Prostate cancer therapy that lowers testosterone levels does not improve survival in elderly men with early-stage prostate cancer, compared with conservative management, US researchers have found.
"For the majority of men with incident prostate cancer, 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)," explain Dr. Siu-Long Yao, from Robert Wood Johnson Medical School in New Brunswick, New Jersey, and colleagues.
However, they add: "Despite a lack of data, increasing numbers of patients are receiving primary androgen deprivation therapy as an alternative to surgery, radiation, or conservative management for the treatment of localised prostate cancer."
The researchers studied data on 19,271 men over 66 years old who were diagnosed with localized prostate cancer between 1992 and 2002 and who received either androgen deprivation therapy (7,867) or conservative management (11,404). By December 2006, 1,560 of the men had died from prostate cancer.
Men who received androgen deprivation therapy were 17% more likely to die of prostate cancer during the monitoring period than those who received conservative management.
Men who received androgen deprivation therapy were also just as likely to die of other causes as those who received conservative management.
"Primary androgen deprivation therapy is not associated with improved survival among the majority of elderly men with localized prostate cancer when compared with conservative management," Dr. Yao and team conclude.
They add: "The significant adverse effects and costs associated with primary androgen deprivation therapy, along with our finding of a lack of overall survival benefit, suggest that clinicians should carefully consider the rationale for initiating primary androgen deprivation therapy in elderly patients with T1-T2 prostate cancer."
JAMA 2008; 300: 173-181. Click here to read full article.