In the March 20 issue of the Journal of the National Cancer Institute, Arnold L. Potosky, Ph.D., of the National Cancer Institute, and his coworkers estimate that roughly 20,000 men in the United States are treated initially with ADT each year for localized prostate cancer. While ADT was associated with increased complications, the authors note that men treated with ADT were generally more satisfied with their treatment decision than men who received no treatment.
Approximately 160,000 men are diagnosed with localized prostate cancer each year, and more than half of these men are treated with either surgery or radiation. About 40% of patients with early stages of the disease are treated more conservatively, with either ADT or a “watch-and-wait” approach.
The use of ADT alone, however, has not been proven to increase the life of prostate cancer patients. Earlier studies of ADT in men with advanced prostate cancer, for whom such therapy is considered the standard of care, have suggested that ADT may be associated with fatigue and decreased sexual functioning.
To compare the quality-of-life of treatment-free people with those receiving ADT, Potosky and his coworkers analyzed data from 661 men who were diagnosed with localized prostate cancer but did not undergo surgery or radiotherapy. The authors found that 245, or 37%, of these patients received ADT. These men tended to have a higher risk of having their cancers progress than untreated men.
After one year, 80% of the treated men reported having become impotent, compared with 30% of the untreated men. Men who received ADT were also five times more likely to report breast swelling and hot flashes. Moreover, men treated with ADT reported a reduction in physical comfort and vitality one year after therapy. However, 58% of men receiving ADT, compared with 46% of men receiving no therapy, believed they were free of cancer.
The authors conclude that, “ADT is a commonly used primary therapy for localized prostate cancer. Therefore, men considering ADT as an initial treatment should be aware that sexual function and some aspects of physical well-being are likely to be affected in the first year following this treatment.”
In a related editorial, James A. Talcott, M.D., of the Massachusetts General Hospital, points out that roughly two-thirds of urologists recommend ADT for early prostate cancer even though the evidence backing the effectiveness of ADT has been lacking.
“Patients deserve better information from randomized clinical trials to help them make [treatment] decisions,” he concludes. “Leaving them to ill-informed hunches is chancy medicine and the road to poor, expensive health policy.”
Contact: NCI Press Office, (301) 496-6641
Editorial: Sue McGreevey, Massachusetts General Hospital, (617) 724-2764; fax: (617) 726-7475, smcgreevey@partners.org
Potosky AL, Reeve BB, Clegg LX, Hoffman RM, Stephenson RA, Albertsen PC, et al. Quality of life following localized prostate cancer treated initially with androgen deprivation therapy or no therapy. J Natl Cancer Inst 2002;94:430–6.
Editorial: Talcott JA. Androgen deprivation as primary treatment for early prostate cancer: should we “just do something”? J Natl Cancer Inst 2002;94:407-9.
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