Abstract
BackgroundAndrogen deprivation therapy (ADT) remains a primary treatment for localized prostate cancer (PCa) even though there is no evidence that its use is beneficial in the absence of curative treatment.MethodsMen aged ≥70 years (n = 16,534) diagnosed with localized PCa from 1985 to 2014 and managed either with primary observation or ADT in the absence of curative treatment were included. The cases were identified from the population-based Finnish Cancer Registry. We estimated the standardized mortality ratios (SMR) for overall mortality by treatment group. We determined the relative risk (RR) of PCa-specific mortality (PCSM) and other-cause mortality between the two treatment groups. Survival was determined using the life table method. Two age groups (70–79 years and ≥ 80 years) and three calendar time cohorts (1985–1994, 1995–2004, and 2005–2014) were compared following adjustment of propensity score matching between the treatment groups with four covariates (age, year of diagnosis, educational level, and hospital district). Follow-up continued until death or until December 31, 2015.ResultsPatients in the observation group had lower overall SMRs than those in the ADT group in both age cohorts over the entire study period. PCSM was higher in men aged 70–79 years undergoing primary ADT compared to those managed by observation only (RR: 1.70, 95% confidence interval [CI]: 1.29–2.23 [1985–1994]; RR 1.55, 95% CI: 1.35–1.84 [1995–2004]; and RR 2.71, 95% CI: 2.08–3.53 [2005–2014]); p = 0.005 for periodic trend. A similar trend over time was also observed in men aged > 80 years; (p for age–period interaction = 0.237). Overall survival was also higher among men in their 70’s managed by observation compared to those undergoing ADT.ConclusionsPrimary ADT within four months period from diagnosis is not associated with improved long-term overall survival or decreased PCSM compared to primary conservative management for men with localized PCa. However, this observational study’s conclusions should be weighted with confounding factors related to cancer aggressiveness and comorbidities.
Highlights
Androgen deprivation therapy (ADT) remains a primary treatment for localized prostate cancer (PCa) even though there is no evidence that its use is beneficial in the absence of curative treatment
We observed higher PCa-specific mortality (PCSM) in patients undergoing primary ADT compared to those managed by observation only (Table 3)
The risk of death from causes other than PCa decreased over time in patients aged 70–79 years undergoing primary ADT compared to those managed by observation only, but the same was not true in patients aged 80 years or older (Table 3)
Summary
Androgen deprivation therapy (ADT) remains a primary treatment for localized prostate cancer (PCa) even though there is no evidence that its use is beneficial in the absence of curative treatment. Androgen deprivation therapy (ADT) has been the cornerstone of treatment for locally advanced and metastatic (M+) prostate cancer (PCa) since the 1940s [1]. The use of ADT increased sharply between 1989 and 2001 in the USA despite the fact that ≤5% of patients with newly diagnosed PCa have distant metastases at first presentation compared with 20–25% ≥20 years ago [3, 4]. The longterm clinical outcomes of localized PCa without initial treatment with curative intent during the PSA era were assessed [8]. Observation with the option of later treatment in the case of disease progression (i.e., watchful waiting) is recommended for localized and locally advanced PCa in elderly patients with competing comorbidities
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