Prostate Cancer Treatment Decreases Survival in Men with Longer Life Expectancy

Primary ADT associated with decreased survival in localized prostate cancer patients.

Androgen deprivation therapy (ADT), which is commonly used to treat prostate cancer, should not be used in patients whose disease has not spread beyond the prostate, according to a recent study.

Published online December 3, 2014 in European Urology, the study found that the therapy exposes men with longer life expectancies to adverse side effects, increases the risk of death, and deprives patients of the chance to achieve a cure through other methods. Known side effects of ADT include heart disease, diabetes, weight gain and impotence, along with growing evidence that suggests the treatment may lead to earlier death.

“The use of ADT as the primary treatment for localized and low risk prostate cancer increased over time, despite known harmful side effects and a lack of data to support such use,” lead author Jesse D. Sammon, DO, said in a press release. “In the 1990s, it became exceedingly common to use ADT in place of radical prostatectomy or radiation therapy.”

The study noted that Medicare reimbursement polices began to shift in 2004 following growing concerns over potential misuse of ADT alone for prostate cancer treatment, in addition to increased awareness to its potential damage. As a result, there was a 40% drop in reimbursement and the inappropriate use of ADT fell from 38.7% to 25.7% for newly diagnosed localized prostate cancers.

“At the same time, there was a growing awareness of ADT’s many possible adverse effects, including decreased libido, anemia and fatigue, and a higher risk of metabolic and cardiovascular disease,” Dr. Sammon said.

As part of the study, the researchers evaluated whether adverse events caused by ADT are more pronounced in men with longer life expectancies who would likely be treated for a longer duration, which exposes them to increased treatment-related side effects.

The researchers examined data from the Surveillance, Epidemiology, and End Results registry and linked to records from Medicare to identify 46,376 men diagnosed with localized prostate cancer. The patients did not undergo radical prostatectomy or radiation therapy for the disease and were diagnosed between 1992 and 2009.

Of those patients, 38.5% were treated with ADT.

The results showed there was no evidence to support the use of ADT in men with low risk, localized prostate cancer and that despite use of the treatment decreasing, it is still very common.

“We found that primary ADT is associated with decreased survival in men with localized prostate cancer relative to men who receive no active treatment, particularly in men with longer life expectancies,” Dr. Sammon said. “So we concluded that ADT should not be used as a primary treatment for men with prostate cancer that has not spread beyond the prostate or men with moderate to high risk disease undergoing radiation therapy.”