Androgen deprivation therapy should be used with caution in some prostate cancer cases, study warnsBMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h5043 (Published 22 September 2015) Cite this as: BMJ 2015;351:h5043
Combining androgen deprivation and radiotherapy is known to improve outcomes in aggressive prostate cancer, but research published in JAMA shows that it should be used with caution in men with coexisting illness.1
Six months of androgen deprivation therapy and radiation therapy is the standard treatment for unfavourable risk prostate cancer. But a post-randomisation analysis found that men with moderate or severe comorbidity showed no survival benefit from combined therapy.
From December 1995 to April 2001, 206 men with unfavourable risk prostate cancer were randomised to receive radiation therapy alone or a combination of radiation therapy and androgen deprivation therapy. After a median follow-up of 16.62 years 156 men died: 29 from prostate cancer (19%), 39 from cardiac causes (25%), and 99 from other causes (56%). Among men with moderate or severe comorbidity 46 of 49 died, compared with 110 of 157 with no or minimal comorbidity.
Survival did not differ between the patients who had radiotherapy alone and those who had radiotherapy and androgen deprivation therapy. However, opposite effects of treatment on survival were observed depending on whether the men had coexisting illness.
In men with no or minimal comorbidity, radiation therapy alone was associated with higher mortality than radiation therapy plus androgen deprivation therapy. However, in men with moderate or severe comorbidity, radiation therapy alone versus combined therapy was associated with significantly decreased overall mortality (hazard ratio 0.36 (95% confidence interval 0.19 to 0.67); P=0.001) and cardiac mortality (0.17 (0.06 to 0.46); P<0.001).
James Catto, editor of European Urology, commented, “These findings are extremely important. Whilst it is known that combined androgen deprivation and radiotherapy can improve the cancer cure outcomes from aggressive prostate cancer, little is known about the long term implications of suppressing a man’s testosterone. Here the authors find that the consequences of this are more vascular and cardiac problems, which eventually lead to more deaths.”
He added, “One must caution the use of androgen suppression in these men, and consider either radiotherapy alone or radical surgery. The latter appears to be superior in many reports of large population outcomes.”
Cite this as: BMJ 2015;351:h5043