Pre-Brachytherapy Hormones May Harm

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This approach raises mortality risk in men older than 70 with localized prostate cancer, study finds.

BOSTON—Men older than 70 years who have localized prostate cancer may be at increased risk of death if they receive neoadjuvant hormone therapy (NHT) before being treated with brachytherapy compared with men treated with brachytherapy alone, data show.

“Hormones are used routinely, and they have been shown to help in intermediate- and high-risk patients but not in low-risk patients,” said lead researcher Amy Dosoretz, MD, a radiation oncology resident at the Harvard Radiation Oncology Program in Boston. “So we were worried that some low-risk individuals were experiencing more harm than benefit.”

Discrepancy exists in the literature regarding the impact of NHT on all-cause mortality risk in men undergoing brachytherapy for localized prostate cancer. One study found an increased risk of all-cause mortality with the use of NHT in men with a median age of 73 (Int J Radiat Oncol Biol Phys. 2005;61:1299-1305).

A second study, however, found that this was not the case in men with a median age of 67 (Int J Radiat Oncol Biol Phys. 2006;65:669-677). NHT is often used to shrink the prostate before brachytherapy treatment of localized prostate cancer, but clinicians have been unclear about when to use this approach in older men with localized disease.

The new study included 1,702 men with localized prostate cancer (median age 75 years; range 70-91 years). A total of 786 men received NHT prior to brachytherapy and 916 did not. The patients did not receive supplemental external beam radiation. All subjects had at least 24 months of follow-up. The cancers were low-, intermediate-, and high-risk in 61%, 25%, and 14% of men, respectively.

The median duration of NHT was 3.5 months. After a median follow-up of five years and adjustment for known prostate cancer prognostic factors and age, NHT was associated with a significant 20% increased risk of all-cause mortality. Increasing age and a Gleason score of 7 or higher also were significantly associated with increased risk of all-cause mortality.

“These results are particularly interesting, since two previous studies that examined similar populations contradicted each other in terms of how hormone therapy impacts the risk of death among prostate cancer patients in this age group,” said Dr. Dosoretz, who presented study findings at the American Society for Therapeutic Radiology and Oncology annual meeting.

“Our study shows that for men over 70 with early-stage prostate cancer, androgen deprivation therapy as a form of treatment may do more harm than good. In older patients, the risks of androgen deprivation need to be carefully weighed by doctors when designing the proper treatment plan.”

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