and Medicine for Seniors
Common prostate cancer treatment associated with
decreased survival in older men
Evidence growing that androgen deprivation therapy
may lead to earlier death
Dec. 4, 2014 - A common prostate cancer therapy -
androgen deprivation therapy (ADT) - should not be used in men whose
cancer has not spread beyond the prostate, says a study led by
researchers at Henry Ford Hospital. The findings are particularly
important for men with longer life expectancies because the therapy
exposes them to more adverse side effects, it is associated with
increased risk of death and it deprives men of the opportunity for a
cure by other methods.
In ADT an injectable or implanted medication is
used to disrupt the body's ability to make testosterone. ADT is known to
have significant side effects such as heart disease, diabetes, increased
weight gain and impotence; however a growing body of evidence suggests
ADT may in fact lead to earlier death.
Since the 1940s, the therapy has been a mainstay of
treatment for prostate cancer that has metastasized, or spread beyond
the prostate gland. Still other studies support the use of ADT when it
is used as an adjuvant, or in addition to, radiation therapy for higher
risk prostate cancer. No evidence exists to support the exclusive use of
ADT for low risk or localized prostate cancer.
"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," says
Jesse D. Sammon, D.O., a researcher at Henry Ford Hospital's Vattikuti
Urology Institute and lead author of the new study. "In the 1990's it
became exceedingly common to use ADT in place of radical prostatectomy
or radiation therapy."
Concerns over the possible misuse of ADT alone in
the treatment of prostate cancer, as well as a growing awareness of its
potential damage, led to changes in Medicare reimbursement policies for
ADT in 2004.
This resulted in a 40 percent drop in
reimbursement, and a reduction in inappropriate use of ADT from 38.7
percent to 25.7 percent 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 says.
"In designing our study, we hypothesized that the
adverse effects of ADT might be more pronounced in men with longer life
expectancies since they would likely be treated with ADT for a longer
period- and be exposed to more treatment-related side effects."
Drawing on data from nations largest cancer
registry (SEER) (Surveillance, Epidemiology, and End Results) the
researchers then linked to records from Medicare and identified 46,376
men diagnosed with localized prostate cancer who did not undergo radical
prostatectomy or radiation therapy for prostate cancer, diagnosed
between 1992-2009. Among them, 38.5 percent were treated with ADT.
Further statistical analysis confirmed the study's
hypothesis, notes Dr. Sammon.
"No evidence supports the use of ADT in men with
low risk, localized prostate cancer, while use of this therapy is
decreasing over time it is still very common," he says
"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. 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
Contributing to this study were Firas Abdollah,
Daniel Pucheril, Akshay Sood and Mani Menon at the VUI Center for
Outcomes Research Analytics and Evaluation, Henry Ford Health System and
Quoc-Dien Trinh at the Harvard Center for Surgery and the Public Health
at Brigham and Women's Hospital, Boston.
The research study has been published online in