAMA Internal Medicine.

In an editorial examining the study by Dr. Lu-Yao and team, Quoc-Dien Trinh, MD, FRSC, an instructor of surgery at Harvard Medical School, noted that “ADT confers neither overall or disease-specific advantage,” based on the study results.

“Perhaps the most important contribution of the study,” Dr. Trinh wrote, “is to demonstrate that use of primary ADT in the setting of localized prostate cancer remains alarmingly high as recently as 2009, regardless of evidence indicating the potential for harm and discouraging its use.”

Grant funding was provided by the National Cancer Institute and Cancer Institute of New Jersey.

Dr. Lu-Yao disclosed paid employment with Merck Research Laboratory.

Review Date: 
July 14, 2014