Sometimes the best therapy for prostate cancer is no therapy

When Nothing is Better than Something

Sometimes the best treatment for prostate cancer is no treatment.

But some patients don’t want to hear that. They want their doctor to do something. And many doctors would prefer to try something, ANYTHING, rather than simply stand aside and let nature take its course.

A new study gives these patients and their doctors some important new guidelines.

To treat or not to treat

Testosterone is a tricky hormone.

After the age of 40, the average man’s testosterone level drops a little more than one percent each year. But even at lowered levels, testosterone stimulates the growth of prostate cancer cells. So one of the tools used to arrest the advance of prostate cancer is primary androgen deprivation therapy (PADT), which blocks production of testosterone and other androgen hormones.

As I’ve noted in previous e-Alerts, prostate cancer is a slow-growing cancer. So when early-stage prostate cancer is diagnosed in older patients, the best treatment is very often no treatment, combined with close monitoring.

Many doctors and older prostate cancer patients who aren’t comfortable with a passive approach often choose PADT to offer an extra assurance that the cancer’s supply line is turned off. But this assurance comes at the cost of potential side effects, which include increased risk of heart disease, sudden cardiac death, diabetes, bone loss, and fracture.

Of course, risk of side effects doesn’t stop most doctors from prescribing medication. But maybe a new study will help put the brakes on unnecessary use of PADT.

An unexpected statistic

A research team led by scientists at the Robert Wood Johnson Medical School designed a study to examine the link between PADT and survival in older men with localized prostate cancer.

STUDY PROFILE

• Researchers evaluated medical records for more than 19,000 patients with early-stage prostate cancer that had not spread beyond the prostate
• All of the men were over the age of 66, and their average age was 77
• Subjects were followed for six years
• Nearly 8,000 subjects received PADT
• Among older men, PADT did not improve survival chances

The most surprising results were found in the numbers of deaths due to prostate cancer during the six-year observation period. About 20 percent of the PADT subjects died of prostate cancer, while only 17 percent of the subjects who received no treatment died of the disease.

Writing in the Journal of the American Medical Association, the researchers noted that the significant adverse effects and costs of PADT, combined with the finding of an overall lack of survival benefit, should be carefully considered before starting this therapy in elderly patients with early stage prostate cancer.

Source:
“Survival Following Primary Androgen Deprivation Therapy Among Men With Localized Prostate Cancer” Journal of the American Medical Association, Vol. 300, No. 2, 7/9/08, jama.ama-assn.org