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Discussion: "We postulate that the diagnosing urologist plays an important role in treatment selection because he or she is the first to convey the diagnosis to the patient and discuss disease severity and management options."
( JAMA Intern Med . Published online July 14, 2014. doi:10.1001/jamainternmed.2014.3021. Available pre-embargo to the media at http://media.jamanetwork.com .)
Editor's Note:
Primary ADT Not Associated with Improved Survival for Men with Localized Prostate Cancer
Author: Grace L. Lu-Yao, M.P.H., Ph.D., of the Rutgers Cancer Institute of New Jersey and Robert Wood Johnson Medical School, New Brunswick, N.J., and colleagues.
Background: There has been no data to support the use of ADT for early-stage prostate cancer, yet it has been widely used as a primary therapy for localized disease, especially among older men. Because the cancers of most patients treated with ADT will become resistant to treatment within a few years and because there are adverse effects associated with ADT, the timing of ADT is crucial.
Results: After a median follow-up of 110 months, primary ADT was not associated with improved 15-year overall or prostate cancer-specific survival after a diagnosis of low-risk prostate cancer. The 15-year overall survival was 20 percent in areas with high primary ADT use vs. 20.8 percent in areas of low primary ADT use among patients with moderately differentiated cancer. The 15-year prostate cancer survival was 90.6 percent in both high- and low-use areas. Among patients with poorly differentiated cancers, the 15-year cancer-specific survival was 78.6 percent in high-use areas vs. 78.5 percent in low-use areas; and the 15-year overall survival was 8.6 percent in high-use areas vs. 9.2 percent in low-use areas.
Discussion: "Health care providers and their older patients should carefully weigh our findings against the considerable adverse effects and costs associated with primary ADT before initiating this therapy in men with clinically localized prostate cancer."
( JAMA Intern Med . Published online July 14, 2014. doi:10.1001/jamainternmed.2014.3028. Available pre-embargo to the media at http://media.jamanetwork.com .)
Commentary: Measuring the Effectiveness of ADT for Prostate Cancer in Medicare Patients
In a related commentary, Quoc-Dien Trinh, M.D. F.R.C.S.C, and Deborah Schrag, M.D., M.P.H., of the Dana-Farber Cancer Institute, Boston, write: "In summary, on the basis of both randomized trials and observational data from SEER-Medicare and from integrated health care networks, there is no compelling evidence to prescribe ADT alone for men with localized prostate cancer. Given persistent high use rates, primary ADT for localized prostate cancer is a prime candidate for inclusion in the American Board of Internal Medicine Foundation and the American Urological Association "Choosing Wisely" campaign to encourage clinicians to avoid use of therapeutic interventions with marginal benefits."
( JAMA Intern Med . Published online July 14, 2014. doi:10.1001/jamainternmed.2014.1107. Available pre-embargo to the media at http://media.jamanetwork.com .)
Media Advisory:
To contact author Karen E. Hoffman, M.D., M.H.Sc., call William B. Fitzgerald at 713-792-9518 or email WBFitzgerald@mdanderson.org . To contact author Grace L. Lu-Yao, M.P.H., Ph.D., call Michele Fisher at 732-235-9872 or email Michele.fisher@rutgers.edu . To contact corresponding commentary author Deborah Schrag, M.D., call Anne Doerr at 617-632-4090 or email Anne_Doerr@dfci.harvard.edu .
To place an electronic embedded link to this study in your story Links for these studies and commentary will be live at the embargo time: http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2014.3021 , http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2014.3028 and http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2014.1107 .
JAMA Internal Medicine