Androgen Deprivation Therapy Ineffective for Most Men with Early Prostate Cancer.

A study of more than 15,000 men with early stage prostate cancer finds that those who received androgen deprivation as their primary treatment instead of surgery or radiation did not live any longer than those who received no treatment.

The research team, which included Marianne Ulcickas Yood, a research associate professor of epidemiology at the BU School of Public Health, said that the risks of serious adverse events associated with the treatment — which has been linked to impaired cognition, heart disease, diabetes and other disorders — “mitigates against any clinical or policy rationale for use of primary androgen deprivation therapy in these men.” The study was led by researchers at Georgetown Lombardi Comprehensive Cancer Center.

The findings, reported in the Journal of Clinical Oncology, draw from cancer registries linked with extensive electronic medical records in three, large integrated health plans. The men included in the study had prostate cancer that had not spread beyond the organ (localized) and did not have surgery or radiation therapy.

Androgen deprivation therapy suppresses the production of testosterone, the male hormone said to fuel growth of prostate cancer. The therapy improves survival when given with radiation for later stages of disease, and is considered the standard of care for men who have metastatic prostate cancer. Effectiveness of primary androgen deprivation therapy (PADT) has not been established.

Use of PADT for early stage prostate cancer is widespread. Despite the lack of randomized clinical trials to test its effectiveness, recent studies have reported it as the second most common treatment, after radiotherapy, for clinically localized prostate cancer among older men age 65 and older. The study did not compare androgen deprivation therapy directly to either surgery or radiation therapy, the two main curative treatment options for prostate cancer.

While the study did not probe the reasons why physicians prescribe the treatment in this setting, it was much more common in older men and those with higher risk of disease progression.

The researchers are now using their database of 15,170 patients to examine rates of potential side effects from the treatment.

Researchers from Kaiser Permanente Southern California, Kaiser Permanente Northern California, Henry Ford Hospital, Harvard Medical School, Massachusetts General Hospital and the Neiman Health Policy Institute also participated in the study. The study was funded by grants from the National Cancer Institute.