Androgen deprivation therapy does not improve survival of older patients with localized prostate cancer compared with the alternative of conservative management, also called watchful waiting, according to an article in the July 9 issue of the Journal of the American Medical Association.

"For the majority of men with incident prostate cancer (approximately 85 percent), disease is diagnosed at localized (T1-T2) stages, and standard treatment options include surgery, radiation, or conservative management (that is, delay of treatment until necessitated by disease signs or symptoms). Although not standard or sanctioned by major groups or guidelines, an increasing number of clinicians and patients have turned to primary androgen deprivation therapy (PADT) as an alternative to surgery, radiation, or conservative management, especially among older men," the authors wrote.

In a 1999-2001 survey, primary androgen deprivation therapy had become the second most common treatment approach in the USA, after surgery, for localized prostate cancer, despite a lack of data regarding its efficacy.

Grace L. Lu-Yao, MPH, PhD, of the Cancer Institute of New Jersey, UMDNJ-Robert Wood Johnson Medical School, Piscataway, N.J., and colleagues assessed the association between primary androgen deprivation therapy and disease-specific survival and overall survival in 19,271 men with T1-T2 (localized) prostate cancer (diagnosed in 1992 - 2002).

The patients, age 66 years or older, did not receive definitive local therapy for prostate cancer. Among the patients, 7,867 (41 percent) received primary androgen deprivation therapy, and 11,404 were treated with conservative management not including hormone treatment.

During the follow-up period (through December 2006 for all-cause mortality and through December 2004 for prostate cancer-specific mortality) there were 1,560 prostate cancer deaths and 11,045 deaths from all causes.

Use of primary androgen deprivation therapy for localized prostate cancer was associated with lower 10-year prostate cancer-specific survival (80.1 percent versus 82.6 percent) and no increase in 10-year overall survival compared with conservative management. However, in a pre-specified subset analysis, use in men with poorly differentiated cancer was associated with improved 10-year prostate cancer-specific survival (59.8 percent versus 54.3 percent) but not overall survival (17.3 percent versus 15.3 percent).

"The significant adverse effects and costs associated with primary androgen deprivation therapy (PADT), along with our finding of a lack of overall survival benefit, suggest that clinicians should carefully consider the rationale for initiating PADT in elderly patients with T1-T2 prostate cancer," the authors concluded.