The Department of Urology, University of Tennessee Health Science Center, Memphis, TN, performed a retrospective study designed to evaluate the overall survival (OS) and disease-specific survival (DSS) in men receiving primary androgen-deprivation therapy (PADT) or salvage medical ADT (SADT) for prostate cancer.
The study included men who were diagnosed and treated with ADT between July 1987 and June 2007. The researchers considered variables such as age at diagnosis and ADT induction, race, PSA level before ADT, ADT schedule (continuous/intermittent), clinical/pathological stage, hormone-refractory prostate cancer (HRCP) status, PADT or SADT, and deaths.
They evaluated statistics from a sample of 548 men. The mean age at diagnosis and ADT induction were 70.1 and 72.3 years, respectively, and 321 (58.6%) were African-American. The median PSA level before ADT was 16.3 ng/mL. ADT was administered continuously in 497 (90.7%) patients; 342 (62.4%) received PADT while 206 (37.6%) received SADT. At mean (range) follow-up of 81.8 (2.1-445) months, 98 (17.9%) deaths occurred; 31 (31.6%) were cancer-specific. The OS and DSS in the PADT and SADT groups were not significantly different (P = 0.36 and P = 0.81, respectively). Mortality rates/distributions were similar between groups (P = 0.68). Multivariate predictors of OS and DSS included age at diagnosis (P = 0.03) and ADT induction (P = 0.009), tumour stage (P < 0.001), and PSA level at ADT induction (P = 0.01). Progression to HRPC worsened OS and DSS (both P < 0.001). The study concluded that PADT and SADT prolong survival in men with prostate cancer. HRPC portends a poor DSS. Age at diagnosis and ADT induction, PSA level before ADT, and disease stage predict both OS and DSS.The authors concluded that most men died from causes unrelated to prostate cancer, thus questioning the true value of ADT in prolonging patient survival (my addition- for this aged population).
My concern and problem about this conclusion revolves around the high mean age of the men in the study, which was over 70 years. They did conclude that ADT does extend life (this to me is the most important conclusion that needs to be emphasized), but they questioned its value because of the more advanced age of the participants. A better conclusion would not question the value of ADT, but perhaps it can be questioned for men who are diagnosed at a more advanced age. For those of us who have a natural life expectancy in excess of ten years, using ADT will extend life and should be seriously considered as a treatment modality.
BJU Int. 2009 Apr 17. Epub ahead of print.
doi: 10.1111/j.1464-410X.2009.08593.x; Diblasio CJ, Malcolm JB, Hammett J, Wan JY, Aleman MA, Patterson AL, Wake RW, Derweesh IH
Joel T Nowak MA, MSW