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Medicineworld.org: Age alone should not be used to determine whether to treat prostate cancer

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Age alone should not be used to determine whether to treat prostate cancer




Concerns regarding the association of hormone treatment used to treat prostate cancer with cardiovascular disease in some older men may lead doctors to forgo hormone therapy solely on the basis of age. But a new study by physicians at Fox Chase Cancer Center shows that men over age 70 with high-risk prostate cancer lived longer and experienced increases in PSA less frequently when treated with long-term androgen deprivation treatment.



Age alone should not be used to determine whether to treat prostate cancer

The benefit of long-term (i.e. 2-3 years) androgen deprivation treatment has been established in high-risk patients with prostate cancer in several prospective, randomized clinical trials. However, concern that androgen deprivation treatment may result in cardiovascular disease, especially in older patients men with certain risk factors for cardiovascular disease, has led researchers to question its role in older men.

"Several studies have demonstrated a survival benefit when androgen deprivation treatment is used along with radiotherapy in men with high-risk, clinically localized prostate cancer," said the study's lead author, Joshua Silverman, MD, PhD, a resident in the Department of Radiation Oncology at Fox Chase. "What we did not know until now is whether this benefit outweighs the risks of cardiovascular and metabolic adverse effects from androgen deprivation treatment." .

In this retrospective study presented today at the 50th annual meeting of the American Society for Therapeutic Radiology and Oncology, scientists identified men with prostate cancer that was confined to the prostate, but considered high-risk (i.e. pre-treatment PSA ≥ 20, Gleason score 8-10, or larger tumors palpable during digital rectal exam) and looked at outcomes with and without the use of hormone treatment.

"We know the risk of distant metastasis, recurrence and death are higher when androgen deprivation treatment is not part of radiation therapy," said Silverman. "We wanted to see if age should be a determining factor for therapy with hormone suppression."

Scientists found the overall rate of biochemical failure (i.e., a rise in the PSA level) is lower for men who received hormone treatment regardless of age. A rise in PSA can indicate the recurrence or spread of prostate cancer and often leads to more testing and more aggressive therapys.

"We saw the greatest advantage of hormone treatment among men who received a longer duration of androgen deprivation treatment, including those with pre-existing cardiovascular and metabolic concerns," said Silverman.

A longer duration (more than 12 months) of hormone treatment resulted in a greater overall survival for all men (≤12 months-87 percent, ≥ 12 months-98 percent; p=0.02) including in men older than 70 (≤12 months-80 percent, ≥ 12 months-98 percent; p=0.03).

Men under 70 who received hormone treatment had a greater 5 year overall survival rate (96 percent v 91 percent; p0.03) than did men over 70 (89 percent v. 86 percent; 0.17).

"This may be explained in part by a trend toward greater pre-existing cardiovascular concerns in men over age 70," Silverman said.

Still, Silverman said, "We concluded that age alone should not be considered a contraindication to hormone therapy in high-risk patients. While co-morbidities may influence clinical decision-making regarding androgen deprivation treatment, we do not have enough data to select patients who should or should not receive therapy of a shorter duration based on age alone".

"One weakness of this study is selection bias because men in this retrospective analysis were not randomized to androgen deprivation treatment." Silverman said, "We still need to continue our careful consideration of each individual's health before recommending androgen deprivation treatment".

Silverman added that the study does not address the impact hormones may have on a man's quality of life. The adverse effects of hormones include muscle loss, cognitive issues, loss of libido, and osteoporosis.


Posted by: Mark    Source




Did you know?
Concerns regarding the association of hormone treatment used to treat prostate cancer with cardiovascular disease in some older men may lead doctors to forgo hormone therapy solely on the basis of age. But a new study by physicians at Fox Chase Cancer Center shows that men over age 70 with high-risk prostate cancer lived longer and experienced increases in PSA less frequently when treated with long-term androgen deprivation treatment.

Medicineworld.org: Age alone should not be used to determine whether to treat prostate cancer

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