Hormone Therapy Before Brachytherapy May Increase Mortality in Prostate Cancer: Presented at ASTRO

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Title: Hormone Therapy Before Brachytherapy May Increase Mortality in Prostate Cancer: Presented at ASTRO
URL: http://www.pslgroup.com/dg/22D756.htm
Doctor's Guide
September 24, 2008

By Martha Kerr, BSN

BOSTON -- September 24, 2008 -- Neoadjuvant hormonal therapy given prior to brachytherapy is associated with increased all-cause mortality in elderly men with localised prostate cancer compared with brachytherapy alone, investigators reported here at the American Society for Therapeutic Radiology and Oncology (ASTRO) 50th Annual Meeting.

In a presentation on September 23, lead investigator Amy M. Dosoretz, MD, Harvard Radiation Oncology Program, Boston, Massachusetts, reported results of a retrospective analysis including 1,709 men at least 70 years old with localised prostate cancer treated between 1991 and 2005.

The study evaluated 786 men who were treated with a short course of neoadjuvant hormone therapy for a median duration of 3.5 months before brachytherapy and 916 men with brachytherapy alone. None of the men received supplemental external beam radiation therapy.

After a median follow-up of 5 years and after adjusting for known prostate cancer prognostic factors and age, the researchers found that neoadjuvant hormone therapy was associated with a hazard ratio of 1.2 for all-cause mortality compared with brachytherapy alone (95% conﬁdence interval, 1.0-1.4; P = .04), Dr. Dosoretz reported.

Increasing age and Gleason score of 7 or greater were also associated with a signiﬁcantly increased risk of all-cause mortality.

"Our study shows that for men over 70 with early-stage prostate cancer, androgen deprivation therapy as a form of treatment may do more harm than good," she said.

"It is currently unclear why hormone therapy before radiation seed implantation may increase the risk of death in older men with early-stage prostate cancer," Dr. Dosoretz said. "It is possible that comorbid illness may raise the risk of treatment-related complications, including cardiovascular complications," she postulated.

"Our message is that in older patients, it is very important to weigh the risks and benefits of hormone therapy when designing a treatment plan for these patients," Dr. Dosoretz said.

The findings of this study are "potentially practice-changing," commented Louis Harrison, MD, Beth Israel Medical Center, New York, New York, and moderator of a press briefing where the findings were released.

[Presentation title: Mortality in Men Age 70 or More With Localized Prostate Cancer Treated With Brachytherapy With or Without Neoadjuvant Hormonal Therapy. Abstract 84]

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