Primary ADT Not Beneficial in Most Cases of Early Prostate Cancer

The treatment is associated with a decreased risk of all-cause mortality in men at high risk.
The treatment is associated with a decreased risk of all-cause mortality in men at high risk.

Recent study results indicate that the majority of men with clinically localized prostate cancer (PCa) derive no survival benefit from the administration of primary androgen deprivation therapy (ADT), although the treatment may be of small clinical benefit to men with higher-risk disease. 

“Primary [ADT] may be preferable to some men with early-stage prostate cancer who would prefer to do something rather than watch and wait for further signs of progression to occur later and then need treatments,” lead investigator Arnold Potosky, PhD, a professor of oncology and director of health services research at Georgetown Lombardi Comprehensive Cancer Center in Washington, DC, said in a statement issued by Georgetown Medical Center. “However, using [primary ADT] by itself immediately after diagnosis in the hopes of limiting cancer's progression does not extend survival, according to this study.”

As noted in the Georgetown statement, recent studies show that primary ADT for early-stage PCa is the second most common treatment, after radiotherapy, for clinically localized tumors among men aged 65 years and older. However, the treatment's effects on cause-specific and overall mortality have not been established, Dr. Potosky and colleagues pointed out in a study published online ahead of print in the Journal of Clinical Oncology.

Dr. Potosky's group conducted a retrospective cohort study in which they analyzed data from 15,170 men with a new diagnosis of clinically localized PCa who were not treated with curative intent therapy. The men all received their diagnosis from 1995 to2008 and received follow-up through December 2010.

After the data were adjusted for all sociodemographic and clinical characteristics, primary ADT was not associated with a decreased risk of all-cause or PCa-specific mortality overall. However, in a subgroup of men with a high risk of cancer progression, the treatment was associated with a decreased risk of all-cause mortality, but not PCa-specific mortality.

“This study is the most comprehensive study on the effectiveness of primary ADT for men who forgo radiation and surgery for their localized prostate cancer, and it tells us there is no strong reason to use it in most patients,” Dr. Potosky said.

Dr. Potosky and his team are now using their database to examine the rates of side effects related to primary ADT.

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