Androgen-deprivation therapy as primary treatment for localized prostate cancer: data from Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE).
BACKGROUND
Prostate cancer is largely an androgen-sensitive disease. Androgen-deprivation therapy (ADT) generally has been used for patients with advanced disease. However, ADT is used increasingly as monotherapy for patients with clinically localized disease. The objective of the current report was to describe the characteristics of patients who underwent ADT for the management of localized disease.


METHODS
Cancer of the Prostate Strategic Urologic Endeavor (CaPSURE), which is a national disease registry of men with prostate cancer, was screened to identify patients who received treatment with primary ADT (PADT) between 1989 and 2002 for clinically localized disease (T1-T3,Nx/N0,Mx/M0). Clinical data (including Gleason score, prostate-specific antigen [PSA] level, and T classification) and sociodemographic data (including age, race, education, income, and insurance coverage) were analyzed with chi-square statistical tests. Time to failure data were analyzed using log-rank tests, the Kaplan-Meier method, and Cox proportional hazards regression analyses.


RESULTS
Of 7045 men, 993 patients (14.1%) with clinically localized disease received primary ADT. Compared with patients who underwent standard treatment, patients who received PADT had higher risk disease (as defined by PSA level, T classification, and Gleason score) and had more comorbidities. Patients who underwent PADT were older, less educated, had lower income, and were more likely to have Medicare than private insurance. The dominant forms of hormone therapy were luteinizing hormone-releasing hormone (LHRH) monotherapy (48.6%) and combined androgen blockade (LHRH agonist and antiandrogens; 38.8%). At 5 years after the initiation of PADT, 67.3% of patients still were receiving treatment with only androgen deprivation, 103 patients (13.8%) had gone on to receive definitive second treatment (radical prostatectomy, external beam radiotherapy, brachytherapy, or cryotherapy), 27 patients (3.9%) underwent second-line therapy (chemotherapy or alternative hormone-deprivation therapy), 22 patients (4.1%) died of prostate cancer, and 146 patients (19%) died of all causes.


CONCLUSIONS
The use of PADT therapy appeared to control disease in the majority of patients who received it, at least for an intermediate period. However, such patients appeared to be unique based on sociodemographic characteristics, comorbidity status, and risk factors compared with patients who received other forms of therapy. The impact of PADT on quality of life needs to be compared with standard therapy, and its long-term durability should be assessed better in patients with prostate cancer.
Kawakami
Jun
J
Department of Urology, Program in Urologic Oncology, Urologic Outcomes Research Group, University of California-San Francisco Cancer Center, San Francisco, California 94115-1711, USA.
Cowan
Janet E
JE
Elkin
Eric P
EP
Latini
David M
DM
DuChane
Janeen
J
Carroll
Peter R
PR
D000230:Adenocarcinoma / Q000401:mortality / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use*; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D004054:Diethylstilbestrol / Q000627:therapeutic use; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D018120:Finasteride / Q000627:therapeutic use; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009376:Neoplasms, Hormone-Dependent / Q000188:drug therapy; D009919:Orchiectomy; D011471:Prostatic Neoplasms / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate
D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; D004791:Enzyme Inhibitors; D007987:Gonadotropin-Releasing Hormone; D018120:Finasteride; D004054:Diethylstilbestrol