Does Primary Androgen-Deprivation Therapy Delay the Receipt of Secondary Cancer Therapy for Localized Prostate Cancer?

Abstract

Background Despite evidence that shows no survival advantage, many older patients receive primary androgen-deprivation therapy (PADT) shortly after the diagnosis of localized prostate cancer (PCa). Objective This study evaluates whether the early use of PADT affects the subsequent receipt of additional palliative cancer treatments such as chemotherapy, palliative radiation therapy, or intervention for spinal cord compression or bladder outlet obstruction. Design, setting, and participants This longitudinal population-based cohort study consists of Medicare patients aged ≥66 yr diagnosed with localized PCa from 1992 to 2006 in areas covered by the Surveillance Epidemiology and End Results (SEER) program. SEER-Medicare linked data through 2009 were used to identify the use of PADT and palliative cancer therapy. Outcome measurements and statistical analysis Instrumental variable analysis methods were used to minimize confounding effects. Confidence intervals were derived from the bootstrap estimates. Results and limitations This study includes 29 775 men who did not receive local therapy for T1–T2 PCa within the first year of cancer diagnosis. Among low-risk patients (Gleason score 2–7 in 1992–2002 and Gleason score 2–6 in 2003–2006) with a median age of 78 yr and a median follow-up of 10.3 yr, PADT was associated with a 25% higher use of chemotherapy (hazard ratio [HR]: 1.25; 95% confidence interval [CI], 1.08–1.44) and a borderline higher use of any palliative cancer surgery (HR: 1.07; 95% CI, 0.97– 1.19) within 10 yr of diagnosis in regions with high PADT use compared with regions with low PADT use. Because this study was limited to men >65 yr, the results may not be applicable to younger patients. Conclusions Early treatment of low-risk, localized PCa with PADT does not delay the receipt of subsequent palliative therapies and is associated with an increased use of chemotherapy.

Association between androgen deprivation therapy and anxiety among 78 000 patients with localized prostate cancer

“…Starting in 2003, Gleason 2–4, Gleason 5–6, and Gleason 7–10 corresponded to well, moderately and poorly differentiated. Patients were stratified based on a modification of risk groups utilized by Lu‐Yao et al . Risk group A was stage I–II and Gleason 2–6 (or well or moderately differentiated if Gleason score was not available); risk group B was stage I–II and Gleason 7–10 (or poorly differentiated if Gleason score was not available); and risk group C was stage III with any Gleason score or grade.…”

Patterns of Declining Use and the Adverse Effect of Primary Androgen Deprivation on All-cause Mortality in Elderly Men with Prostate Cancer

“…Nonetheless, approximately 40% of men >65 yr not treated with RP or RT for localized CaP receive pADT following diagnosis [18]. In the 2 yr following the Medicare Modernization Act of 2003, which led to a 40% decrease in reimbursement for ADT administration, there was a reduction in the inappropriate use of ADT from 38.7% to 25.7% of newly diagnosed localized CaPs [15].…”

Fifteen-Year Survival Outcomes Following Primary Androgen-Deprivation Therapy for Localized Prostate Cancer

“…For patients with less aggressive cancers, deferred ADT is safe and reduces the risks of treatment-associated adverse effects, such as osteoporosis, weight gain, decreased libido, decreased muscle tone, diabetes mellitus, and metabolic syndrome. These findings, the fact that primary ADT does not delay the use of secondary cancer therapies, 7 and the fact that randomized clinical trials show no survival benefit, 27 demonstrate that there is a limited role for ADT as primary therapy for men with localized prostate cancer. Health care providers and their older patients should carefully weigh our findings against the considerable adverse effects and costs associated with primary ADT before initiating this therapy in men with clinically localized prostate cancer.…”

“…We have also reported that ADT does not delay the use of secondary cancer therapies and that ADT is associated with an increased risk of fracture and subsequent mortality. 6,7 One of the major limitations of our earlier publication was the limited length of follow-up. 4 To determine whether primary ADT provides a long-term survival advantage, we expanded our study to include more Surveillance, Epidemiology and End Results (SEER) regions and extended the follow-up an additional 6 years, from 2003 to 2009.…”