Androgen-deprivation Therapy— A Help or a Hindrance for Survival in High-risk Prostate Cancer?

There is mounting evidence that androgen-deprivation therapy (ADT) for prostate cancer carries significant health risks. General awareness of the unpleasant but typically tolerable side effects of androgen suppression is not lacking. Recent studies have reported clinically significant cardiovascular morbidity and increased mortality, calling into question the safety of androgen suppression. In the mid-1990s, there was a precipitous rise in the use of ADT in the face of emerging data of improved disease control and preliminary results of a randomized trial that demonstrated an overall survival (OS) benefit with ADT. What followed was a dramatic expansion in the role of hormone therapy from primarily palliation of symptomatic metastases to a component of definitive treatment. It is estimated that over 600,000 men in the US currently receive ADT. A recent report on practice patterns suggested that almost 70% of hormone therapy is prescribed to patients for whom benefit has not been proved.