Hormone Therapy Only Helps Some Older Men With Prostate Cancer
TUESDAY Jan. 22, 2008 -- Adding hormone therapy to radiation treatment for fast-moving prostate cancer can save lives, but the benefit often doesn't apply to men who have other serious medical problems, a new study shows.
"The new message from this study is that there definitely is a difference in outcome, depending on the gentleman's health," said Dr. Anthony V. D'Amico, chief of genitourinary oncology at Brigham and Women's Hospital in Boston. His report is published in the Jan. 23 issue of the Journal of the American Medical Association.
The old message, reported in 2004 on the five-year point of the study, was that treatment to suppress the activity of male hormones known as androgens improved survival of older men with aggressive prostate cancer, D'Amico said.
But the new report showed the benefit was limited to men without other serious medical problems. Adding hormone therapy to radiation treatment in the 206-man study decreased the rate of death significantly, but the benefit was confined to men without other health issues.
"This report is important, because it is part of a story that is emerging about hormone therapy in men with prostate cancer who are elderly," D'Amico said. "If a man is 75 and otherwise healthy, adding hormone therapy is likely to help. If the same man has had a heart attack or stroke, or if he is a smoker or diabetic, adding hormone therapy makes it worse."
In terms of clinical practice, the finding means that "before I treat him, I get him to a specialist and try to get his health cleared up as much as possible before giving the hormone therapy," D'Amico said. "If he has heart disease, I would consult a cardiologist; if a stroke, I would consult a neurologist; if diabetes, a diabetologist."
The idea is not anything new in medicine, he added. "It is the same as with a surgical procedure," D'Amico said. "You do not give the therapy until it is cleared by the appropriate specialist."
The study is relatively small and requires further confirmation, said Dr. Durado Brooks, director of prostate and colorectal cancer at the American Cancer Society.
"But for men trying to make a decision about prostate cancer treatment, it provides useful information for the men and their physicians," Brooks said. "A man who has had radiation treatment, if he and his doctor talk about the results of this study, it can help them make a decision about hormone treatment in a more informed way."
The results apply to "a significant percentage of older prostate cancer patients," Brooks said, noting that the average age of men in the study was over 70.
Until now, only general advice about hormone treatment could be given to such men, he said. "Now we can be a little more specific and say, 'If you don't have underlying cardiac disease or other major co-morbid conditions, the chance of having a good response to the treatment is better.' But many men with heart disease or other problems may decide they do not want to deal with the side effects of hormone treatment."
Posted: January 2008