Hormone therapy does not improve survival in elderly men with prostate cancer

The research, published in The Journal of the American Medical Association, shows that elderly men with localised prostate cancer who are given hormone therapy that deprives the prostate of androgens, provides no better survival than conservative treatment.

Hormone therapy is often used as an alternative to surgery, particularly in older men and is the second most common treatment for this cancer if it is localised, after surgery. This is even though there is little evidence available to suggest that hormone therapy is in fact effective. Conservative treatment comprises a wait and see approach, in which treatment is not started unless there are troublesome signs and symptoms associated with the disease.

Grace Lu-Yao and colleagues looked at more than 19 000 men aged 65 or older with localised prostate cancer who were diagnosed between 1992 and 2002. The focus of the research was to analyze the potential association between hormone therapy and prostate cancer-specific survival and overall survival. None of the patients received a prostatectomy or other definitive local therapy, but 7 867 (41%) received hormone therapy and 11 404 received conservative management treatment that did not include hormone therapy. Patients were followed up through December 2006 for all-cause mortality (11 045 deaths) and through December 2004 for prostate cancer-specific mortality (1 560 deaths).

Results showed that the 10-year prostate cancer-specific survival for men who receive hormone therapy was 80.1%, compared to 82.6% for those who were treated with conservative managements. That is, hormone therapy was associated with a lower 10-year prostate cancer-specific survival compared to conservative management. In addition, the hormone depriving therapy was not associated with a better 10-year overall survival compared to conservative management.