Hormone Therapy for Prostate Cancer May Not Be Worth It

Study says side effects include impotence, and benefits are debated

TUESDAY, March 19, 2002 (HealthDayNews) -- If you're a man in the early stages of prostate cancer, therapy that reduces your level of male hormones may be more trouble than it's worth.

A new study from the National Cancer Institute found men who had the therapy were more than twice as likely to become impotent and five times more likely to suffer hot flashes and breast swelling, when compared to men who didn't opt for the treatment.

Worse, that suffering may be in vain because there's no proof that androgen deprivation therapy (ADT) actually does these men any good when used alone, says lead author Arnold L. Potosky, a researcher at the institute.

The study appears tomorrow in the Journal of the National Cancer Institute.

"There are a lot of men who are receiving androgen deprivation therapy as a sole therapy for localized prostate cancer, despite a lack of any evidence that in that specific situation it can prolong survival, compared to any other therapy or compared to no therapy," Potosky says.

He and his colleagues analyzed data from 661 men diagnosed in 1994 and 1995 with prostate cancer that hadn't spread beyond the prostate. None had surgery or radiation for the cancer. The men, from six different areas of the United States, were tracked for a year after diagnosis.

The authors found that 245, or 37 percent, of the men received ADT. After one year, 80 percent of the men who received ADT reported they'd become impotent, compared to 30 percent of men who didn't receive treatment. Men who received ADT were also five times more likely to report breast swelling and hot flashes.

While ADT caused these complications, 56 percent of the men receiving ADT said they believed they were free of their cancer, while only 45.3 percent of the men receiving no therapy reported the same relief, the study found.

The goal of ADT is to lower or eliminate male hormones, which promote tumor growth in the prostate. There are several ways to accomplish that, including removing the testicles or having patients take the female hormone estrogen.

Since the early 1990s, luteinizing hormone-releasing hormone (LHRH) agonists have become a common form of ADT. LHRH agonists, given by regular injection, prevent the testicles from producing testosterone.

In this study, LHRH agonists were given to 78 percent of the men who underwent ADT.

The authors note that about 160,000 American men each year are diagnosed with localized prostate cancer. More than half of those men are treated with either surgery or radiation. It was estimated in 1996 that about 20,000 American men undergo the more conservative ADT treatment each year and that figure is likely much higher now, Potosky says.

"So just the prevalence of this therapy is an interesting finding in and of itself, and that hasn't been documented on a population-wide basis in the U.S.," he says.

The LHRH agonists have made ADT a simple method of treatment. However, Potosky stresses there are no definitive studies to show the therapy improves the length or quality of life for men with localized prostate cancer.

"So we don't really know if it's beneficial in terms of survival, but it certainly has a down side in terms of sexual impairment and reduced physical function, that we document in this paper, within the first year of its use," Potosky says.

He hopes this study stimulates clinical trials to establish whether ADT is effective when used as the sole treatment for localized prostate cancer.

Another expert agrees this area needs more research.

"ADT alone isn't recommended for patients with localized prostate cancer anywhere in the medical literature. It is an unproven use of therapy," says Dr. James A. Talcott, assistant professor of medicine and director, Center for Outcomes Research, at the Massachusetts General Hospital Cancer Center in Boston.

One important discovery is the study shows the large number of American men receiving ADT as primary treatment for their prostate cancer, says Talcott, who wrote an editorial that accompanies the article.

"They really need to understand that androgen deprivation therapy has down sides, and those down sides aren't well-studied and the drugs are being used in situations beyond where they've been proven effective," Talcott says.

What To Do

For more information about prostate cancer and treatment, go to the National Cancer Institute, or the National Prostate Cancer Coalition.

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