Prostate Cancer Hormone therapy: Early is better than postponed

Hormone therapy: Early is better than postponed

In locally advanced prostate cancer, hormone therapy should be done early and not only in the progression of the disease, according to the results of a new study, a meta-analysis of eight studies.

As a locally advanced prostate cancer is called a tumor that already broken through the prostate capsule, but not yet culminated (clinically detectable) metastases to lymph nodes or other parts of the body has (T3, N0, M0). At this stage, the following forms of treatment are possible: Controlled watchful waiting, radical prostatectomy, radiotherapy and hormone therapy. Most often a combination of the last two is used because even in patients with a still limited to the prostate tumor, according to studies (to T2) as the disease progresses in 25-40% of cases after radical prostatectomy or radiation therapy.

When hormone therapy to lower blood levels of androgens (male sex hormones) that promote cancer growth. This can be achieved by orchiectomy (removal of testicles), antiandrogens (drugs against androgen effect) and LH-RH analogues (drugs against androgen formation; details, refer to sex hormones ).

From a deferred hormone therapy (HT) is when it is started in the event of progression of the disease, ie the detection of metastases or a local recurrence of the tumor. An early HT should, however, reduce the risk of progression and is therefore used despite possible adverse effects even in combination with another primary treatment: Prior to the beginning (neoadjuvant HT), accompanying (konkomitante HT) or to the end and then ( adjuvant HT).

The aim of this study was to find out now whether the early or deferred hormone therapy promises better results. For this purpose, the authors have been identified, all tests in which the two approaches were compared. Of these, seven corresponded to the strict criteria of the study, so that their data could be analyzed together in a meta-analysis as above.

The data strongly support an early and against a deferred hormone therapy. Thus, the total mortality overall progression of 26%, the local progression by 35% and the incidence of metastases by 33% fell to 14%, the mortality from prostate cancer by 28%, effective from.

Since different primary treatments and hormone therapies were performed in the evaluated studies and not all cases, adverse effects of treatment and discontinuations were present data on the follow-up period (5.5 to 7.8 years), some subgroup analyzes were not possible.

However, it was demonstrated that the nature of early hormone therapy (HT), the overall mortality rate hardly influenced further (with neoadjuvant HT by 16% and in adjuvant HT lower by 13% than with deferred HT). Unlike the primary treatment: In the case of radiation therapy, the overall mortality rate was formerly HT by 31% lower than with deferred HT, in the case of controlled Zuwartens by only 12%. This could be due to the fact that radiation and hormone therapy act in the same direction, while mainly patients are selected with a low risk for the controlled watchful waiting.

Conclusion of the authors: In patients with locally advanced prostate cancer leads an early hormonal therapy to lower mortality and less frequent progression of the disease as a hormone therapy that is delayed until the failure of the primary treatment. Whether this also applies to patients with earlier tumor stages, should be reviewed in the context of studies of patients with far advanced prostate cancer, the advantage has already been demonstrated.

Source: Boustead, G., Edwards SJ: Systematic review of early vs deferred hormonal treatment of locally advanced prostate cancer: a meta-analysis of randomized controlled trials. BJU International 99:1383-1389 (2007)