July 16, 2008
American Cancer Society

Hormone Therapy Not Shown to Benefit Older Patients with Early Prostate Cancer

A study of nearly 20,000 men aged 66 and older with early-stage prostate cancer found that those who were prescribed androgen deprivation hormone therapy instead of other treatments were no better off than their counterparts who adopted a "wait and see" approach. However, younger men who aren't good candidates for surgery or radiation should still consider the therapy, which reduces androgen levels and often makes prostate cancers shrink or grow more slowly.

For men with early-stage cancer – men whose cancer has not spread to other parts of the body-- the usual treatment options are radiation, surgery, or “watchful waiting.” Men who choose watchful waiting or “active surveillance,” monitor their cancer for changes, rather than aggressively treat the disease. Watchful waiting is often recommended if the cancer is slow-growing, the man is older, the cancer isn't causing any problems, and it is confined to one area of the prostate.

Hormone therapy is generally used on advanced or aggressive prostate cancers, or those that have come back after other treatments. When used along with radiation, it can also help men with early prostate cancer live longer. In recent years, though, androgen deprivation therapy has become an increasingly popular first-line alternative to the 3 most common treatments, especially among older men with early-stage disease. However, there hasn't been any research to show it actually helps these men, and some studies have shown that it's actually harmful.

"There have been more reports of health risks such as fractures, diabetes, heart disease, and other adverse effects associated with chronic use of this therapy; therefore, it is imperative that more exploration is done on the appropriate application of this treatment,” said lead researcher Grace Lu-Yao, PhD, MPH, cancer epidemiologist at the Cancer Institute of New Jersey and associate professor of environmental and occupational medicine at the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School.

The research, published in the Journal of the American Medical Association, was based on data from 19,271 men collected from the Surveillance, Epidemiology, and End Results (SEER) program database as well as linked Medicare files. The researchers, who were from the Robert Wood Johnson Medical School and the Cancer Institute of New Jersey, flagged men who were 66 and older, had been diagnosed with early-stage prostate cancer between 1992 and 2002, and had not received radiation or surgery in the first 6 months of their diagnosis. The men were followed through 2006.

Forty-one percent of the men (median age of 77) received androgen deprivation therapy, while the rest adopted watchful waiting. The researchers found no overall benefit for men taking hormone therapy, and the risk of death was essentially the same for men in both groups, regardless of other factors such as race, class, and family history.

"The significant adverse effects and costs associated with primary androgen deprivation therapy, along with our finding of a lack of overall survival benefit, suggest that clinicians should carefully consider the rationale for initiating this therapy in elderly patients with T1-T2 prostate cancer,” write the authors. (T1-T2 refer to the two earliest stages of prostate cancer; for more information, see “How is Prostate Cancer Staged?")

Prostate cancer is the most common cancer (other than skin cancer) and the second leading cause of cancer death among American men. In 2008, the American Cancer Society estimates 28,660 men will die of the disease.