In a recent study titled “Patterns of Declining Use and the Adverse Effect of Primary Androgen Deprivation on All-cause Mortality in Elderly Men with Prostate Cancer”, published in the European Urology journal, a group of researchers from the Henry Ford Hospital found that a commonly used prostate cancer therapy, primary androgen deprivation therapy (pADT), should not be prescribed to men whose cancer has not yet metastasized.
This is especially important for younger men who have a longer life expectancy, since pADT disturbs the body’s capacity to produce testosterone and is associated with severe side effects, such as heart disease, diabetes, weight gain and impotence, thus compromising quality of life and increasing the risk of death.
For over 70 years pADT has been a commonly used therapy for treating metastasized prostate cancer, and several studies encourage its use as an adjuvant or in conjunction with radiation therapy in cases considered to be of higher risk. However, there is no scientific proof that pADT should be used for low risk or localized disease.
“The use of ADT as the primary treatment for localized and low risk prostate cancer increased over time, despite known harmful side effects and a lack of data to support such use,” lead author of the study Jesse D. Sammon, D.O., a researcher at Henry Ford Hospital’s Vattikuti Urology Institute said in a press release. “In the 1990’s it became exceedingly common to use ADT in place of radical prostatectomy or radiation therapy.”
Due to concerns on the misuse of pADT for the therapy of prostate cancer, some Medicare changes in reimbursement policies were adopted in 2004, leading to a 40% drop in reimbursement and a significant reduction in the misuse of pADT for prostate cancer treatment.
“At the same time, there was a growing awareness of ADT’s many possible adverse effects, including decreased libido, anemia and fatigue, and a higher risk of metabolic and cardiovascular disease,” Dr. Sammon said. “In designing our study, we hypothesized that the adverse effects of ADT might be more pronounced in men with longer life expectancies since they would likely be treated with ADT for a longer period– and be exposed to more treatment-related side effects.”
Using data from the Surveillance, Epidemiology, and End Results cancer registry and correlating it to Medicare records, the researchers found that a total of 46,376 men diagnosed with localized prostate cancer between 1992-2009 did not receive radical prostatectomy or radiation therapy. Furthermore, among these men, 38.5% received pADT.
“No evidence supports the use of ADT in men with low risk, localized prostate cancer, while use of this therapy is decreasing over time it is still very common,” said Dr. Sammon. “We found that primary ADT is associated with decreased survival in men with localized prostate cancer relative to men who receive no active treatment, particularly in men with longer life expectancies. So we concluded that ADT should not be used as a primary treatment for men with prostate cancer that has not spread beyond the prostate or men with moderate to high risk disease undergoing radiation therapy.”