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9 July 2008
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Primary hormone therapy for prostate cancer 'does not improve survival'
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MedWire News: A type of prostate cancer therapy that involves depriving the prostate of the male home androgen does not improve survival in elderly men with early-stage prostate cancer, compared with conservative management, US researchers have found.
"For the majority of men with incident prostate cancer, disease is diagnosed at localised (T1-T2) stages, and standard treatment options include surgery, radiation, or conservative management (ie, deferral of treatment until necessitated by disease signs or symptoms)," explain Dr Siu-Long Yao, from Robert Wood Johnson Medical School in New Brunswick, New Jersey, and colleagues.
However, they add: "Despite a lack of data, increasing numbers of patients are receiving primary androgen deprivation therapy as an alternative to surgery, radiation, or conservative management for the treatment of localised prostate cancer."
To investigate whether androgen deprivation therapy improves survival among such men, the researchers studied data on 19,271 patients, aged at least 66 years, who were diagnosed with localised prostate cancer between 1992 and 2002 and who received either androgen deprivation therapy (7867) or conservative management (11,404).
By December 2006, 11,045 of the men had died, including 1560 from prostate cancer.
Analysis revealed that men who received androgen deprivation therapy were 17% more likely to die of prostate cancer during the monitoring period than those who received conservative management.
Men who received androgen deprivation therapy were also just as likely to die of other causes as those who received conservative management.
"Primary androgen deprivation therapy is not associated with improved survival among the majority of elderly men with localised prostate cancer when compared with conservative management," Dr Yao and team conclude.
They add: "The significant adverse effects and costs associated with primary androgen deprivation therapy, along with our finding of a lack of overall survival benefit, suggest that clinicians should carefully consider the rationale for initiating primary androgen deprivation therapy in elderly patients with T1-T2 prostate cancer."
The research is published in the Journal of the American Medical Association.
JAMA 2008; 300: 173-181
http://jama.ama-assn.org/cgi/content/full/300/2/173
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