One of the more common myths about hormone therapy (ADT) to treat prostate cancer is that its effectiveness will last only for one and a half to two years. For some men this might be true, but it is not a reality in today’s prostate cancer landscape. What makes this myth worse is that it is believed equally in both the patient community and among doctors. This belief is not true.
This myth probably developed as a result of a paper published in 1989 by David Crawford. Crawford conducted a large, randomized controlled trial comparing Lupron to Lupron and Flutamide (Eulexin). At the time that Dr. Crawford did his research men were initially diagnosed with prostate cancer with much more aggressive and advanced prostate cancer than today. The use of PSA screening has meant earlier prostate cancer diagnosis, thus earlier medical intervention. Men starting ADT today have less disease, less symptoms, a longer run on ADT and longer survival.
When Dr. Crawford did his study he classified men by labeling them as being advanced, moderate, or having minimal disease. He found that men who had been classified with advanced disease (men with many bone metastases and significant symptoms) became resistant to ADT in about eight months. Those with moderate disease (men with many bone metastases but minimal or no symptoms) became resistant to ADT after an average of 18 months.
The 18-month myth probably is a carry over from the moderate disease classification from this study.
The other error many make is the use of this statistic as a predictor of an individual’s result. This is a statistic and statistics only measure a group trend, they do not predict an individual result. We are all individuals, not groups. Even when Dr. Crawford performed his study half of the men in the moderate disease group continued to respond positively to ADT.
Although not scientific, I know an extraordinary number of men who have greatly far exceeded the 18-month number. Today, I remain hormone responsive after having been on ADT for six (6) years. In one of my face-to-face advanced prostate cancer support groups there is a participant who remains hormone responsive after 14 years and another who is coming up on his 18th year of being responsive!
So, lets finally let this assumption that ADT will only be effective for 18 months go where it deserves, into the trashcan. Statistics are only good to look at group trends, not as predictors of an individual’s result and ADT will last longer today than in 1998 because we are starting it earlier in the disease progression (or with more men with minimal disease).
When we have any treatment we cannot predict our individual result. We cannot predict what side effects we might experience or if we will benefit. What we do know is that results are better today than they were yesterday and they will be even better tomorrow.
Joel T. Nowak, M.A., M.S.W.
My neighbor has been on Zolodex for 13 years after having a radical prostectamy and his PSA is 0.2. We can’t say he is still responsive to ADT until he is taken off the implant.
After 20 months, my metastised PC was no longer responsive and the treatment was stopped. Two years later my PSA is out of control reading over 4000 yet I am still quite functional – not well but surviving better than my doctors predicted.
As a still asymptomatic Gl.9 T3cN0Mx nine year ‘survivor’ who has been on intermittent ADT3 for the full period, I do not know whether I have ADT to thank for lasting this long or whether I would have done just as well without it and avoided the lousy side effects. I have yet to see convincing evidence that ADT extends overall survival. Nevertheless I’m giving ADT the benefit of the doubt and don’t intended to stop anytime soon.
Joel, everything I have read about ADT agrees with your conclusions, both about effectiveness and about why the responsiveness times quoted in the literature are so low.
If I remember correctly, no less an authority than Dr. Patrick Walsh of Johns Hopkins claimed in his book that ADT has the same benefit whether applied early or late, about 18 months. Therefore we should save it for use late, when the patient most needs it, while giving men who don’t yet need it time free of ADT side effects. He thought it should be applied when men were on the verge of symptoms from their metastases.
I think we now know that that view is wrong, but it was a very influential view and there may still be doctors who don’t realize that it is wrong.
Still responsive after nine years on Lupron monotherapy