Does Androgen Deprivation Therapy Benefit All Patients?
Prostate cancer can be broken down into localized disease that has not spread beyond the prostate and advanced disease that has extended beyond into local structures such as the seminal vesicles, lymph nodes or distant spread to bone. Traditionally, if the patient has a 10 year life expectancy, often times treatment will be offered to the patients that will involve either surgery, radiation therapy or cryotherapy. Disease that has spread beyond the prostate will often be treated with hormone therapy (androgen deprivation therapy), which involve the administration of medications that alter the patients’ testosterone levels, and in essence creates a medical castration.
However many time patients who have localized prostate cancer may receive hormone deprivation therapy for varying reasons. Androgen deprivation therapy (ADT) is a medical therapy that creates a medical castration. This form of therapy nearly eliminates the male hormone, testosterone, and deprives the prostate of the substance that it needs to continue growth. Eliminating the male hormone will in many cases control the cancer.
Patients, who are not candidates for definitive therapy on the basis of advanced age or disease states, may be placed on ADT. Other times however patients who do not meet the criteria for actually receiving these medications may be using them, such as men with clinically localized prostate cancer
A recently published article in the Journal of Clinical Oncology (March 2014) specifically addresses this alternative treatment. In this study primary androgen deprivation therapy was not shown to be an alternative to no therapy at all. The use of these medications did not change the survival rates in patients with early stage prostate cancer who received them. Earlier studies have also demonstrated similar findings.
Several concerns about androgen deprivation therapy exist that serve as further evidence for the need for them to be used appropriately. This includes the great cost that is associated with their use, as long as their potential long-term complications including cardiovascular risk, impaired cognition, muscle loss, and bone loss or fracture. Prior to embarking on course of androgen deprivation therapy, patients should have a thorough discussion with their Urologists regarding all these issues.
Jay Motola, MD, is a board-certified urologist and attending physician, Department of Urology, Mount Sinai West, and Assistant Professor of Urology, Icahn School of Medicine at Mount Sinai. Dr. Motola is a summa cum laude, Phi Beta Kappa graduate of Boston University, and earned his medical degree at the State University of New York at Stony Brook.