Primary androgen therapy linked to reduced survival

Use of primary androgen deprivation therapy (ADT) in men with localized prostate cancer is associated with decreased survival compared to men who receive no active treatment, according to new research findings.

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The findings are particularly important for men with longer life expectancies because ADT exposes them to more adverse side effects and deprives them of the opportunity for a cure by other methods, say study authors from Henry Ford Hospital’s Vattikuti Urology Institute in Detroit. Their study appears online in European Urology (Oct. 29, 2014).

Since the 1940s, hormonal therapy has been a mainstay of treatment for metastatic prostate cancer, but no evidence exists to support the exclusive use of ADT for low-risk or localized prostate cancer.

“The use of ADT as the primary treatment for localized and low-risk prostate cancer increased over time, despite known harmful side effects and a lack of data to support such use,” said Jesse D. Sammon, DO, lead author of the study. “In the 1990s it became exceedingly common to use ADT in place of radical prostatectomy or radiation therapy.”

A similar study, from the University of North Carolina, Chapel Hill, shows that overuse of ADT by some urologists is still problematic. Overuse was more likely among urologists who are in solo practice and those lacking a medical school affiliation and affecting older patients and those in ethnic minority groups, the North Carolina researchers reported at the 2014 American Society of Clinical Oncology annual meeting in Chicago.

Concerns over the possible misuse of ADT led to changes in Medicare reimbursement policies for ADT in 2004, according to a Henry Ford Hospital news release. This resulted in a 40% drop in reimbursement and a reduction in inappropriate use of ADT from 38.7% to 25.7% for newly diagnosed localized prostate cancers.

“At the same time, there was a growing awareness of ADT’s many possible adverse effects, including decreased libido, anemia and fatigue, and a higher risk of metabolic and cardiovascular disease,” Dr. Sammon said.

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Dr. Sammon and colleagues hypothesized that ADT’s adverse effects may be more pronounced in men with longer life expectancies because they would likely receive the treatment over a longer period and be exposed to more treatment-related side effects.

Drawing on data from the Surveillance, Epidemiology, and End Results database, the researchers identified 46,376 men diagnosed with localized prostate cancer diagnosed between 1992 and 2009 and who did not undergo radical prostatectomy or radiation therapy for prostate cancer. Among them, 38.5% were treated with ADT. Further statistical analysis confirmed the study’s hypothesis, according to Dr. Sammon.

“No evidence supports the use of ADT in men with low-risk, localized prostate cancer,” he said. “While use of this therapy is decreasing over time, it is still very common.

“We concluded that ADT should not be used as a primary treatment for men with prostate cancer that has not spread beyond the prostate or men with moderate to high risk disease undergoing radiation therapy.”

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