Adding Hormone Therapy to Brachytherapy May Raise Death Risk in Older Men

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Adding androgen deprivation therapy (ADT) to brachytherapy for localized prostate cancer may increase the risk of death among men aged 73 years and older, data suggest.

Researchers led by Anthony V. D'Amico, MD, PhD, of Brigham and Women's Hospital and Dana Farber Cancer Institute in Boston, studied 2,474 men with localized prostate cancer treated with brachytherapy; of these, 1,083 also received ADT and 1,391 did not. The team stratified patients into two age groups: younger than 73 years and 73 years and older. All patients had at least two years of follow-up.

After a median follow-up of 4.8 years and adjusting for known prostate cancer prognostic factors and age, ADT was associated with a significant 24% increased risk of death from any cause among men aged 73 and older, according to findings published in Cancer (2010; published online ahead of print). The researchers observed no association between ADT and all-cause mortality in younger men.

Dr. D'Amico's group acknowledged that the link they observed between ADT use and all-cause mortality does not prove causality. Causes of death were not available for all patients in the study, so they chose to report on all-cause mortality, the team noted. Men aged 73 years and older would be expected to have more comorbidities than younger men, and ADT could accentuate these, the researchers pointed out.

Their study supports a growing body of literature showing that as men age and acquire comorbidities—particularly cardiovascular comorbidities—even short-duration ADT may decrease or not improve overall survival, the investigators observed. The diagnostic tests and interventions required to attenuate the mortality risk associated with ADT remains to be worked out.

Meanwhile, the authors concluded: “Physicians should carefully weigh the risks and benefits of hormone therapy in each individual patient when designing the treatment plan.”

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