Primary androgen deprivation of limited value in localized prostate cancer

July 8, 2008

NEW YORK (Reuters Health) - In general, primary androgen deprivation therapy (PADT) does not improve the survival of patients with localized prostate cancer compared with conservative management, new research shows. However, such therapy may improve prostate cancer-specific survival in men with poorly differentiated disease, according to the report in the Journal of the American Medical Association for July 9.

More and more patients with localized disease are receiving PADT as an alternative to surgery, radiotherapy, and conservative management, yet data supporting this approach are lacking, note Dr. Siu-Long Yao, from Robert Wood Johnson Medical School in Brunswick, New Jersey, and colleagues.

Their investigation involved 19,271 men, 66 years of age or older (median, 77 years), who were diagnosed with stage T1-T2 prostate cancer and did not receive definitive local therapy. Of these patients, 7867 received PADT and 11,404 received conservative management, i.e. deferral of treatment until necessitated by disease progression.

During follow-up, a total of 1560 men died from prostate cancer and 11,045 died from other causes.

With PADT, prostate-cancer specific and overall survival rates at 10 years were 80.1% and 30.2%, respectively, not significantly different from the corresponding rates of 82.6% and 30.3% seen with conservative management.

In men with poorly differentiated cancer, 10-year prostate cancer-specific survival with PADT was 59.8%, significantly higher than the 54.3% observed with conservative management (p = 0.049). Overall survival, however, did not differ significantly between the treatments, hovering around 16%.

"The significant adverse effects and costs associated with PADT, along with our findings of a lack of overall survival benefit, suggest that clinicians should carefully consider the rationale for initiating PADT in elderly patients with T1-T2 prostate cancer," the authors conclude.