Widely used hormone-blocking drugs fails to improve survival
in older men with early prostate cancer that has not spread, according to a new
study published in the July 9 issue of the Journal of the American Medical
Association.
The method, also known as androgen deprivation therapy,
suppresses the testosterone that feeds prostate tumors and is usually
administered to men in their 70s or older although there’s no scientific evidence
that it really helps. According to an earlier study in the Journal of the
National Cancer Institute, the number of low-risk patients treated only with
hormone therapy instead of surgery or radiation grew from 5 percent in 1989 to
14 percent in 2001.
Surgery is generally not recommended for older men because
many would die of other causes before the cancer killed them. Although not a
cure, hormone therapy can ameliorate symptoms and, in some cases, lengthen survival,
many experts say.
Most obvious side effect of hormone therapy is sexual
dysfunction. However, recent studies have linked this therapy to greater risks
such as diabetes, bone fractures, heart disease, and reduced muscle mass.
Now, according to the new study conducted by Grace L.
Lu-Yao, PhD, MPH, of the University of Medicine & Dentistry of
Dr. Lu-Yao and her colleagues looked at the medical records
of 19,271 men with an average age of 77 who were diagnosed with early prostate
cancer from 1992 to 2002 and were monitored through 2006. None of the men
underwent surgery or radiation treatment for early prostate cancer.
Forty percent of the participants had received hormone
therapy for an average of 18 months; the rest of the patients let fate decide.
Overall, 19.9 percent of those on hormone therapy died of
prostate cancer within 10 years, compared with only 17.4 of those in the other
group.
The hormone therapy may work for late-stage cancer. However,
“the bottom line is that it makes no difference in survival, and it may even be
worse for people who have very early stage cancer,” Dr. Lu-Yao said.
Moreover, according to Dr. Patrick Walh, a urologist at the
Johns Hopkins School of Medicine, there’s never been any evidence that hormonal
treatments help older men with early-stage disease who expose themselves to
many side effects such as weight gain, hot flashes, loss of muscle mass and
decrease in mental acuity.
However, many people suffering from prostate cancer believe that it’s better to follow hormone therapy rather than doing nothing about their disease, “but that may not be true,” Dr. Lu-Yao said. Many prostate tumors grow so slowly they don’t need to be treated because older men are likely to die of other reasons. So why should these people be exposed to such therapy who may give them a hard time because of the side effects and, of course, costs of it should not be forgotten.
“I would hope that a study like this would make us be much more cautious" about giving hormone-blocking treatment, Dr. Otis Brawley, the American Cancer Society's chief medical officer said as quoted by the Associated Press.
According to the National Cancer Institute, about 186,000 new cases of prostate cancer are expected to be diagnosed in the U.S. this ear and more than 28,000 Americans are expected to die of the disease. About a quarter of older men with localized prostate cancer currently receive hormone therapy.