Hormone Therapy Not Best for Older Prostate Cancer Patients
TUESDAY Sept. 23, 2008 -- Older men with early-stage prostate cancer who are given hormone therapy before radiation seed implant therapy face a 20 percent greater risk of dying than those who get radiation treatment alone, new research suggests.
Focusing on men over the age of 70, the study summed up the risks of death from any cause linked to androgen-deprivation therapy. Such treatment is sometimes given before radiation treatment to lower male hormone levels, shrink the prostate, and retard cancer growth. Brachytherapy itself involves the insertion of small radioactive seeds into the prostate to destroy cancer cells.
"We know that hormone therapy has a lot of side effects," noted study author Dr. Amy M. Dosoretz, a radiation oncology resident with the Harvard Radiation Oncology Program in Boston. "Depression, fatigue and anemia, among others. Yet it can be worth it, because it has a significant benefit for many patients. But for some patients, the risks may outweigh the benefits. And here, we found that in this particular group of patients -- early-stage prostate cancer patients over 70 -- there was an increased risk for mortality."
Dosoretz and her colleagues were expected to present their findings Tuesday at the American Society for Therapeutic Radiology and Oncology annual meeting, in Boston.
The team's risk assessment is based on a mortality analysis involving more than 1,700 early-stage, localized prostate cancer patients. The men were between the ages of 70 and 91, and received either hormone and brachytherapy treatments or brachytherapy alone between 1991 and 2005.
For those who received hormone therapy, treatment lasted three and a half months on average.
The authors found that undergoing such hormonal intervention was associated with an increased risk of dying from all causes. Being older and having a more aggressive form of prostate cancer was similarly associated with an increased risk of dying from all causes.
"But we still don't know exactly why there's an increased risk for mortality for these patients," Dosoretz cautioned. "So, we need to look into this important issue further, with randomized trials that take in all the bias. Meanwhile, when deciding about hormone therapy treatment, it's important -- especially among elderly men who have early-stage prostate cancer -- to really weigh the benefits and risks."
Dr. Charles J. Ryan, a urologic cancer specialist and an assistant clinical professor of medicine in the division of hematology/oncology at the University of California, San Francisco, agreed.
"We have a pretty good sense that hormone therapy can increase the relative risk for cardiac risk, diabetes and some of the major problems that are likely to kill patients with prostate cancer," Ryan noted. "However, here, the researchers do not address prostate-cancer specific mortality but rather all-cause mortality. And it does a disservice to what hormone therapy can do well to ignore the fact that there have been several studies going back years that show that hormone therapy in addition to radiation improves survival for high-risk patients."
"So, basically, the decision with what to do with hormone therapy needs to be taken in the context of risk," Ryan said.
Posted: September 2008
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