Treatment to lower testosterone is an important tool for oncologists helping men battle advanced prostate cancer. But a study published this week by researchers at the Rutgers Cancer Institute of New Jersey finds that’s not the case for early-stage cancers.
Lead author professor of medicine, Grace Lu-Yao, used cancer registry and Medicare data to track the outcomes of 66,717 patients over 15 years. She found there was no survival benefit for men in areas where androgen-deprivation therapy, as the treatment is formally known, was more likely to be prescribed.
“Although there’s no evidence to support the use of this particular treatment, it is commonly used among elderly patients,” Lu-Yao said. “It’s the quality of life that’s impacted by this medication, also the substantial cost associated with it.”
Men lowering their testosterone are at higher risk for bone fractures and diabetes — as well as fatigue and impotence. For cases where it’s not recommended, the direct cost of the drugs for the Medicare population has been estimated at 42 million dollars annually.
“It’s popular among elderly patients because it’s not as aggressive as surgery, it’s simpler than radiotherapy because they just need to go for injection that lasts for either three months or six months,” said Lu-Yao. Implants, she added, last about a year.
For low-risk patients, Lu-Yao says the better approach is watchful waiting.
“The majority of patients may not need aggressive therapy right away, so a lot of doctors nowadays monitor those patients closely, and if there’s a sign of progression, they will administer the active treatment at that time,” she said.
The use of testosterone-lowering medicines in early-stage cancer has never been recommended in medical guidelines. But the practice became common in recent decades. Among men 75 and over with prostate cancer that has yet to metastasize, Lu-Yao estimated a quarter will get the treatment.
“Patients actually don’t know where to look for the doctors who give watchful waiting because in our current health system, it’s reimbursement by procedure,” she said.
Based on these findings, which were published this week in the journal JAMA Internal Medicine, and those of others, some physicians are calling for the medicines to be highlighted in several medical societies’ “Choosing Wisely” campaigns, aimed at discouraging the use of ineffective treatments.