Androgen deprivation does not improve survival in older men

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Compared with conservative management of the disease, androgen deprivation therapy does not appear to be associated with improved survival in elderly men with localized prostate cancer, according to a study in JAMA (2008; 300:173-81).

Compared with conservative management of the disease, androgen deprivation therapy does not appear to be associated with improved survival in elderly men with localized prostate cancer, according to a study in JAMA (2008; 300:173-81).

A group led by researchers from the Cancer Institute of New Jersey, New Brunswick, and the University of Connecticut, Farmington, assessed the association between ADT and disease-specific survival and overall survival in 19,271 men with T1-T2 prostate cancer diagnosed between 1992 and 2002. The patients, 66 years of age or older, did not receive definitive local therapy for prostate cancer. Instead, 7,867 (41%) received ADT and 11,404 were treated with conservative management.

During the follow-up period (through December 2006 for all-cause mortality and through December 2004 for prostate cancer-specific mortality), 1,560 men died from prostate cancer and 11,045 died from all causes.

Researchers found that use of ADT for localized prostate cancer was associated with lower 10-year prostate cancer–specific survival (80.1% vs. 82.6%) and no increase in 10-year overall survival compared with conservative management. However, in a pre-specified subset analysis, ADT use in men with poorly differentiated cancer was associated with improved 10-year prostate cancer-specific survival (59.8% vs. 54.3%), but not overall survival (17.3% vs. 15.3%).

“The significant adverse effects and costs associated with ADT, along with our finding of a lack of overall survival benefit, suggest that clinicians should carefully consider the rationale for initiating ADT in elderly patients with T1-T2 prostate cancer,” concluded the authors, led by Grace L. Lu-Yao, MPH, PhD, of the Cancer Institute of New Jersey and UMDNJ-Robert Wood Johnson Medical School.

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