New To Hormone Treatment Of Prostate Cancer and Life Expectancy
On the German Urology Congress in 2007 has been reported several recent studies that provide answers to some previously open questions about hormone therapy for locally advanced and metastatic prostate cancer.Hormone therapy aims to eliminate the cancer growth-promoting androgens (male sex hormones). At such androgen deprivation are usually used: orchiectomy (removal of testicles), antiandrogens (drugs against androgen effect) and LH-RH analogues (drugs against androgen formation; details, refer to sex hormones and hormone therapy for prostate cancer ).
The main areas of use of hormone therapy, the locally advanced and metastatic prostate cancer are: In the first case, the prostate capsule is broken, but no metastases detected (clinical stage T3-4 N0 M0), in the second case, the tumor has local lymph nodes (N1) or other parts of the body affected (M1; TNM system to see the growth and spread of prostate cancer ).
Numerous detailed questions on hormone therapy were or are the subject of investigations, for combination with another form of therapy, at the time of onset, the duration and interruptions.Here are the latest results:
Early or late hormone therapy
Thanks to the measurement of PSA (prostate-specific antigen, see also PSA test ) are now detected prostate cancers predominantly at an early stage. An immediate androgen deprivation would affect many who would not die of this tumor, and would be required in other for a very long time, so that possible adverse effects of more consequence. It is therefore important to decide which patients the benefits of immediate androgen deprivation predominate.
In patients with metastatic tumor, an immediate androgen deprivation is usually displayed.Compared to the treatment that is delayed until the appearance of symptoms, although the rate of major complications is the survival time not longer, but significantly lower. Even in patients with locally advanced tumors that are irradiated, an immediate androgen deprivation has great advantages (see also in the magazine " hormone therapy: Early is better than deferred ").
A survival benefit with immediate androgen deprivation also have the following two groups: patients with locally advanced tumors, which are not treated locally curative (no local treatment with healing intention as surgery or radiation), and patients after radical prostatectomy in which an infestation of many lymph nodes (pN1 ), the seminal vesicles (pT3b) or the edges of the removed tissue (R1) has been detected. The same could apply to patients with early PSA rebound after locally curative therapy.
The aim is to limit the hormone in these cases to patients who would die with high probability to the tumor. For decision-making here the PSA-DT could offer (of English doubling time, doubling time of PSA value.): Compared to a PSA-DT of more than 12 months, the risk of death is seven times with a PSA-DT of up to 12 months increased. PSA DT is important for the determination of the prognosis, and the. Both before and after a local therapy of prostate cancer
Neoadjuvant hormonal therapy before radical prostatectomy
In this study, 38 men were studied with locally advanced prostate cancer, where surgery because of local tumor spread first came out of the question (T3-4). To reduce the size of the tumor in them was therefore androgen deprivation prior to radical prostatectomy performed (neoadjuvant hormone therapy). Only about 10% was needed after the operation androgen (adjuvant hormonal therapy), and about 30% due to a rise in PSA recovery in the further course (deferred hormone). According to calculations by almost 43% have no PSA rise again without hormone therapy within 5 years.
The conclusion of the authors: In locally advanced prostate cancer, the primary is not regarded as operable, leads neoadjuvant hormonal therapy before radical prostatectomy in an effective tumor removal and a good prognosis, even if the initial findings were (PSA about 20ng/ml, unfavorable Gleason score about 7).
Adjuvant radiotherapy and hormone therapy
This study was of men with locally advanced prostate cancer after radical prostatectomy, with no metastases in the lymph nodes (pN0) and either a stage pT3a R1 (broken tumor through the prostate capsule, infected cut edges) or a stage pT4 (tumor not in the seminal vesicles, but in other neighboring structures grown). They received a maximum androgen blockade (MAB = LH-RH analogue plus antiandrogen). At 40 men, this was carried on continuously, however, ended at 173 at the end of adjuvant (additional) irradiation again, which began after four weeks and 25 days lasted.
After a mean follow-up period of about 9 years in the first group and about three and a half years in the second group, the 8-year survival rates were calculated, on the one without disease progression (progression free survival), to the other without dying from the tumor (tumor-specific survival). The former was about 91% at stage R1 pT3a and about 62% in stage pT4, the latter more 100% at stage R1 pT3a and about 84% in stage pT4. It did not matter which group the men belonged. The irradiation also did not worsen the rate of urinary incontinence (involuntary loss of urine) and urethral stricture.
The conclusion of the authors: In locally advanced prostate cancer without lymph node metastasis (pN0 pT3a R1 and pT4 pN0) are at least equally effective after radical prostatectomy, the continuous hormone deprivation and adjuvant irradiation with short-term hormone withdrawal. The latter is also few side effects, can potentially lead to healing and provides the option to re-hormone with a possible progression of the disease.
Intermittent or continuous androgen deprivation
Included in this study were men with metastatic prostate cancer (clinical stage T1-4 and metastases in lymph nodes and / or at other locations). They were initially for 24 weeks maximum androgen blockade (MAB = LH-RH analogue plus antiandrogen). In 335 of them fell by the PSA value below 4ng/ml or at least 90%. They were divided into two groups: the MAB was further performed continuously in a group of intermittently with the other, so again only the progression of the disease.
No significant (significant) difference between the two groups was observed regarding the progression of the disease (at about 2/3), the median time to progression (with intermittent therapy slightly later: 16.6 versus 11.5 months), the median survival time (about 53 months) and adverse events. With intermittent therapy, the general condition and the sexual activity of the patients were better, and 88% took more than half the time no treatment.
The conclusion of the authors: Intermittent androgen blockade is a safe therapeutic option for metastatic prostate cancer. On average, more than 40% of the time are free therapy, which contributes to the quality of life of patients.
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