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Androgen Deprivation Therapy for Localized Prostate Cancer

Summary and Comment |
March 19, 2014

Androgen Deprivation Therapy for Localized Prostate Cancer

  1. Robert Dreicer, MD, MS, FACP

Primary ADT has little utility for most patients who do not undergo curative-intent treatment.

  1. Robert Dreicer, MD, MS, FACP

Although the use of primary androgen deprivation therapy (ADT) as monotherapy in men with clinically localized prostate cancer may be slowly declining, recent evidence suggests that it remains a frequently used management approach for men older than 65. Moreover, previous risk-benefit assessments of primary ADT in this population have provided mixed results.

Now, investigators have conducted a retrospective cohort study of 15,170 patients from one of three health plans with newly diagnosed, clinically localized prostate cancer who had not undergone curative-intent treatment with radiotherapy or surgery. Of these patients, 23% (median age, 76) received primary ADT within 12 months of initial diagnosis, and 77% (median age, 69) did not receive primary ADT. Patients who received ADT had worse prognostic factors, including higher Gleason scores and prostate-specific antigen values.

Patients who received primary ADT versus those who did not experienced higher rates of all-cause mortality (49% vs. 28%) and prostate cancer–specific mortality (13% vs. 5%). However, when the analysis was adjusted for clinical and sociodemographic features, primary ADT was associated with a decreased risk for all-cause mortality but not prostate-cancer–specific mortality for most patients.

Comment

These results add to the weight of evidence that primary androgen deprivation therapy has little utility for most men with clinically localized prostate cancer who, for a variety of reasons, are not managed with curative intent. The adverse effects and economic burden of ADT should be carefully weighed in this clinical setting.

  • Disclosures for Robert Dreicer, MD, MS, FACP at time of publication Consultant / Advisory board Dendreon; Eli-Lilly; Endo Pharmaceuticals; Ferring; Janssen; Millennium; Novartis Speaker's bureau Janssen Editorial boards Urology Leadership positions in professional societies National Cancer Institute (Co-Chair, GU Oncology Steering Committee)

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