Usage and outcomes of primary androgen deprivation therapy for localized prostate cancer

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Apr 11 2006

In the online March 2006 version of Cancer, Dr. Kawakami and associates report from the CaPSURE database that primary androgen deprivation therapy (PADT) is used in 14% of prostate cancer (CaP) patients with reasonable outcomes at approximately 5 years follow-up.

Between 1989 and 2002, 7045 men in the CaPSURE database with clinically localized CaP were identified and clinical and sociodemographic data evaluated. Distribution of treatments by these patients indicated that 50% elected surgery, 13% radiotherapy, 13% brachytherapy, 4% cryotherapy and 14.1% with CaP elected PADT. Men selecting PADT usually received an LHRH agonist (49%) or combined androgen blockade (39%).

Compared to all other treatments, men electing PADT were older (mean age = 74 years), with lower incomes, less education and they were more likely to have Medicare than private insurance. PADT patients had higher risk disease compared to all other treatments; Gleason score >7 in 51% and 29%, respectively and median PSA 10.4ng/ml and 6.6ng/ml, respectively.

Five years after starting PADT, 13.8% of men then received definitive therapy and 3.9% received treatment for hormone-refractory disease. What is unknown is how these patients might have fared with active surveillance or definitive therapy, as CaPSURE is a database. Only randomized trials will be able to address these questions.

By Christopher P. Evans, MD

Reference:

Cancer. 2006 Mar 16;106(8):1708-1714 [Epub ahead of print]