Length of androgen-deprivation therapy

Men with locally invasive prostate cancer who have received external beam radiation do better with 3 years of androgen-deprivation therapy compared to 6 months of therapy according to a new study from Europe. After receiving radiation therapy, 970 men were randomly assigned to 6 months of androgen suppression (n = 483) vs 3 years of suppression (n = 487). After mean follow-up of 6.4 years, 132 patients in the short-term group and 90 patients in the long-term group had died. The number of deaths due to prostate cancer was 47 in the short-term group and 29 in the long-term group. The 5-year overall mortality was 19% vs 15.2% for short-term and long-term suppression, respectively, with an observed hazard ratio of 1.42 (P = 0.65 for non-inferiority). The authors conclude that the combination of radiotherapy plus 6 months of androgen suppression provides inferior survival as compared with radiation therapy plus 3 years of androgen suppression in men with locally advanced prostate cancer (N Engl J Med 2009;360:2516-2527). In an accompanying editorial, Peter Albertson, MD, points out the importance of determining the optimal length of androgen-deprivation therapy because of long-term side effects including weight gain, fatigue, hot flushes, osteoporosis, cardiac disease, and depression. With the high level of regular screening for prostate cancer, most men are diagnosed earlier with much lower grade disease than those addressed in this study, and it is unclear whether these findings can be applied to these men with clinically localized cancer. Radiation plus or minus androgen deprivation vs surgery, age of the patient at diagnosis, and staging of the tumor all are important in determining therapy (N Engl J Med 2009;360:2572-2574).