Early ADT for prostate cancer fails to improve survival

Androgen deprivation therapy provides no survival benefit in older men with localized prostate cancer at 15 years, newly published research shows.

Study findings, from Rutgers Cancer Institute of New Jersey in New Brunswick, appear online in JAMA Internal Medicine (July 14, 2014).

RELATED - ADT overuse still problematic among some urologists

Researchers used information from 66,717 Medicare patients aged 66 years and older diagnosed with clinical stage T1-T2 prostate cancer between 1992 and 2009. Patients did not have surgery or radiation treatment within 6 months of their diagnosis. The data were compiled from the population-based Surveillance, Epidemiology, and End Results (SEER) database linked to Medicare files.

In previous research on ADT by the same research team, similarly aged men were only followed until 2003. In this study, investigators, led by Grace Lu-Yao, PhD, MPH, extended the follow-up period by 6 years and included an additional 47,000 patients from different population areas covered by the SEER database. Median follow-up for overall survival was 9 years.

In the new study, study authors found that when ADT was administered as the primary treatment for localized disease during the initial 6-month period following diagnosis, the hormone therapy was not associated with improved 15-year overall survival or prostate cancer-specific survival, especially among the majority of older men in the study group, according to a Rutgers news release. This was compared to those patients who received no treatment of any type and instead underwent regular assessment.

The study also showed little difference in survival rates between patient populations in areas of the country where ADT was more frequently used as a sole treatment versus areas where it was not. In both high- and low-use areas where ADT was used as the sole treatment, 15-year prostate cancer-specific survival was 90.6% among patients with moderately differentiated cancer.

Dr. Lu-Yao notes that while previous research has shown ADT is appropriate for use in high-risk patients and in combination with other treatments, sole use-especially in an older population-should be carefully considered.

“Because of the potential side effects of osteoporosis, diabetes, and decreased muscle tone, clinicians must carefully consider the rationale behind ADT treatment if used as the primary therapy for older patients,” Dr. Lu-Yao said.

She added that as the data only included men 66 and older, results could differ for younger men.

In addition to colleagues at Rutgers, Dr. Lu-Yao's co-authors included Peter C. Albertsen, MD, of the University of Connecticut Health Center, Farmington.

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