A popular hormonal treatment for prostate cancer does nothing to extend the lives of men over 65 with early-stage tumors and may actually be harmful, according to a study published today.
The report, which reviewed the cases of almost 20,000 older men with early disease, further casts into doubt the common public perception that doing something for cancer is always better than doing nothing.
Most older men whose cancers have not spread beyond the prostate gland would do better to forgo treatment and have their condition monitored, according to authors at the Robert Wood Johnson Medical School in New Jersey.
Drugs that suppress the male hormone testosterone - a proven treatment for prostate cancers that have already spread - are not only ineffective in the early stages of the disease, but also contribute to well-known side effects that include cardiovascular disease, diabetes, bone fractures, fatigue and other ills, researchers said.
"Patients need to think about what the potential side effects could be, not that they have cancer and something needs to be done," said Grace Lu-Yao, a cancer epidemiologist at Johnson and lead author of a study appearing in today's Journal of the American Medical Association.
Prostate cancer is the second most frequently diagnosed cancer in men - after skin cancer - and is the second leading cancer killer among men. Only lung cancer kills more.
About 186,000 new cases are diagnosed and about 28,600 deaths attributed to prostate cancer each year, according to the American Cancer Society. But most new cases are diagnosed in the early stages, when treatment decisions can be difficult to make.
The patients
For this study, researchers tapped a database of 19,271 men ages 66 and older with cancer that was still confined to the prostate. The patients were diagnosed between 1992 and 2002 and tracked through 2006.
The 10-year survival rate was about 80 percent, whether or not the patients had received the hormonal treatment - injections that shut off male hormone that promotes tumor growth.
The median age of the men in the study was 77. Among younger men with localized prostate cancer, options include monitoring the cancer until it shows signs of turning aggressive, or surgically removing the prostate immediately. Removing the prostate cures the disease if the cancer has truly not spread.
Surgery is generally not recommended for older men because many would die of other causes before the cancer killed them, if it spread at all.
