Whether the men in the study had all the factors involving the two treatment options described for them wasn't addressed by the research, Jones said. "It has always been clear that the effectiveness and side effects of the two treatments appeared to be equal," he said. "So, the choice remains one of preference. When two treatments are equal, the choice is the patient's."
LHRH agonists render the testicles as inactive as surgical removal does, Jones said, so, "the choice is to some degree in the eyes of the beholders. Is it better to have a one-time operation or to come in for an injection every few months?"
Almost all the men in the study were 65 or older, and it's not possible to say whether different choices might have been made by younger men, Jones said.
In a way, the change in medical practice detailed in the study represents a reversion to the earlier treatment of prostate cancer, to the era before the drugs were developed, Jones said. "Before these medications came into existence, almost everyone was treated by surgical removal of the testicles," he said.
In an accompanying editorial in the journal, Dr. Gerald W. Chodak, director of the Midwest Prostate and Urology Health Center in Chicago, wrote that "changing a recommendation to a patient from an LHRH agonist to surgical castration solely for economic reasons is ethically inappropriate."
"However," he added, "asking urologists to take a financial loss while treating patients also is inappropriate."
Chodak said doctors should be totally honest with patients, making them aware of their choices in prostate cancer treatment.
Dr. Ethan Basch, an assistant attending physician at Memorial Sloan-Kettering Cancer Center in New York City, called the new study an interesting but incomplete picture.
"The trend is probably real, but I feel the study doesn't get in as deep as one
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