They can wait and see whether this usually slow-moving cancer becomes a
problem (called conservative therapy or watchful waiting). They can undergo
radiation therapy and suffer its side effects. Or they can undergo
androgen-deprivation therapy: hormonal drugs (Lupron, Viadur, Eligard,
or Zoladex) or surgery (orchiectomy) that cut off production of male
In the U.S., older men often opt for stand-alone hormone therapy, even
though there's no proof that it really helps. Hormone therapy's most obvious
side effect is sexual dysfunction. Of greater concern are several recent
studies linking androgen deprivation therapies to
bone fractures, and reduced muscle mass.
Now a new study strongly suggests that hormone therapy offers older men no
benefit to justify these serious risks.
Grace L. Lu-Yao, PhD, MPH, of the University of Medicine & Dentistry of
New Jersey, and colleagues collected data on more than 19,000 men diagnosed
with early-stage prostate cancer at an average age of 77. None of the men
underwent surgery or radiation treatment for early prostate cancer. Nearly
8,000 of the men opted for androgen deprivation therapy.
"Use of hormone therapy does not improve survival," Lu-Yao tells
WebMD. "The reason patients want this is they want something that will
improve their quality of life or their survival. But hormone therapy has a
detrimental effect on quality of life. And we cannot find any survival benefit
for these men in their 70s with very early-stage cancer."
Why have so many U.S. men undergone an unproven treatment that now seems to
do more harm than good?
"It's an American phenomenon," Otis Brawley, MD, chief medical
officer for the American Cancer Society, tells WebMD. "The problem is that
if a U.S. man has early-stage prostate cancer, both patients and doctors
culturally feel that you have to do something. The end result is a number of
men who should get conservative therapy get some kind of intervention."
Lu-Yao and Brawley suggest that these older men would have done just as well
if their cancers had never been detected. Brawley notes that many of these men
likely underwent continued prostate cancer screening with PSA tests. Others
probably had possible prostate abnormalities detected by a urologist.
Regardless of how they got there, all these older men must have agreed to
undergo prostate biopsies. And that may not have been the result of a fully
informed decision, says Simon Hall, MD, head of urology at New York's Mount
Sinai School of Medicine.