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Title: Androgen Deprivation Therapy for Localised Prostate Cancer Not Associated With Improved Survival
URL: http://www.pslgroup.com/dg/22548A.htm
Doctor's Guide
July 8, 2008

CHICAGO -- July 8, 2008 -- Primary androgen deprivation therapy (PADT) is not associated with improved survival for elderly men with localised prostate cancer, compared to conservative management of the disease, according to a study in the July 9 issue of JAMA.

Grace L. Lu-Yao, PhD, Cancer Institute of New Jersey, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Piscataway, New Jersey, and colleagues, assessed the association between PADT and disease-specific survival and overall survival in 19,271 men with T1-T2 prostate cancer who were diagnosed between 1992 and 2002.

The patients, aged 66 years or older, did not receive definitive local therapy for prostate cancer. Of the patients, 7,867 (41%) received PADT, and 11,404 were treated with conservative management, not including PADT.

Patients were followed-up for all-cause mortality through December 2006, and for prostate cancer-specific mortality through December 2004. During this follow-up period, there were 1,560 prostate cancer deaths and 11,045 deaths from all causes.

The researchers found that use of PADT for localised prostate cancer was associated with lower 10-year prostate cancer-specific survival (80.1% vs 82.6%) and no increase in 10-year overall survival compared with conservative management.

However, in a prespecified subset analysis, PADT use in men with poorly differentiated cancer was associated with improved 10-year prostate cancer-specific survival (59.8% vs 54.3%) but not overall survival (17.3% vs 15.3%).

"The significant adverse effects and costs associated with PADT, along with our finding of a lack of overall survival benefit, suggest that clinicians should carefully consider the rationale for initiating PADT in elderly patients with T1-T2 prostate cancer," the authors wrote.


SOURCE: JAMA

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