Androgen Deprivation Therapy: A Survival Benefit or Detriment in Men With High-Risk Prostate Cancer?

Friday, 27/08/2010  |   Prostate Cancer  |  1 comment

Androgen deprivation therapy (ADT) has been used in the management of prostate cancer for more than four decades. Initially, hormone therapy was given largely for palliation of symptomatic metastases. Following several randomised trials of patients with intermediate- to high-risk prostate cancer that demonstrated improvements in biochemical control and survival with the addition of ADT to external beam radiotherapy, there was a dramatic increase in the use of hormone therapy in the definitive setting. More recently, the safety of ADT has been questioned, as some studies have suggested an association of hormone therapy with increased cardiovascular morbidity and mortality. This is particularly worrisome in light of practice patterns that show ADT use extrapolated to situations for which there has been no proven benefit. In the setting of dose escalation with modern radiotherapy, in conjunction with the latest concerns about cardiovascular morbidity with ADT, the magnitude of expected benefit along with potential risks of ADT use must be carefully considered for each patient.

Furthermore, the authors state; It is of concern that practice patterns have been shown to be driven by inappropriate extrapolation of existing data and financial incentives. This is particularly worrisome in light of growing evidence that ADT may be detrimental to the survival of our patients. Recent available data suggest possible increased cardiovascular morbidity and mortality associated with androgen suppression that must not be taken lightly. Given the large number of men receiving ADT, this is a serious health concern. ADT should be used discriminately and strictly in settings in which a clear benefit has been shown. Only in the rigorously selected patient will the benefit of ADT outweigh its risks. Modifiable cardiac risk factors ought to be addressed when initiating ADT, and special attention should be paid to patients’ global health status, to insure that we are not harming patients in the pursuit of improving cure rates and other less noble causes.

Fang, L.C., Merrick, G.S. & Wallner, K.E. ONCOLOGY. Vol. 24 No. 9.

One Comment

  1. Philip Niu
    Aug 27, 2010

    I am very interested in the treatment of Prostate Cancer. Thank you for your help.

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