Androgen deprivation does not improve survival in older men

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.