For many men diagnosed with early-stage prostate cancer, drugs commonly are prescribed to suppress their production of testosterone. Despite its frequent use, these drugs have not been shown to extend patients’ lives, and they have devastating side effects of what is colloquially termed "chemical castration."
As reported last week in the New York Times, “androgen deprivation therapy” was studied for 15 years by researchers, whose results were published by JAMA Internal Medicine. The study’s lead author, Dr. Grace L. Lu-Yao from the Rutgers Cancer Institute of New Jersey, told The Times, “There are so many side effects associated with this therapy, and really little evidence to support its use. I would say that for the majority of patients with localized prostate cancer, this is not a good option.”
Patients usually are put on the drugs for life. Among the side effects of this “chemical castration” are:
- bone loss (leading to fractures and sometimes disability)
- heart disease
- hot flashes
Lu-Yao’s team studied tens of thousands of men with early prostate cancer for as long as 15 years. Those who received androgen deprivation therapy lived no longer on average than those who didn’t get the drugs. The study is only the latest to indicate that many men with early prostate cancer are better off not taking testosterone-suppressing medicine.
Still, as Dr. James M. McKiernan, the acting chairman of urology at New York-Presbyterian Hospital/Columbia University Medical Center, observed, many doctors recommend the treatment. Many of the patients who follow that advice have experienced negative consequences beyond the medical, such as deteriorating marriages.
About 250,000 new cases of prostate cancer are diagnosed in the U.S. every year. More than 9 in 10 of these patients have an early form of the disease in which the cancer has not spread and is classified as low-risk. In many cases, as we’ve pointed out in previous prostate cancer blogs, these men will die of something else besides their slow-growing, essentially nonlife-threatening cancer.
Drugs that suppress the hormone testosterone can be appropriate for men with more advanced or aggressive cancers; they can shrink tumors or retard their growth, which can improve outcomes, especially when the drugs are combined with radiation or other treatments.
In the 1990s, according to The Times, use of the drugs rose sharply for patients of all ages and stages of the disease, especially older people. It’s estimated that at least 1 in 4 of all patients older than 75 are chemically castrated.
Lu-Yao’s study involved more than 66,700 men at least 66 years old with prostate cancer. Researchers compared men living where the drugs were frequently prescribed with men living where they used less often. They found the drugs were not associated with greater long-term survival.
A large, randomized trial of Europeans found that the hormone treatments improved survival only for men with a more aggressive form of the disease.
If you or a loved one is diagnosed with early-stage prostate cancer, and your doctor prescribes hormone-suppressing therapy, it’s time for a second opinion. And maybe a new doctor.