Is there a right and wrong time to use ADT?

Fifteen-year survival outcomes following primary androgen-deprivation therapy for localized prostate cancer. By Lu-Yao et al. 2014 


Key sentence from the paper: “Primary ADT is not associated with improved long-term overall or disease-specific survival for men with localized prostate cancer.

For the full abstract, see:


Commentary: This paper just came out in JAMA Internal Medicine, which is a prestigious journal and the article has a lot of press attention. When ADT was first used to treat prostate cancer, more than a half of century ago, all the patients had symptomatic disease. The discovery that ADT worked—helping to reduce symptoms and extend the life of those patients—justified Dr. Charles Huggins a Nobel price in medicine. However, things now have change in the modern era of the PSA test.

 Men are now diagnosed and treated for prostate cancer at a much earlier stage, before the disease is symptomatic. It has become common in the last twenty years to start men on ADT, if they have a rise in PSA after a primary treatment, such as surgery or radiotherapy, even if they have no other symptoms. This paper is important in showing that such an early use of ADT has no benefit in terms of overall survival. Part of the problem is the many side effects of ADT. It doesn’t help for example, that ADT can increase the risk of death from a cardiovascular disease for patients who already have risks in that area.

 It will be interesting to see whether this paper leads to a decrease in the use of ADT in patients, who are otherwise asymptomatic. For that to happen, not only the physicians need to write fewer prescription for the drugs, but many patients will need to learn to live with slowly rising PSA rather than being hell-bent on getting their PSA treated. What matters is survival, not the PSA. 


Lu-Yao GL, Albertsen PC, Moore DF, Shih W, Lin Y, DiPaola RS, Yao SL. 2014. Fifteen-Year Survival Outcomes Following Primary Androgen-Deprivation Therapy for Localized Prostate Cancer. JAMA Internal Medicine. 14 July 2014 [Epub ahead of print].