Androgen Deprivation Therapy Ineffective For Early-Stage Prostate Cancer

By Jane Farrell

Men who got androgen deprivation therapy as the primary treatment in the early stages of prostate cancer didn’t live any longer than those who got no treatment at all, a study shows.

The researchers say that this conclusion, along with the risk of serious side effects such as heart disease and diabetes, “mitigates against any clinical or policy rationale for use of primary androgen deprivation therapy [PADT] in these men.”

The findings, reported in the Journal of Clinical Oncology, draw from cancer registries linked with extensive electronic medical records.  The men included in the study had localized prostate cancer.

Androgen deprivation therapy suppresses the production of testosterone, the male hormone said to fuel growth of prostate cancer. It does improve survival when given in the later stages of cancer and is the standard treatment for men with metastatic prostate cancer.

Until now, the effectiveness of the treatment hasn’t been established for men in the early stages of the illness. It is the second most common treatment, after radiation therapy, for early-stage prostate cancer.

“This study is the most comprehensive study on the effectiveness of PADT for men who forgo radiation and surgery for their localized prostate cancer, and it tells us there is no strong reason to use it in most patients,” said the study’s lead investigator, Arnold Potosky, PhD, a professor of oncology and director of health services research at Georgetown University’s Lombardi Comprehensive Cancer Center. “We found only a small survival benefit for primary androgen deprivation therapy compared to no therapy in men diagnosed with higher-risk localized prostate cancer.”

Potosky speculated that patients and physicians may choose PADT because they are wary of undergoing surgery or radiation.

“Primary androgen deprivation therapy may be preferable to some men with early stage prostate cancer who would prefer to do something rather than watch and wait for further signs of progression to occur later and then need treatments,” Potosky added. “However, using PADT by itself immediately after diagnosis in the hopes of limiting cancer’s progression does not extend survival, according to this study.”

“Given the aging American population, more men are likely to be faced with prostate cancer so it’s very important to understand the whether the risks of primary androgen deprivation therapy outweigh the survival benefit,” he says.   “Ultimately, this is a decision for men and their doctors to make together, and we hope that our study provides some helpful information to guide these decisions.”