Another ADT Study

#1 11-12-2006, 01:28 AM

Excess Mortality Seen Among Prostate Cancer Patients on Long Term Androgen
Deprivation Therapy: Presented at ASTRO
By Ed Susman

PHILADELPHIA, PA -- November 9, 2006 -- In a surprise finding, a
retrospective study suggests long-term use of anti-male hormone drugs
increase the risk of mortality among patients who were at high risk for
recurrence of prostate cancer, doctors said here at the American Society of
Therapeutic Radiology and Oncology (ASTRO) 48th annual meeting.

"More than 6 months' treatment with these androgen deprivation drugs appears
to double the risk of mortality in these patients," said Cliff Robinson, MD,
resident in oncology, The Cleveland Clinic, Cleveland, Ohio.

Dr. Robinson and colleagues reviewed the charts of 579 men treated for
prostate cancer at the Cleveland Clinic between the years 1998 and 2003.

"Specifically, we were looking for ways to improve outcomes of high risk
patients," said study co-author Chandama Reddy, MS, biostatistician, The
Cleveland Clinic. "We weren't looking to find something wrong with
anti-hormone treatment, but these numbers just jumped out."

Dr. Robinson said that the 5-year survival after definitive treatment for
prostate cancer among the 153 high-risk individuals who had not received any
post-procedure treatment was 92%.

Among the 351 patients who received anti-hormone treatment for 1 to 6
months, the survival rate was also 92%. But among the 74 patients who took
the anti-hormone treatment for longer than 6 months, the survival was 76% (P
= .0007). "That's a significant difference," Dr. Robinson said.

In addition, Jay Ciezki, MD, staff physician, The Cleveland Clinic, and
another co-author of the study, said that with or without hormone therapy
there did not appear to be any impact on prostate cancer recurrence.

The group's poster was presented November 8th.

Patients in the study had all undergone surgery to remove the prostate or
radiation therapy to kill the cancer, either with external beam radiation
sources or brachytherapy, the insertion of radioactive pellets into the
prostate gland.

Before any treatment was performed, the men who were considered to be at
high risk for prostate cancer recurrence had to have the following: a
prostate specific antigen (PSA) level higher than 20 ng/mL; a cancer that
was judged by pathologists to be highly aggressive; or cancer that had
already extended through the wall of the prostate. They could also be judged
at high risk if they had both a PSA score of 10 ng/mL and a moderately
aggressive cancer.

The Cleveland Clinic researchers are now looking to determine the cause of
death of the study patients to determine if the use or lack of use of the
monthly injections of androgen deprivation drugs prevents prostate cancer
deaths, Dr. Robinson said.

[Presentation title: Greater Than 6 Months of Androgen Deprivation Therapy
Does Not Improve Overall Survival for High-risk Prostate Cancer Patients
Treated with Radiotherapy or Prostatectomy. Abstract

#2 11-12-2006, 01:28 AM

Unless I'm missing the obvious, this study discusses the risk of
recurrence - meaning it hasn't yet. I would think the large majority
are on androgen deprivation after it has recurred. Maybe I'm not
reading this right.

Rich

#3 11-12-2006, 01:28 AM

On Veterans Day, Tom Cular posted, in pertinent part:
> Excess Mortality Seen Among Prostate Cancer Patients on Long Term Androgen
> Deprivation Therapy: Presented at ASTRO
> By Ed Susman
>
> PHILADELPHIA, PA -- November 9, 2006 -- In a surprise finding, a
> retrospective study suggests long-term use of anti-male hormone drugs
> increase the risk of mortality among patients who were at high risk for
> recurrence of prostate cancer, doctors said here at the American Society of
> Therapeutic Radiology and Oncology (ASTRO) 48th annual meeting.
>
> "More than 6 months' treatment with these androgen deprivation drugs appears
> to double the risk of mortality in these patients," said Cliff Robinson, MD,
> resident in oncology, The Cleveland Clinic, Cleveland, Ohio.
>
If true, this is startling and discouraging news.

But is it accurate? It's certainly contrary to my experience.

My own experience leads me to wonder.

