Hormone therapy as a primary cancer treatment for older men

The number of men receiving androgen deprivation therapy (ADT) as an alternative to surgery, radiation, or active surveillance for the treatment of localized prostate cancer has increased dramatically over the past several years, despite limited evidence showing a benefit. A recent study concluding that ADT does not extend survival compared with active surveillance may reverse that trend.

Using data from the Surveillance, Epidemiology, and End Results program and Medicare files, researchers identified 19,271 men diagnosed with localized prostate cancer during a 10-year period who did not undergo surgery or radiation. Of that group, 41% were treated with ADT, also called hormone therapy. The rest pursued active surveillance, a “wait-and-see” approach to treatment. The median age of participants was 77, and they were followed for nearly seven years, on average.

The researchers found no overall survival benefit for men who used ADT as their primary therapy for the treatment of prostate cancer. They also concluded that men who took hormones were actually more likely to die from prostate cancer than their untreated peers.

The findings don’t apply to everyone. All of the men in the study were at least 66 years old; results could vary for younger men. Also, other studies have supported the use of ADT in men with high-risk or advanced prostate cancer, which has spread beyond the prostate. Men suffering a recurrence of prostate cancer may also benefit from taking hormones.

Given these findings, as well as the expense and possible side effects of ADT — bone loss and fractures, diabetes, and heart trouble, to name a few — the researchers suggest that clinicians think twice before prescribing ADT as a primary therapy to older patients with early-stage disease.

SOURCE: Lu-Yao GL, Albertsen PC, Moore DF, et al. Survival Following Primary Androgen Deprivation Therapy Among Men With Localized Prostate Cancer. Journal of the American Medical Association 2008;300:173–81. PMID: 18612114.