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Androgen suppression therapy useful in treatment of prostate cancer
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After six months of androgen suppression therapy and radiation therapy combined, overall survival improved in men with localized, unfavorable-risk prostate cancer.
Researchers from Massachusetts and Connecticut randomly assigned 206 men with localized, unfavorable-risk prostate cancer to radiation therapy and androgen suppression therapy combined or radiation therapy alone between Dec. 1, 1995 and April 15, 2001.
After a median follow-up of 7.6 years, the researchers reported 74 deaths. Those assigned to radiation therapy alone had an increased risk for all-cause mortality, compared with those assigned radiation and androgen suppression therapy combined (44 vs. 30 deaths; HR=1.8; 95% CI, 1.1-2.9). For men with moderate or severe comorbidities, however, those assigned radiation therapy alone vs. the combined treatment did not have an increased risk (13 vs. 19 deaths; HR=0.54; 95% CI, 0.27-1.10).The researchers found that those with an increased risk in the radiation-only group had no or minimal comorbidity (31 vs. 11 deaths; HR=4.2; 95% CI, 2.1-8.5).
The researchers concluded that further trials are required to address the interaction between androgen suppression therapy and radiation therapy in men without moderate or severe comorbidity. – by Stacey L. Adams
JAMA. 2008;299:289-295.
The data from this study confirms that the addition of hormone therapy for only six months can confer an overall survival benefit to patients with localized prostate cancer who have unfavorable risk factors – in this case risk factors are defined as having a prostate-specific antigen >10, Gleason 7 or higher or radiographic extension beyond the prostate by endorectal coil magnetic resonance imaging. This benefit was pronounced in healthy men; however, among those who had moderate or severe comorbidities (many due to cardiovascular problems) there was no apparent benefit to the addition of hormone therapy. In fact, there is a legitimate question regarding the benefit for any therapy in this setting because only one out of 49 patients in this study with moderate to severe comorbidities died of prostate cancer. This really calls into question the current practice of treating localized prostate cancer in elderly men with moderate to severe comorbidities, and it particularly questions the practice of using androgen suppression therapies in this subset of patients. This is a retrospective subset analysis and the issue of comorbidities in prostate cancer patients clearly deserves further study. As we move forward with new studies in prostate cancer, these findings will need to be kept in perspective. Newer trials will need to be both designed and interpreted in light of these important findings.
– Oliver Sartor, MD
Piltz Professor of Cancer Research, Department of Medicine and Urology, Tulane Medical School, New Orleans