Medical castration to treat localized prostate tumors does not prolong survival and its side effects far outweigh any potential benefit for most patients, researchers reported today.
The technique, which involves using drugs to block the body's production of the male hormone androgen, is a powerful tool when used in conjunction with surgery or radiation for treating aggressive prostate tumors.
Many oncologists had assumed this treatment could be of benefit with localized tumors as well, and the use of the drugs surged a decade ago, with an estimated 30% to 50% of such patients receiving the therapy.
But its use has fallen in the last five years because of changes in Medicare's reimbursement policy, and some experts think this new finding might spell the end for the treatment.
"This study suggests that physicians who recommend hormonal therapy for localized tumors are not doing their patients any favors," said Dr. Howard M. Sandler, a radiation oncologist at the University of Michigan Medical School who spoke as a representative of the American Society of Clinical Oncology.
"I hope that it does change clinical practice and that fewer men do receive primary hormonal therapy," he said.
Added Dr. Matthew B. Rettig, an oncologist at UCLA's Jonsson Comprehensive Cancer Center, "There is no clear data that has ever shown that patients with early-stage disease benefit from primary hormone therapy . . . and this is further evidence to support that."
One in six American men will be diagnosed with prostate cancer during his lifetime. An estimated 186,000 new cases will occur this year, with nearly 29,000 deaths.
An estimated 85% of newly diagnosed prostate tumors are localized, so-called stages T-1 and T-2. Guidelines promulgated by national organizations recommend one of three approaches for treating such tumors: surgical removal, radiation therapy or expectant management, better known as watchful waiting.
The rationale for watchful waiting is that most of these tumors grow so slowly that an elderly patient is likely to die of something else before the tumor kills him.
"A lot of men think radiation and surgery are too aggressive, but observation sounds like you are not doing enough," said Dr. Siu-Long Yao of the Cancer Institute of New Jersey, who led the new study. Hormonal therapy, which sounds rather benign, "has become the second-most popular treatment after surgery, surpassing radiation," he said.
