Androgen Deprivation Therapy Not Viable for Early Prostate Cancer Patients

While men with early prostate cancer have long been administered drug therapy in order to suppress their testosterone production, a new analysis finds this treatment, known as androgen deprivation therapy, does not extend the lives of these patients.

Surgery, radiation, or conservative management have typically been the “traditional choices” for managing early stage prostate cancer, says Grace Lu-Yao, PhD, MPH, professor of medicine at the Robert Wood Johnson Medical School, resident member at the Rutgers Cancer Institute of New Jersey, and lead author of the study.
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Androgen deprivation therapy “has often been used as another alternative, often for men who do not want the side effects of surgery or radiation,” says Lu-Yao, “but want something more than conservative management.”

There are, however, significant side effects associated with androgen deprivation therapy, such as impotence, diabetes, and bone loss. There is little evidence to support its use, according to Lu-Yao and her team of researchers, who followed tens of thousands of men for as long as 15 years to conduct their analysis.

Their study included more than 66,700 men with prostate cancer, age 66 or older. The researchers compared men in areas of the country where drug therapy was frequently prescribed to men in other regions where the drugs were less commonly used. Overall, the investigators found the drug therapy was not associated with greater long-term survival.

The findings underscore the idea that “men with early localized prostate cancer should either be managed by active surveillance or should receive a definitive treatment such as radiation or surgery,” says Peter C. Albertsen, MD, chief and program director as well as a professor in the department of surgery at the UConn Health Center, and co-author of the study. “The use of androgen deprivation therapy as primary therapy for localized disease is inappropriate.”

Primary care physicians “should feel comfortable advising patients that the evidence supporting the use of androgen deprivation in this setting is limited,” adds Lu-Yao, “and that it may be reasonable to adopt a more conservative approach, in order to minimize side effects such as hot flashes, bone loss, loss of muscle mass, and increased cardiovascular risk.

“Good advice in this setting can go a long way toward fulfilling the important primary care goals of maximizing quality of life, reduction of polypharmacy, and prevention of injury,” she continues, “since the use of hormonal therapy can be associated with significant side effects, the need for other treatments to manage its side effects, and increased risks of injury due to loss of muscle and bone.”

—Mark McGraw

Reference

Lu-Yao G, Albertsen P, et al. Fifteen-Year Survival Outcomes Following Primary Androgen-Deprivation Therapy for Localized Prostate Cancer. JAMA Intern Med. 2014.