I'd very much appreciate it if Tom would post the actual link to this
article so that others might read the original source, not the
interpretation of some journalism-school graduate who may or may not be
qualified to report on technical subjects.

Does the cock's crow cause the sunrise?? IOW, what is the causal
relationship between ADT and increased PCa mortality?

As Sam Clemens (Mark Twain) is cited as saying, there are lies, damned
lies, and statistics.

TIA

Regards,

Steve J

#4 11-12-2006, 01:28 AM

Steve Jordan wrote:

> If true, this is startling and discouraging news.
> But is it accurate? It's certainly contrary to my experience.
> My own experience leads me to wonder.

> I'd very much appreciate it if Tom would post the actual link to this
> article so that others might read the original source, not the
> interpretation of some journalism-school graduate who may or may not be
> qualified to report on technical subjects.

Is he a doctor? Here are the results of a search on
the name "Ed Susman."

Mountain biking threatens male fertility By Ed Susman UPI Science ...
By Ed Susman UPI Science News From the Science & Technology Desk
Published
12/2/2002 1:46 PM http://www.upi.com/view.cfm?Story
ID=20021202-124357-7021r ...
http://www.healingsearch.com/_Report...threatens_male...

AEGiS-UPI: AIDS: Is 'Paradise' next?
Ed Susman covers medical research and health issues for UPI Science
News. E-mail
sciencemail@upi.com. 031210 UP031202 ...
http://www.aegis.com/news/upi/2003/UP031202.html

Neurology Now - Fall 2005, Volume 1, Issue 3
LEEZA GIBBONS: Easing the Burden of Alzheimer's Disease. Ed Susman.
HTML ·
PDF (3.15 M). 37. A Leeza's Place for Every County. Ed Susman ...
http://www.neurologynow.com/pt/re/ne...00501030-00000....

AEGiS-UPI: Complacency threatens Thai AIDS success
Ed Susman covers medical issues for UPI Science News. E-mail
sciencemail@upi.com 040708
UP040703. Copyright © 2004 - United Press International. ...
http://www.aegis.org/news/upi/2004/UP040703.html

AEGiS-UPI: Report: AIDS catastrophe feared in Asia
United Press International - July 6, 2004 Ed Susman, UPI Science News
....
Ed Susman covers medical issues and research for UPI Science News. ...
http://www.aegis.org/news/upi/2004/UP040704.html

AEGiS-UPI: AIDS: Catastrophe builds in Asia
(Ed Susman, a medical writer for UPI, has been covering the AIDS
epidemic for
more than 20 years). 030915 UP030905. Copyright © 2003 - United Press
....
http://ww2.aegis.com/news/upi/2003/UP030905.html

Walther Cancer Institute
Ed Susman. May 21, Proapoptotic BAX and BAK: a requisite gateway to
mitochondrial
dysfunction and death. Wei MC, Zong WX, Cheng EH, Lindsten T, ...
http://www.walther.org/wcf_blogs/BasicHotTopics.html

Abt Associates - In the News 2002
by Ed Susman, E-Hospital Journal, September 2002. This article cites a
presentation
.... by Ed Susman, The American Medical Directors Association, June 2002
....
http://www.abtassociates.com/Page.cf...FamilyID=16000

United Press International - The Washington Times, America's Newspaper
(Ed Susman) · Malaria new opponent for Serena Williams · Analysis:
New deivce
prevents breast burns (Ed Susman) · Global Fund cuts HIV funds for
Uganda ...
http://secure.washtimes.com/upi/

Intermittent HIV Treatment Proves Disappointing
Ed Susman. July 17, 2003 (Paris) — Researchers found disappointing
results in a
trial that investigated ... Ed Susman is a freelance writer for
Medscape. ...
http://www.medscape.com/viewarticle/458787

#5 11-13-2006, 04:54 AM

Richbro wrote:
> Unless I'm missing the obvious, this study discusses the risk of
> recurrence - meaning it hasn't yet. I would think the large majority
> are on androgen deprivation after it has recurred.

I'm not sure about the "majority" part. Many oncs push ADT after RP or
RT "just in case".

I.P.

