Men over 70 years of age with early-stage prostate cancer have a 20% higher mortality if they are treated first with hormone therapy before being treated with radiation seed implants (brachytherapy), compared to men who are treated with brachytherapy alone, according to the largest cohort study of its kind presented September 23, 2008, at the 50th Annual Meeting of the American Society for Therapeutic Radiology and Oncology in Boston.
New research shows that hormone therapy can have negative effects on survival, in addition to many other previously known side affects from this treatment. This is important to consider when weighing treatment options, especially since neoadjuvant hormone therapy is sometimes used to shrink the prostate before brachytherapy treatment of localized prostate cancer but does not improve the patient’s chance of being cured.
“Our study shows that for men over 70 with early-stage prostate cancer, androgen deprivation therapy as a form of treatment may do more harm than good,” commented Amy Fox, md, lead author of the study and a radiation oncology resident at the Harvard Radiation Oncology Program in Boston. “In older patients, the risks of androgen deprivation need to be carefully weighed by doctors when designing the proper treatment plan.”
“These results are particularly interesting, since two previous studies that examined similar populations contradicted each other in terms of how hormone therapy impacts the risk of death among prostate cancer patients in this age group,” she added.
The cohort study involved 1,709 men at least 70 years old with localized prostate cancer who were treated with either neoadjuvant hormonal therapy and brachytherapy or with brachytherapy alone at centers within the 21st Century Oncology consortium between 1991 and 2005. Findings show that men in this age group with localized prostate cancer who were treated with both neoadjuvant hormonal therapy and brachytherapy had a 20% increased risk of dying, compared to men who were not treated with hormonal therapy.
A 70-year-old man with a history of localized prostate cancer treated with whole-pelvis radiation therapy with a boost to the prostate, in conjunction with androgen deprivation therapy 7 years prior, presented with lower back pain. A bone scan revealed an area of activity in the sacrum. What is the most likely diagnosis?
