Hormonal therapy is a proven treatment for men whose cancers have spread to other parts of the body. Though not a cure, experts say, suppression of male hormone can ameliorate symptoms and, in some cases, lengthen survival.
Is more better?
Since the 1990s, however, many urologists have expanded the use of androgen deprivation therapy, as it's known. They have operated on the theory that "if it works for late-stage cancer, it may work for early stage cancer," said Lu-Yao.
Today, she said, about a quarter of older men with localized prostate cancer receive the treatment.
"The bottom line is that it makes no difference in survival, and it may even be worse for people who have very early stage cancer," she said.
Dr. Patrick Walsh, a urologist at the Johns Hopkins School of Medicine, said there's never been any evidence that hormonal treatments help older men with early-stage disease.
"There are many side effects, including weight gain, hot flashes, loss of muscle mass, a decrease in mental acuity," Walsh said.
Recently, he said, he met a man who had lost strength and dexterity in his hands, making it difficult for him to work as a jeweler.
Patients can also become fatigued and depressed, and all will lose sexual function. But the worst side effects are cardiovascular, he said. The treatment can raise blood lipid levels and exacerbate diabetes, both of which can trigger heart attacks.
Windfall for some
"Many urologists thought in a well-meaning way that they would be benefiting patients," he said. But others saw a financial windfall. In the face of aggressive marketing, they discovered they could earn tens of thousands of dollars a year by marking up the price they pay to obtain the hormone-suppressing drugs.
New Medicare rules have forced doctors to use the least costly alternative, said Lu-Yao, resulting in a possible decline in hormonal treatments for this population.
"Overall, I agree with the results of this paper," said Dr. Michael Naslund, a urologist at the University of Maryland Medical Center. "I use hormonal therapy quite a bit in different types of patients but would not use it in an older man with localized treatment who chooses not to be treated otherwise."
Those who benefit
