Study: Hormones not for all prostate cancer patients
Hormone therapy, which blocks the production of the testosterone that feeds prostate tumors, is a mainstay of treatment for men with advanced disease. Studies show it also improves survival in patients with aggressive tumors that are still limited to the prostate.
Doctors also sometimes use hormones in men with early prostate cancer to shrink a tumor, making it easier to kill with radioactive seeds.
There’s no evidence to show that hormones help patients with slow-growing or “low-risk” tumors, says lead author Amy Dosoretz, who presented the paper at a meeting of the American Society for Therapeutic Radiology and Oncology in Boston on Tuesday.
And in the past two years, studies have suggested that hormone therapy increases the risks of heart attacks and diabetes.
Now, in a study of 1,707 prostate cancer patients, Dosoretz found that men over age 70 given hormones before their seed implants had a 20% higher risk of death than patients who treated only with the implants. After five years, 19.1% of those who took hormones died, compared to 16.6% of those who didn’t get hormones.
Hormones did not increase the risk of death in men under 70, says Dosoretz, a resident in the Harvard Radiation Oncology Program.
Men received hormone therapy for a median of 3½ months. Doctors did not randomly assign patients to one treatment or another, but simply observed how men given each type of treatment fared.
Two earlier studies in this type of patient have had mixed results, Dosoretz says. While one study found that hormonal treatment increased the risk of death, another study did not.
Michael Zelefsky, a professor of radiation oncology at Memorial Sloan-Kettering Cancer Center, says it’s striking that taking hormones for such a short time could increase the risk of death. He notes that other studies presented at the conference have not shown an increased risk of death.
Grace Lu-Yao, an associate professor at the Robert Wood Johnson Medical School in New Jersey, says doctors and patients need to weigh the risks and benefits of therapy very carefully. Among men with early tumors, the elderly and those with other health problems — such as heart disease — may be more hurt than helped by hormones, she says.