#6 11-13-2006, 04:54 AM

"NICK" <CALIFORNIA_CHIEF@PEOPLEPC.COM> wrote in message
news:1163298331.353233.249890@h48g2000cwc.googlegr oups.com...
....
> Is he a doctor? Here are the results of a search on
> the name "Ed Susman."

My reading of the news article was that Susman was the author
of the news article, not of the study. I presume he is not a
doctor but was attempting (well or ill we don't know) to summarize
a presentation by a doctor.

Alan

#7 11-13-2006, 04:54 AM

This study certainly raises more questions than it answers.

To begin with, it directly contradicts the other study discussed
here that said that patients with 2 years of post treatment ADT
had higher long term survival rates.

Next, it doesn't say what the patients died of.

It also fails to state why these patients were on ADT longer
than other patients. In the other study, the one that said ADT
patients live longer, the patients were randomized to 4 months
or 4 + 24 months of ADT. In this study, we don't know from
the report how the assignment to ADT was made. Presumably
the men given ADT had higher grade disease - higher Gleason,
staging, PSA, etc. It could be that that accounts for a higher
death rate.

Also, it is not uncommon to put older men on ADT, without
treatment. That could easily account for a higher death rate.
Maybe the ADT population died off because they were closer
to the end of their natural lifespans.

I don't want to draw too many conclusions from a newspaper
report. It could be that the presentation was clear and intelligent
but the reporter didn't understand it.

However it wouldn't surprise me if the original presentation
simply left out these issues. It seems to be the rule rather than
the exception that researchers rush to publication with every
finding they have, whether or not they have any idea what it
means.

Alan

#8 11-13-2006, 04:54 AM

Alan Meyer wrote:
> "NICK" <CALIFORNIA_CHIEF@PEOPLEPC.COM> wrote in message
> news:1163298331.353233.249890@h48g2000cwc.googlegr oups.com...
> ...
> > Is he a doctor? Here are the results of a search on
> > the name "Ed Susman."
>
> My reading of the news article was that Susman was the author
> of the news article, not of the study. I presume he is not a
> doctor but was attempting (well or ill we don't know) to summarize
> a presentation by a doctor.
>
> Alan

Alan the Scientist. You are right to bring up this issue. I am
scrupulous to present only research that is completely backed up by
credible evidence. I too worship the God of science but only to an
extent. What about art, music poetry, let alone spirituality.

Best to you,

Leah

#9 11-13-2006, 04:54 AM

Richbro wrote:
> Unless I'm missing the obvious, this study discusses the risk of
> recurrence - meaning it hasn't yet. I would think the large majority
> are on androgen deprivation after it has recurred. Maybe I'm not
> reading this right.

I think it was comparing mortality for patients who were at high risk
for recurrence but for whom recurrence, as indicated by an increase in
PSA, had not yet occurred.

It is not clear what this says about patients who have had signs of
recurrence through PSA increase. Clearly, if they have clinical
symptoms of cancer or seem very close to that because of relatively high
PSA, then they are better off with hormone therapy. Whether it says
anything about whether or not to begin HT at the first sign of
recurrence through PSA increase is unclear. I presume more study is
indicated.

>
> Rich
>

#10 11-13-2006, 04:54 AM

Steve Jordan wrote:
> On Veterans Day, Tom Cular posted, in pertinent part:
>
>> Excess Mortality Seen Among Prostate Cancer Patients on Long Term
>> Androgen Deprivation Therapy: Presented at ASTRO
>> By Ed Susman
>>
>> PHILADELPHIA, PA -- November 9, 2006 -- In a surprise finding, a
>> retrospective study suggests long-term use of anti-male hormone drugs
>> increase the risk of mortality among patients who were at high risk
>> for recurrence of prostate cancer, doctors said here at the American
>> Society of Therapeutic Radiology and Oncology (ASTRO) 48th annual
>> meeting.
>>
>> "More than 6 months' treatment with these androgen deprivation drugs
>> appears to double the risk of mortality in these patients," said Cliff
>> Robinson, MD, resident in oncology, The Cleveland Clinic, Cleveland,
>> Ohio.
>>
>
> If true, this is startling and discouraging news.
>
> But is it accurate? It's certainly contrary to my experience.
>
> My own experience leads me to wonder.
>
> I'd very much appreciate it if Tom would post the actual link to this
> article so that others might read the original source, not the
> interpretation of some journalism-school graduate who may or may not be
> qualified to report on technical subjects.
>
> Does the cock's crow cause the sunrise?? IOW, what is the causal
> relationship between ADT and increased PCa mortality?

