title: Fifteen-year survival outcomes following primary androgen-deprivation therapy for localized prostate cancer.
abstract: OBJECTIVE
  One in 6 American men will be diagnosed as having prostate cancer during their lifetime. Although there are no data to support the use of primary androgen-deprivation therapy (ADT) for early-stage prostate cancer, primary ADT has been widely used for localized prostate cancer, especially among older patients.
  
  
  OBJECTIVE
  To determine the long-term survival impact of primary ADT in older men with localized (T1/T2) prostate cancer.
  
  
  METHODS
  This was a population-based cohort study of 66,717 Medicare patients 66 years or older diagnosed from 1992 through 2009 who received no definitive local therapy within 180 days of prostate cancer diagnosis. The study was conducted in predefined US geographical areas covered by the Surveillance, Epidemiology, and End Results (SEER) Program. Instrumental variable analysis was used to assess the impact of primary ADT and control for potential biases associated with unmeasured confounding variables. The instrumental variable comprised combined health services areas with various usage rates of primary ADT. The analysis compared survival outcomes in the top tertile areas with those in the bottom tertile areas.
  
  
  METHODS
  Prostate cancer-specific survival and overall survival.
  
  
  RESULTS
  With a median follow-up of 110 months, primary ADT was not associated with improved 15-year overall or prostate cancer-specific survival following the diagnosis of localized prostate cancer. Among patients with moderately differentiated cancers, the 15-year overall survival was 20.0% in areas with high primary ADT use vs 20.8% in areas with low use (difference: 95% CI, -2.2% to 0.4%), and the 15-year prostate cancer survival was 90.6% in both high- and low-use areas (difference: 95% CI, -1.1% to 1.2%). Among patients with poorly differentiated cancers, the 15-year cancer-specific survival was 78.6% in high-use areas vs 78.5%, in low-use areas (difference: 95% CI, -1.8% to 2.4%), and the 15-year overall survival was 8.6% in high-use areas vs 9.2% in low-use areas (difference: 95% CI, -1.5% to 0.4%).
  
  
  CONCLUSIONS
  Primary ADT is not associated with improved long-term overall or disease-specific survival for men with localized prostate cancer. Primary ADT should be used only to palliate symptoms of disease or prevent imminent symptoms associated with disease progression.
authors.affiliation: Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey3Department of Epidemiology, The Rutgers School of Public Health, Piscataway, New Jersey4Rutgers Cancer Institute of New Jersey, New Brunswick6The Dean and Betty.
authors.forename: Grace L
authors.initials: GL
authors.lastname: Lu-Yao
authors.affiliation: Department of Surgery (Urology), University of Connecticut Health Center, Farmington.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Albertsen
authors.affiliation: Department of Biostatistics, The Rutgers School of Public Health, Piscataway, New Jersey4Rutgers Cancer Institute of New Jersey, New Brunswick.
authors.forename: Dirk F
authors.initials: DF
authors.lastname: Moore
authors.affiliation: Department of Biostatistics, The Rutgers School of Public Health, Piscataway, New Jersey4Rutgers Cancer Institute of New Jersey, New Brunswick.
authors.forename: Weichung
authors.initials: W
authors.lastname: Shih
authors.affiliation: Department of Biostatistics, The Rutgers School of Public Health, Piscataway, New Jersey4Rutgers Cancer Institute of New Jersey, New Brunswick.
authors.forename: Yong
authors.initials: Y
authors.lastname: Lin
authors.affiliation: Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey4Rutgers Cancer Institute of New Jersey, New Brunswick6The Dean and Betty Gallo Prostate Cancer Center, New Brunswick, New Jersey.
authors.forename: Robert S
authors.initials: RS
authors.lastname: DiPaola
authors.affiliation: Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey4Rutgers Cancer Institute of New Jersey, New Brunswick7Merck Research Laboratories, Kenilworth, New Jersey.
authors.forename: Siu-Long
authors.initials: SL
authors.lastname: Yao
mesh_terms: D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use*; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D006278:Medicare; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D009376:Neoplasms, Hormone-Dependent / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D018426:SEER Program; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States
chemical_list: D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal