NEW YORK (Reuters Health) - In elderly men with localized or "organ-confined" prostate cancer, a therapy that involves depriving the prostate gland the male hormone androgen, which is known to promote prostate cancer growth, does not appear to improve survival, compared to a conservative "wait and see" management strategy, a study shows.
"The significant adverse effects and costs associated PADT," the investigators conclude, "along with our findings of a lack of overall survival benefit, suggest that clinicians should carefully consider the rationale for initiating PADT in elderly patients with (localized) prostate cancer."
More and more men with localized prostate cancer are receiving PADT as an alternative to surgery, radiation, and conservative management (i.e, deferring treatment until necessitated by disease signs or symptoms), yet data supporting this approach are lacking, note Dr. Siu-Long Yao, from Robert Wood Johnson Medical School in Brunswick, New Jersey, and colleagues.
They investigated 19,271 men who were diagnosed with localized prostate cancer who did not "definitive" treatment such as removal of the prostate. Of these patients, 7867 received PADT and 11,404 received conservative management.
During follow-up, a total of 1560 men died from prostate cancer and 11,045 died from other causes.
PADT did not improve the overall survival rate compared with conservative management. At 10 years, overall survival was 30.2 percent with PADT compared with 30.3 percent with conservative management.
There was also no difference in the 10-year prostate cancer-specific survival rates (80.1 percent with PADT versus 82.6 percent with conservative management).
However, in men with poorly differentiated tumors, which are more likely to spread, prostate cancer-specific survival at 10 years with PADT was 59.8 percent -- significantly higher than the 54.3 percent observed with conservative management. However, overall survival did not differ significantly between the two approaches, hovering around 16 percent.
SOURCE: Journal of the American Medical Association, July 9, 2009.