I thought it was total mortality, not necessarily PC specific mortality
that was at issue.

>
> As Sam Clemens (Mark Twain) is cited as saying, there are lies, damned
> lies, and statistics.
>
> TIA
>
> Regards,
>
> Steve J
>

#11 11-13-2006, 04:54 AM

Folks,

Here is a link to ASTRO's press release page. they state that the abstract
will be released on 11/05/06; I've been unable to find the abstract.
http://www.astro.org/annual_meeting/...506hormone.htm

The following is a link to a Medscape article on the same study.

http://www.medscape.com/viewarticle/547320

Please don't shoot the messenger; I've got a "Google Alert" set for
"prostate cancer awareness"; the article was flagged, and I thought some
folks might have some interest.

Tom

"Alan Meyer" <ameyer2@yahoo.com> wrote in message
news:9bidnaFeU9DOW8vYnZ2dnUVZ_v-dnZ2d@comcast.com...
> This study certainly raises more questions than it answers.
>
> To begin with, it directly contradicts the other study discussed
> here that said that patients with 2 years of post treatment ADT
> had higher long term survival rates.
>
> Next, it doesn't say what the patients died of.
>
> It also fails to state why these patients were on ADT longer
> than other patients. In the other study, the one that said ADT
> patients live longer, the patients were randomized to 4 months
> or 4 + 24 months of ADT. In this study, we don't know from
> the report how the assignment to ADT was made. Presumably
> the men given ADT had higher grade disease - higher Gleason,
> staging, PSA, etc. It could be that that accounts for a higher
> death rate.
>
> Also, it is not uncommon to put older men on ADT, without
> treatment. That could easily account for a higher death rate.
> Maybe the ADT population died off because they were closer
> to the end of their natural lifespans.
>
> I don't want to draw too many conclusions from a newspaper
> report. It could be that the presentation was clear and intelligent
> but the reporter didn't understand it.
>
> However it wouldn't surprise me if the original presentation
> simply left out these issues. It seems to be the rule rather than
> the exception that researchers rush to publication with every
> finding they have, whether or not they have any idea what it
> means.
>
> Alan
>

#12 11-13-2006, 04:54 AM

Tom Cular wrote:

> Folks,

> Please don't shoot the messenger;

We wouldn't think of that.

The question was "who is he?" and it turns out he's a free-lance
medical writer who pretty much does nothing but quote from medical
journals of any genre.

#13 11-13-2006, 04:54 AM

"callalily" <lfcjjk@aol.com> wrote in message
news:1163347307.695397.294190@m73g2000cwd.googlegr oups.com...
> ...
> Alan the Scientist.

I regard that as a high compliment. Thank you.

> You are right to bring up this issue. I am
> scrupulous to present only research that is completely backed up by
> credible evidence. I too worship the God of science but only to an
> extent. What about art, music poetry, let alone spirituality.

I hope that science is not in conflict with art, music, or poetry,
just as art is not in conflict with music and neither is in conflict
with poetry.

"Spirituality" however seems to mean many different things.
To the extent that it means "supernaturalism", then my intepretation
is that science is in conflict with that. To the extent that it means
a desire to seek and find the good, the true and the beautiful,
to cultivate both deep and lofty feelings in ourselves, to elevate
our relations to the world and to other people, I don't think
science is in conflict with that. I'd even go so far as to say
that a scientific worldview is helpful in achieving that kind
of spirituality.

There have been many scientists whom we would probably
classify as highly spiritual people. Some of them are
religious believers. Some are not.

I think Einstein, for example, was a highly spiritual person. He
even played the violin. See the Wikipedia article on Einstein
under the subheading "Religious views". There are some
wonderful quotes there.

>
> Best to you,
>

And to you. I always enjoy your postings.

Alan