A large retrospective analysis of nearly 67,000 Medicare patients shows that there is no evidence that treating men with early-stage prostate cancer with androgen-deprivation therapy (ADT) is beneficial in terms of survival from the cancer itself, nor in terms of overall survival.
The new study appears in the current JAMA Internal Medicine, and was led by Dr. Grace L. Lu-Yao, PhD MPH and colleagues from the Rutgers Robert Wood Johnson Medical School and the School of Public Health in New Jersey. The authors compared prostate-cancer specific and overall survival among men with localized prostate cancer who received ADT to those who had not. ADT includes either bilateral orchiectomy (surgical castration) or the use of luteinizing hormone-releasing hormone agonists or antagonists to suppress testosterone production (chemical castration).
While the theory sounded valid since the prostate is influenced by male hormones, androgens, the cancerous proliferation of prostate cells may well have become suppressed by removing androgenic stimulation there has in fact been no study-derived evidence that such treatment is beneficial for early-stage cancer. Indeed, other studies have shown a similar lack of effect, yet the procedure and treatment approach have remained commonplace. And since about one-quarter million cases of prostate cancer are diagnosed in America each year, and since (with the advent of the PSA screening test over 20 years ago) most such are diagnosed in the early stage, ADT has become the standard of care in the elderly population especially.
But ADT is accompanied by a substantially higher risk of several serious and/or unpleasant side-effects, including: thinning of the bones, increased risk of heart disease, weight gain, loss of libido, diminished muscle tone, and diabetes.The author told the Times Anahad O Connor: There are so many side effects...and really little evidence to support its use, I would say for the majority of patients with localized prostate cancer, this is not a good option.
ACSH s Dr. Gil Ross added this: It never ceases to amaze me how treatments and approaches can become ingrained with little or no evidentiary support. Even though ADT is backed by medical logic and rationale, it should be clear now that the evidence does not support its use for early prostate cancer. Common sense and logic must yield to data, and hopefully docs caring for men with localized prostate cancer will get this message. Of course, there is evidence that ADT can help men with advanced or aggressive prostate cancer.
