Androgen-deprivation therapy as primary treatment for localized prostate cancer : Data from cancer of the prostate strategic urologic research endeavor (CaPSURE)

Prostate cancer is largely an androgen-sensitive disease. Androgen-deprivation therapy (ADT) generally has been used for patients with advanced disease. However, ADT is used increasingly as monotherapy for patients with clinically localized disease. The objective of the current report was to describ...

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Bibliographic Details
Published in:Cancer 2006-04, Vol.106 (8), p.1708-1714
Main Authors: KAWAKAMI, Jun, COWAN, Janet E, ELKIN, Eric P, LATINI, David M, DUCHANE, Janeen, CARROLL, Peter R
Format: Article
Language:English
Subjects:
Adenocarcinoma - mortality
Adenocarcinoma - therapy
Aged
Aged, 80 and over
Androgen Antagonists - therapeutic use
Antineoplastic Agents, Hormonal - therapeutic use
Biological and medical sciences
Diethylstilbestrol - therapeutic use
Enzyme Inhibitors - therapeutic use
Finasteride - therapeutic use
Gonadotropin-Releasing Hormone - agonists
Humans
Longitudinal Studies
Male
Medical sciences
Middle Aged
Neoplasms, Hormone-Dependent - drug therapy
Nephrology. Urinary tract diseases
Orchiectomy
Prostatic Neoplasms - mortality
Prostatic Neoplasms - therapy
Survival Rate
Tumors
Tumors of the urinary system
Urinary tract. Prostate gland
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Summary:Prostate cancer is largely an androgen-sensitive disease. Androgen-deprivation therapy (ADT) generally has been used for patients with advanced disease. However, ADT is used increasingly as monotherapy for patients with clinically localized disease. The objective of the current report was to describe the characteristics of patients who underwent ADT for the management of localized disease. Cancer of the Prostate Strategic Urologic Endeavor (CaPSURE), which is a national disease registry of men with prostate cancer, was screened to identify patients who received treatment with primary ADT (PADT) between 1989 and 2002 for clinically localized disease (T1-T3,Nx/N0,Mx/M0). Clinical data (including Gleason score, prostate-specific antigen [PSA] level, and T classification) and sociodemographic data (including age, race, education, income, and insurance coverage) were analyzed with chi-square statistical tests. Time to failure data were analyzed using log-rank tests, the Kaplan-Meier method, and Cox proportional hazards regression analyses. Of 7045 men, 993 patients (14.1%) with clinically localized disease received primary ADT. Compared with patients who underwent standard treatment, patients who received PADT had higher risk disease (as defined by PSA level, T classification, and Gleason score) and had more comorbidities. Patients who underwent PADT were older, less educated, had lower income, and were more likely to have Medicare than private insurance. The dominant forms of hormone therapy were luteinizing hormone-releasing hormone (LHRH) monotherapy (48.6%) and combined androgen blockade (LHRH agonist and antiandrogens; 38.8%). At 5 years after the initiation of PADT, 67.3% of patients still were receiving treatment with only androgen deprivation, 103 patients (13.8%) had gone on to receive definitive second treatment (radical prostatectomy, external beam radiotherapy, brachytherapy, or cryotherapy), 27 patients (3.9%) underwent second-line therapy (chemotherapy or alternative hormone-deprivation therapy), 22 patients (4.1%) died of prostate cancer, and 146 patients (19%) died of all causes. The use of PADT therapy appeared to control disease in the majority of patients who received it, at least for an intermediate period. However, such patients appeared to be unique based on sociodemographic characteristics, comorbidity status, and risk factors compared with patients who received other forms of therapy. The impact of PADT on quality of life needs to be com
ISSN:0008-543X
1097-0142
DOI:10.1002/cncr.21799