The influence of hormonal therapy on survival of men with advanced prostatic cancer

Although hormonal therapy has been used for almost 40 years in the management of patients with prostatic cancer there is no consensus on whether this treatment prolongs life in these men. In an attempt to answer this question survival of 65 control patients seen from 1937 to 1940 was compared to survival of patients who received hormonal therapy from 1942 to 1944. These intervals were selected in an attempt to minimize the influence of medical advances other than hormonal therapy. Although life table graphs indicated that survival was extended for patients who entered in the hormonal era our analyses indicate that the difference in survival between treatment and control groups can be accounted for by a trend toward lower mortality in patients who entered later in the study rather than by hormonal therapy. The temporal trend was noted in all major subgroups of patients. These data suggest that in this study hormonal therapy had little impact on the over-all survival of men with advanced prostatic cancer and that every effort must be made to explore new avenues for the treatment of these patients. In the future, hormonal therapy may be most effectively used when the poorly responsive patients can be identified at an earlier time in the disease and treated with alternate forms of therapy.