Here is another review article detailing the risks and benefits of ADT for men with high-risk prostate cancer that may nevertheless still be localized disease. The study is out of Japan, and the authors point out that patients in their country—particularly if they are elderly—are often offered ADT as their first therapy. This contrasts with North America, where either surgery or radiotherapy might be attempted first…with the hope that it turns out to be curative. Indeed, some recent North American guidelines specifically recommend delaying ADT until there is clear evidence that the cancer has spread beyond the gland.
The article is outstanding in a couple of regards. First, it is very readable and comprehensive, with many excellent tables summarizing previous research on survival and disease control with ADT. The tables and the text summarize a multitude of previous studies showing survival benefit and ones showing little or no benefit. There are a lot of studies to review and the way they are laid out in this paper helps to make patterns stand out.
In terms of adverse effects of ADT, three are singled out for review. These are the serious ones of: 1) dementia, 2) osteoporosis plus bone fracture and 3) cardiovascular disease. The authors conclude, as many others have before them, that these are genuine risks that need to be monitored.
An intriguing comment in this paper is that “Asians, including Japanese, may be expected to benefit more from ADT than Caucasians.” Japanese men live longer in general than Caucasian men and are overall healthier than most European and North American men. In comparing cancer survival for various ethnic groups one needs to carefully match the patients on age, disease status and comorbidities, such as heart disease and diabetes. The authors don’t explore the extent to which any extra benefit that Japanese prostate cancer patients may get from ADT reflect genetic factors versus differences in lifestyle.
To read the full article, see: https://www.mdpi.com/2072-6694/14/7/1803
Reference:
Iwamoto, H., Izumi, K., Makino, T., & Mizokami, A. (2022). Androgen Deprivation Therapy in High-Risk Localized and Locally Advanced Prostate Cancer. Cancers, 14(7), 1803.