title: Effectiveness of primary androgen-deprivation therapy for clinically localized prostate cancer.
abstract: OBJECTIVE
  Primary androgen-deprivation therapy (PADT) is often used to treat clinically localized prostate cancer, but its effects on cause-specific and overall mortality have not been established. Given the widespread use of PADT and the potential risks of serious adverse effects, accurate mortality data are needed to inform treatment decisions.
  
  
  METHODS
  We conducted a retrospective cohort study using comprehensive utilization and cancer registry data from three integrated health plans. All men were newly diagnosed with clinically localized prostate cancer. Men who were diagnosed between 1995 and 2008, were not treated with curative intent therapy, and received follow-up through December 2010 were included in the study (n = 15,170). We examined all-cause and prostate cancer-specific mortality as our main outcomes. We used Cox proportional hazards models with and without propensity score analysis.
  
  
  RESULTS
  Overall, PADT was associated with neither a risk of all-cause mortality (hazard ratio [HR], 1.04; 95% CI, 0.97 to 1.11) nor prostate-cancer-specific mortality (HR, 1.03; 95% CI, 0.89 to 1.19) after adjusting for all sociodemographic and clinical characteristics. PADT was associated with decreased risk of all-cause mortality but not prostate-cancer-specific mortality. PADT was associated with decreased risk of all-cause mortality only among the subgroup of men with a high risk of cancer progression (HR, 0.88; 95% CI, 0.78 to 0.97).
  
  
  CONCLUSIONS
  We found no mortality benefit from PADT compared with no PADT for most men with clinically localized prostate cancer who did not receive curative intent therapy. Men with higher-risk disease may derive a small clinical benefit from PADT. Our study provides the best available contemporary evidence on the lack of survival benefit from PADT for most men with clinically localized prostate cancer.
authors.affiliation: Arnold L. Potosky, Huei-Ting Tsai, George Luta, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; Reina Haque, Kaiser Permanente Southern California, Pasadena; Stephen K. Van Den Eeden, Kaiser Permanente Northern California, Oakland, CA; Andrea E. Cassidy-Bushrow, Henry Ford Hospital, Detroit, MI; Marianne Ulcickas Yood, Boston University School of Public Health; Nancy L. Keating, Brigham and Women's Hospital and Harvard Medical School; Matthew R. Smith, Massachusetts General Hospital, Boston, MA; Miao Jiang, Harvey L. Neiman Health Policy Institute, Reston, VA.
authors.forename: Arnold L
authors.initials: AL
authors.lastname: Potosky
authors.forename: Reina
authors.initials: R
authors.lastname: Haque
authors.forename: Andrea E
authors.initials: AE
authors.lastname: Cassidy-Bushrow
authors.forename: Marianne
authors.initials: M
authors.lastname: Ulcickas Yood
authors.forename: Miao
authors.initials: M
authors.lastname: Jiang
authors.forename: Huei-Ting
authors.initials: HT
authors.lastname: Tsai
authors.forename: George
authors.initials: G
authors.lastname: Luta
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Keating
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Smith
authors.forename: Stephen K
authors.initials: SK
authors.lastname: Van Den Eeden
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D002140:California / Q000453:epidemiology; D015331:Cohort Studies; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives / Q000037:antagonists & inhibitors; D006801:Humans; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009376:Neoplasms, Hormone-Dependent / Q000401:mortality / Q000473:pathology / Q000628:therapy; D009919:Orchiectomy; D016016:Proportional Hazards Models; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D018714:Radiotherapy, Adjuvant; D012042:Registries; D012189:Retrospective Studies; D018426:SEER Program; D016896:Treatment Outcome
chemical_list: D018931:Antineoplastic Agents, Hormonal; D007987:Gonadotropin-Releasing Hormone