Primary Androgen Deprivation Therapy in Men With Prostate Cancer—Reply

Abstract

To the Editor: The analysis of prostate cancer–specific and overall survival by Dr Lu-Yao and colleagues concluded that primary androgen deprivation therapy (PADT) offered no benefit compared with conservative management in elderly men with localized prostate cancer. Since their comparison was based on epidemiologic data rather than those obtained in a prospective randomized trial, there is a possibility that confounding variables may have influenced patient outcomes. Serum prostate-specific antigen (PSA) has been shown to be an independent predictor of outcome in newly diagnosed patients and may often be used by clinicians to choose recommended therapy. It seems likely that men with higher PSA levels (and thus worse prognoses) were those who were given PADT. However, the study by Lu-Yao et al does not include an analysis of PSA data and their possible influence on treatment recommendations. In the absence of this information, it is not possible to conclude that PADT confers no benefit, especially to a high–PSA-level subpopulation of patients.