The ASCO GU conference begins tomorrow and they are already releasing news blurbs related to papers and other goings on at the meeting. In a news conference today, the findings of a study that compared 36 months of androgen deprivation therapy with 18 months given at the time of radiation to patients with high risk disease (Gleason >7, PSA>20, or T3-T4 disease) was presented. It showed no difference in disease specific survival at 10 years. This provides an important new endpoint, since the “Bolla Study” compared 36 months to 6 months and found that 36 months offered superior survival. Interestingly, the most common cause of death in this new study was a second cancer (7.3%), prostate cancer (4.9%), and cardiovascular disease (4.4%). One of my favorite things to point out to patients I interact with is that “if you die of a heart attack, we call that a cure”. Maybe it is not the most sensitive thing (although I still think it is funny in a ‘truth hurts’ sort of way) to say, but a comment that deserves some contemplation for all of us over the age of 65. Anything we can do to reduce the time on androgen deprivation is worth considering, given the side effects that many men experience. When I discuss this (as well as the controversy about intermittent vs. continuous treatment for metastatic disease), I point out that this is one area where “personalized medicine” is already here. If you have lots of side effects, your quality of life may not be worth the small advantage that continuous treatment supposedly gives you.
Elsewhere, PCF has announced that it will start sending men who are going through chemotherapy text messages they can sign up for. You can learn more about this here and let us know if it seems helpful. I’m not sure I want any more txt msgs or tweets in my life, but for some people, maybe this is just the ticket
4 responses to “Prost8care and duration of ADT”
Michael, I think it would be very helpful to your audience if you would explain all of the different ways that these studies “stack” the statistics in favor of their particular interests. Such things as”death by another cause” as being considered “a cure” is, I am sure, just a single example of many such distortions that most of us are unaware. More enlightenment in this area would be very useful.
I am having some trouble posting the reply that I want due to technical issues. However, the single most important thing to keep in mind is that prostate cancer is a cause of death primarily in older patients who are dying from MANY different causes during the periods of followup. Thus, when you hear of “prostate cancer specific death rate” being changed by something (like screening), you always have to put it in context. If the prostate cancer specific death rate is “dropped by 30%” by xyz, then the next thing to evaluate is whether the overall death rate has been changed. 3% of men die from prostate cancer. Dropping to 2% would be a 30% drop. But in the bigger picture, if the overall death rate by age 80 drops from 48% to 47% have we really accomplished much? That is the kind of thinking that needs to be kept in mind when you look at a specific disease problem like prostate cancer. That, and of course the “costs” both financial and biologic of achieving a cure for those who are the 1% beneficiaries.
Shortened hormone therapy sounds intuitively better.
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