Standard treatments for when prostate cancer is still confined to the prostate include surgery, radiation or "waiting and seeing."
"Prostate cancer is not as typical as some of other cancers. It grows at a slower pace, and it tends to occur in men that are elderly, so there a lot of other things going on like heart disease or lung disease or kidney disease or diabetes," explained study senior author Dr. Siu-Long Yao, a clinical assistant professor of medicine at the Cancer Institute of New Jersey in New Brunswick. "If you treat someone for prostate cancer, they could [still] drop dead from a heart attack. The key in this disease where it grows slower is prediction. Who's going to drop dead of a heart attack and who's going to have problems with prostate cancer. It leads to complexity. It's a guessing game more so than in other cancers."
Nowadays, however, more and more men, especially older men, are opting for primary androgen deprivation therapy (PADT) instead of the tried-and-true standards.
"A lot of men think surgery and radiation seem aggressive while observation seems like you're doing nothing," Yao said. "Men and their physicians have started looking for an alternative, which has become hormonal therapy. Use of [PADT] in this setting has grown tremendously in the last decade or two. It is the second most popular treatment [after surgery] but, in spite of that, nobody has really studied whether it works or not."
Yao and his colleagues looked at 19,271 Medicare patients aged 66 and over, none of whom had received "definitive local therapy" such as surgery.
Forty-one percent of the participants had received PADT for an average of 18 months; the rest had simply waited and watched.
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