Can Some Prostate Cancer Patients Skip Hormone Therapy?

If a tumor hasn't spread from the organ, the unpleasant treatment doesn't extend life, research shows.

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Older men with localized prostate cancer may do well to avoid hormone therapy, especially if they're suffering from other chronic diseases such as osteoporosis or heart disease. That's the upshot of new research, released today, that shows older men who receive what doctors call primary androgen deprivation therapy—a treatment that typically involves either surgical removal of the testicles or medical treatment to quench the body's ability to produce testosterone—survive no longer than men who forgo that side-effect-laden treatment.

According to Siu-Long Yao, an oncologist at the Cancer Institute of New Jersey who authored the study in this week's Journal of the American Medical Association, an increasing number of clinicians and patients are turning to hormone therapy as an alternative to surgery, radiation, or watchful waiting even for low-risk cancers that are unlikely to spread. "Hormonal therapy has become the compromise," says Yao, noting that many men feel compelled to do something to confront prostate cancer but worry that surgery and radiation are too aggressive.

Hormone treatment is most beneficial for men with metastasized cancer that has spread beyond the prostate. For those patients, cutting off the supply of testosterone may slow tumor growth and extend survival. For localized tumors, however, overall survival rates were essentially the same for men who received hormone therapy as for those who did not, Yao's analysis of some 19,000 men aged 66 or older shows. That's probably because prostate tumors typically strike late in life and are often so slow-growing that unrelated diseases, not the cancer, take many patients' lives. For older men who have a localized tumor that doesn't appear to be aggressive and who have other health problems, experts say, the cancer isn't likely to prove lethal.

That's why, according to Yao, it is crucial for men to balance the risks and benefits of aggressive treatment before plunging forward. There certainly is a downside to hormone therapy: Reduced testosterone levels increase a man's risk of fractures, diabetes, coronary heart disease, and heart attacks by between 10 and 50 percent. Likewise, one study found that the chance of developing enlarged breasts jumps 500 percent after one year of hormone therapy and the risk of impotence rose by 267 percent.

For more on the disease, see some of my earlier articles about proton beam therapy, robotic prostatectomy, how to prevent prostate cancer, how to weigh treatment options, and 11 things to know about prostate cancer. The U.S. News Prostate Cancer Channel, developed with Johns Hopkins, offers additional information.