When is Hormone Therapy Used for Prostate Cancer?

Use of hormone therapy explained.

hormone therapyHormone therapy, also known as anti-hormonal therapy, works by reducing serum testosterone levels.  This is highly effective in controlling the growth and progression of prostate cancer cells in early stage as well as advanced stage prostate cancers.

In trials, research has shown that patients live longer if they receive six-month of hormone therapy in addition to radiation compared to radiation alone. Researchers have also found that three years of hormone deprivation is superior to six month of hormone deprivation in higher risk patients. Given the scientifics of hormone deprivation, new trials are are attempting to see whether two years is possible.  In more advanced prostate cancer, meaning when the cancer has spread to other organs, the first line of therapy is actually to reduce the patient’s testosterone level with hormone deprivation therapy.

Farshid Dayyani MD:  Hormone therapy is highly effective and used in all stages of prostate cancer.

By hormone therapy, we actually mean antihormonal therapy or reducing the serum testosterone levels.  This is highly effective in controlling the growth and progression of prostate cancer cells in early stage as well as advanced stage.

So, let’s review the indication and use of this therapy for each stage.  In localized prostate cancer, meaning prostate cancer that has not spread to other organs.  The treatment options include observation of the patients with very low risk disease, radical prostatectomy, or radiation therapy.

There are clinical factors that try to predict the risk for this patient to have a recurrence of his cancer after local therapy.  Those include a so called Gleason score, the serum PSA level and the size or clinical stage of the tumor at diagnosis.  Based on those criteria, we classify patients in low risk, intermediate risk, and higher risk.  This is important because if the patient chooses to undergo radiation therapy for an intermediate risk disease, it is recommended to combine the radiation with six-month of hormone deprivation therapy.

In big trials, we have seen that patients live longer if they receive six-month of hormone therapy in addition to radiation compared to radiation alone.  If the patient is higher risk, for example with a PSA greater than 20 or a Gleason score of 8 or greater and he chooses to undergo radiation then the combination with hormone therapy should be significantly longer.

We know that three years of hormone deprivation is superior to six month of hormone deprivation in higher risk patients, but given the scientifics of hormone deprivation, the new trials are tying to see whether we can come down to two years.  In the more advanced prostate cancer, meaning when the cancer has spread to other organs, the first line of therapy is actually to reduce the patient’s testosterone level with hormone deprivation therapy.

More than 8 or 9 out of 10 patients will benefit upfront from this treatment, the pain will get better, the lymph nodes will shrink, and the PSA will come down.  Unfortunately, this will last only on an average for 18 to 24 months before other treatments have to be added to that modality.

Farshid Dayyani
Dr. Dayyani earned his medical degree in Munich, Germany at Ludwig-Maximilians Universitaet before completing his internal medicine internship and residency at Beth Israel Deaconess Medical Center in Boston, Mass.
Farshid Dayyani

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