Use of androgen deprivation therapy for metastatic prostate cancer in older men

Abstract

OBJECTIVETo assess factors associated with early or delayed androgen deprivation therapy (ADT) among men diagnosed with metastatic prostate cancer, and to assess the relationship between ADT and overall survival, as there is uncertainty about the ideal timing for initiating ADT in men with metastatic prostate cancer.PATIENTS AND METHODSWe studied a population‐based cohort of American men aged ≥66 years diagnosed with metastatic prostate cancer during 1992–2002 and followed to 2003. We assessed the receipt of ADT early (≤4 months from diagnosis), delayed (>4 months), or not at all, using multinomial logistic regression to identify factors associated with treatment, and Cox proportional‐hazard models to assess whether treatment was associated with survival.RESULTSOverall, 69.5% of men received early ADT and 7.3% delayed. Adjusted rates of early ADT were lower for black than white men (58.3% vs 71.0%), and of delayed ADT were higher for black than white men (12.7% vs 6.2%). Receipt of ADT was associated with improved survival (adjusted hazard ratio 0.69, 95% confidence interval 0.66–0.73). The benefit of early treatment did not differ from delayed treatment (P = 0.58).CONCLUSIONSA large minority of men with metastatic prostate cancer, particularly black men, receive delayed or no ADT. Early or delayed ADT was associated with similarly prolonged survival. After controlling for patient and tumour characteristics, survival did not differ by race, and receipt of ADT did not contribute to racial differences in survival.

Survival outcomes in men receiving androgen‐deprivation therapy as primary or salvage treatment for localized or advanced prostate cancer: 20‐year single‐centre experience

“…In a prospective cohort study of 8671 men with metastatic prostate cancer from the Surveillance, Epidemiology, and End Results (SEER) database, Keating et al. [5] reported survival outcomes with ADT. This series evaluated the receipt of early (≤4 months), late (>4 months) and no ADT.…”

“…Since the seminal discovery of the androgen‐dependence of prostate cancer, androgen‐deprivation therapy (ADT) with GnRH analogues or bilateral orchidectomy has played a fundamental role in prostate cancer treatment [2]. ADT remains widely used for treating men with locally advanced disease, and as salvage (SADT) therapy after failure of primary definitive treatment [3–5]. Further, use of primary ADT (PADT) has emerged as an option for men with clinically localized or loco‐regional disease [4,6], with significant increases in the use of PADT documented [7,8].…”

Androgen Deprivation Therapy: Appropriate Patients, Timing to Initiate ADT, and Complications

“…At the time of the last follow up in 2003, there were still significant improvement in disease-specific survival in the immediate group. 44 Finally, immediate versus delayed ADT (orchiectomy) was investigated in patients with T0-4 N0-2 M0 prostate cancer who were not candidates for curative local treatment (EoRTC 30891). In a similar study, Schroder et al (EoRTC 30846) evaluated the effect of early androgen deprivation versus delayed androgen suppression in pN1-3 prostate cancer.…”

Use of androgen deprivation therapy as salvage treatment after primary therapy for clinically localized prostate cancer

“…Androgen deprivation therapy (ADT) has been the standard treatment for metastatic prostate cancer for decades [3]. It has also been used as primary therapy for localized disease and has been increasingly used as adjuvant or salvage therapy among men diagnosed with localized disease after prior surgery or radiotherapy [4].…”