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Adapted from the NCI Cancer Bulletin, vol. 5/no. 14, July 8, 2008 (see the current issue ²).

Using androgen deprivation therapy alone in older men with localized prostate cancer does not improve survival outcomes when compared with a conservative management approach, according to a new analysis in the July 9, 2008, Journal of the American Medical Association (see the journal abstract ³). For localized prostate cancer, androgen deprivation therapy has become a common treatment, despite a lack of definitive evidence that it is more effective than other options, noted the study authors.

To conduct the study, the researchers, from The Cancer Institute of New Jersey, used data from the National Cancer Institute's Surveillance, Epidemiology, and End Results ⁴ (SEER) program and linked Medicare files to compare the outcomes in men aged 66 and older, who were diagnosed with localized prostate cancer between 1992 and 2002 and had not undergone surgery. Of these men, nearly 8,000 received androgen deprivation therapy and approximately 11,400 were treated with conservative management, often called "watchful waiting ⁵."

Patients treated with androgen deprivation therapy - half of whom were treated for more than 30 months - had a lower 10-year, cancer-specific survival rate than those who underwent conservative management (80.1 percent vs. 82.6 percent) and equivalent 10-year overall survival rates. Androgen deprivation therapy did slightly improve cancer-specific survival at 10 years in men with poorly differentiated cancer, the authors noted, but there was no significant difference in overall survival in that patient subset.

"There have been more reports of health risks such as fractures, diabetes, heart disease, and other adverse effects associated with chronic use of this therapy," said the study's lead author, Dr. Grace L. Lu-Yao. "Therefore, it is imperative that more exploration is done on the appropriate application of this treatment."

Glossary Terms

Treatment to suppress or block the production or action of male hormones. This is done by having the testicles removed, by taking female sex hormones, or by taking drugs called antiandrogens. Also called androgen ablation and androgen deprivation.

In cancer, refers to how mature (developed) the cancer cells are in a tumor. Differentiated tumor cells resemble normal cells and tend to grow and spread at a slower rate than undifferentiated or poorly differentiated tumor cells, which lack the structure and function of normal cells and grow uncontrollably.

Restricted to the site of origin, without evidence of spread.

The percentage of people in a study or treatment group who are alive for a certain period of time after they were diagnosed with or treated for a disease, such as cancer. The overall survival rate is often stated as a five-year survival rate, which is the percentage of people in a study or treatment group who are alive five years after diagnosis or treatment. Also called survival rate.

In statistics, describes a mathematical measure of difference between groups. The difference is said to be significant if it is greater than what might be expected to happen by chance alone. Also called statistically significant.