Prostate Cancer Treatment Can Be Risky
Hormone Treatment May Have Adverse Effects for Some Patients
ADT and Men With Chronic Health Conditions
Anthony D'Amico, MD, PhD, of Harvard Medical School, and colleagues followed more than 200 men with localized prostate cancer who were treated with radiation alone or radiation plus ADT therapy for six months.
All had at least one risk factor for prostate cancer disease progression.
By eight years later, men who got radiation alone were 80% more likely to die than if they received hormone treatment plus radiation.
But further analysis showed that the survival benefit associated with hormone treatment was "pretty much confined to men who were otherwise healthy," D'Amico tells WebMD. Men with other illnesses were twice as likely to die if they received androgen deprivation therapy, D'Amico says.
The bottom line, says Klein, is that older men with other health ills who have a high risk of dying of causes other than cancer can probably be treated with radiation alone.
"They may actually be harmed by ADT, even though it has a higher cure rate overall. It's a matter of what gets you first," he says.
ADT vs. Watchful Waiting
In a second study, Philadelphia researchers found men who opted for "watchful waiting" lived longer than men who got hormone treatment.
Yu-Ning Wong, MD, and colleagues at Fox Chase Cancer Center analyzed data on more than 22,000 men ages 65 to 80 in a National Cancer Institute database who were diagnosed with localized prostate cancer between 1991 and 1999. About one-fourth underwent hormone therapy. The others opted for "watchful waiting." None of them got either surgery or radiation treatment.
By the end of 2002, men who got ADT were 17% more likely to die than those who opted for close observation.
"It's possible that the men who received ADT got the treatment because of rising PSA levels, indicating worse disease," Wong says.
"But it's also possible that hormone therapy, which has been associated with heart disease, osteoporosis, and other health problems, could have compromised survival," Wong tells WebMD.
In another study, Dutch researchers showed that men who delayed hormone therapy were no more likely to die than those who started treatment immediately.