Researchers from the Dana Farber Cancer Center have reported that elderly men with high-risk prostate cancer without a history of cardiac infarction have a lower prostate-specific mortality following brachytherapy plus androgen deprivation therapy (ADT) than following brachytherapy alone. The details of this study were published early online in Cancer on March 22, 2010.[1]

Current treatment options for prostate cancer include watchful waiting, surgery, chemotherapy, ADT, external beam radiotherapy, cryotherapy, brachytherapy, or a combination of brachytherapy and external beam radiotherapy. ADT is also used for adjuvant and neoadjuvant therapy in conjunction with surgery or radiotherapy. Because long-term survival from prostate cancer remains high following several treatment modalities, the contribution of each treatment to mortality is poorly understood. This is especially true for ADT, where side effects must be weighed against benefits. The main side effects of ADT include: loss of libido, weight gain, osteoporosis, fractures, and anemia. Patients with prostate cancer also frequently die of cardiovascular disease; however the impact of ADT therapy on cardiovascular morbidity and mortality is not well defined. Researchers from Sweden have previously reported that ADT in men with advanced prostate cancer may lead to an increased risk of heart disease.

The current study included 764 men with Stage T3 or T4 non-metastatic prostate cancer with PSA levels greater that 20 ng/ml and/or a Gleason score of 8-10. The median age of this group of men was 73 years with a range of 70-73. Patients in this study had no history of myocardial infarction or had a history of myocardial infarction treated with a stent or surgical intervention. These patients received brachytherapy alone (n=206) or brachytherapy plus ADT (n=558). The median follow-up of these patients was five years. During this time there were 25 deaths from prostate cancer. Patients receiving brachytherapy plus ADT had a 71% decreased risk of death compared with patients receiving brachytherapy alone.

Comments: These data suggest that relatively healthy older men with high-risk prostate cancer benefit from added ADT with a decreased rate of death from prostate cancer. This is a surprising result given the adverse effects of ADT in elderly patients. It will be of interest to follow this group of men for a longer period to see if the positive effect persists.

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