According to a recent article published in the International Journal of Radiation Oncology, Biology and Physics, long-term androgen deprivation therapy improves overall survival at 5 years when compared with short-term androgen deprivation following radiation therapy in patients with prostate cancer who have a prostate-specific antigen level of 20 or higher.

The prostate is a gland of the male reproductive system. It produces some of the fluid that transports sperm during ejaculation. After skin cancer, prostate cancer is the most common form of cancer diagnosed in men. The outlook for men diagnosed with prostate cancer is good, as overall survival rates for all stages of prostate cancer have improved dramatically over the past 20 years.

Current treatment options for prostate cancer include watchful waiting, surgery, chemotherapy, radiation or androgen deprivation therapy (also referred to as hormonal therapy).

Androgen deprivation therapy is designed to block testosterone from stimulating the growth of hormone-dependent types of prostate cancer. The optimal duration of time for treatment with androgen deprivation therapy has not yet been established, although results from previous studies have indicated that long-term use of hormone therapy appears to improve outcomes in patients compared to short-term use.

Following treatment for prostate cancer, patients typically have their prostate-specific antigen (PSA) levels closely monitored to determine if they are responding to treatment or if they are experiencing a progression of cancer. PSA are proteins that are normally shed by the prostate and can be measured in circulating blood. If elevated, PSA levels may indicate either the presence or progression of cancer. Patients whose PSA levels remain in the normal range following treatment may be referred to as having biochemical control, or no evidence of disease (bNED).

Researchers from Canada recently reviewed data from the Prostate Cancer Outcomes Initiative database of British Columbia Cancer Agency to compare different treatment times of androgen deprivation therapy in patients with early prostate cancer who underwent radiation therapy.

The data included 307 patients whose cancer had not spread from the prostate but who had PSA levels that were at least 20 ng/mL upon diagnosis. Patients underwent radiation therapy and were then treated with either short-term androgen deprivation therapy (ST-AD), consisting of an average of 6 months of androgen deprivation therapy, or were treated with long-term androgen deprivation therapy (LT-AD), consisting of an average of nearly 26 months of androgen deprivation therapy.

Overall, patients treated with LT-AD had greater survival:

• bNED rate was 37% for ST-AD and 62.5% for LT-AD

• Overall survival at 5 years was 75% for patients treated with ST-AD and 87.5% for patients treated with LT-AD

• At 5 years, 18% of patients treated with ST-AD had died from prostate cancer, compared with only 6% of patients treated with LT-AD

The researcher concluded that LT-AD provides superior survival and bNED for patients with prostate cancer who undergo radiation therapy and have a PSA level of 20 or greater upon diagnosis. However, androgen deprivation therapy is associated with side effects, so patients are encouraged to speak with their physician regarding their individual risks and benefits of the duration of time of treatment with androgen deprivation therapy.

Reference: Berthelet E, Pickles T, Won Jae Lee K, et al. Long-term androgen deprivation therapy improves survival in prostate cancer patients presenting with prostate-specific antigen levels >20 ng/mL. International Journal of Radiation Oncology, Biology, Physics. 2005;63: 781-787.

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