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Early detection and aggressive treatment for prostate cancer is linked to more use of androgen-deprivation therapy for older men

Androgen deprivation therapy (ADT), which reduces testosterone and other male hormones (androgens), is traditionally reserved for advanced prostate cancer. Even though use of prostate-specific antigen (PSA) screening has caught substantially more prostate cancers at the local stage, PSA screening and aggressive treatment in the United States is associated with more, not less, use of ADT over time, according to a new study.

This is probably because neoadjuvant therapy, treatment for cancer recurrences, and primary therapy have become common indications for ADT. Also, men are now being treated with ADT for earlier stage disease, explains Michael J. Barry, M.D., of Massachusetts General Hospital. For example, men who have prostate cancer discovered through PSA screening usually have their PSA levels monitored serially after attempted curative radiotherapy or radical prostatectomy (surgical removal of the prostate). If the PSA level begins to increase, even minimally, they are increasingly likely to be treated with ADT.

Dr. Barry's team correlated the prevalence of ADT among a 5 percent sample of Medicare-insured men with prostate cancer from 1993 to 2000 with rates of prostate procedures (indication of treatment intensity) performed in 1987-1991 in the 306 U.S. hospital referral regions. The prevalence of men with prostate cancer receiving ADT increased steadily from 1.8 percent of male Medicare beneficiaries in 1993 to 2.9 percent in 2000.

Regions with higher rates of prostate biopsy in 1987-1991 had a higher prevalence of ADT in 1993, 1995, and 1997. Regions with higher rates of transurethral prostatectomy in 1987-1991 had a higher prevalence of ADT in 1993-2000. Regions with higher rates of radical prostatectomy in 1987-1991 had higher rates of ADT in 1993-1999.

As men weigh the pros and cons of PSA testing, they should also consider that such testing might increase their risk of eventually requiring ADT, which can be costly and problematic, but which also has potential, although largely unconfirmed, benefits. The study was supported in part by the Agency for Healthcare Research and Quality (HS10278).

More details are in "The rising prevalence of androgen deprivation among older American men since the advent of prostate-specific antigen testing: A population-based cohort study," by Dr. Barry, Michael A. Delorenzo, Ph.D., Elizabeth S. Walker-Corkery, M.P.H., and others, in the British Journal of Urology International 98, pp. 973-978, 2006.

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