Use of hormonal therapy in men with metastatic prostate cancer

Abstract

4559 Background: Although the timing of hormonal treatment is controversial, there is agreement that prostate cancer patients should receive hormonal therapy before dying of cancer. The objectives of this study were to 1) provide population-based cohort estimates of the effect of hormonal therapy use on overall survival in men with metastatic prostate cancer, and 2) provide population-based estimates of hormonal therapy use in men who ultimately died of prostate cancer, a population for which hormonal therapy is clearly indicated. Methods: The Surveillance, Epidemiology and End Results (SEER)-Medicare linked database was used to measure hormonal therapy use in 9,110 men who died of prostate cancer during 1991–2000 whereas the impact of hormonal use on survival was examined in men ≥65 years old diagnosed with metastatic prostate cancer (N=6,098). Hormonal therapy was defined as orchiectomy or use of luteinizing hormone releasing hormone agonist. Logistic regression was used to identify factors associated with hormone use. Kaplan-Meier estimates were used to estimate survival. Results: Approximately one third (36%) of African-American and one quarter (22%) of Caucasian men aged 65 or older did not receive hormonal therapy prior to death caused by prostate cancer. Compared with Caucasians, African-Americans were 57% less likely to receive hormonal therapy (P=0.005). Similar ethnic differences were observed in all subgroups examined (age, cancer stage and grade at diagnosis, income, geographic regions, and comorbidity status). Median overall survival was significantly better for men who received hormonal therapy (26 months) compared with those who did not (10 months), largely due to differences in prostate cancer specific survival. Survival in African-Americans and Caucasians was similar when adjusted for hormonal therapy use. Conclusions: Hormonal therapy is associated with improved disease-specific and overall survival in men with metastatic prostate cancer. However, implementation of this treatment may not be optimal and there are substantial ethnically dependent differences. No significant financial relationships to disclose.