According to a recent article published in the Lancet Oncology, six months of androgen deprivation therapy given before and during radiation therapy improves cancer-free survival and reduces the risk of cancer progression in men with locally advanced prostate cancer. However, it is important for individuals to speak with their physician regarding their individual risks and benefits of treatment with androgen deprivation therapy.
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; overall survival rates for all stages of prostate cancer have improved dramatically during 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. Furthermore, the use of androgen deprivation therapy in the treatment of prostate cancer that is still localized (has not spread to distant sites in the body) is controversial and remains under evaluation.
Since androgen deprivation therapy is associated with side effects such as bone loss, hot flashes, reduction in sexual interest, enlargement of breasts, and other side effects, researchers are trying to determine if it has definite benefit for patients with localized prostate cancer. In addition, researchers are trying to determine if some patients with localized prostate cancer are better candidates for androgen deprivation therapy than others. Evaluation also continues into its optimal timing and scheduling.
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 their cancer is progressing. 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), whereas those whose PSA levels rise following therapy may be referred to having biochemical failure.
Researchers from Australia recently conducted a large clinical trial to evaluate androgen deprivation therapy in the treatment of locally advanced prostate cancer. This trial included 818 men with locally advanced prostate cancer who were divided into three treatment groups: radiation therapy only; a total of 3 months of androgen deprivation therapy before and during radiation therapy; a total of 6 months of androgen deprivation therapy before and during radiation therapy.
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At a median follow-up of nearly 6 years, the following results were presented:
- Compared to the group of patients who only received radiation therapy, those who received 3 months of androgen deprivation therapy had a 44% reduced risk of a cancer recurrence at or near the prostate; a 30% reduction in the risk of biochemical failure; a 35% improvement in cancer-free survival; and a 27% reduced risk for the need of subsequent treatment.
- Compared to the group of patients who only received radiation therapy, those who received 6 months of androgen deprivation therapy had a 58% reduced risk of a cancer recurrence at or near the prostate; a 42% reduction in the risk of biochemical failure; a 44% improvement in cancer-free survival; a 47% reduced risk for the need of subsequent treatment; a 33% reduced risk in developing cancer spread to distant sites in the body; and a 44% reduced risk of dying from prostate cancer.
The researchers concluded that 6 months of androgen deprivation therapy before and during radiation therapy significantly improves the outcomes of patients with locally advanced prostate cancer compared to radiation therapy alone. Further study is necessary to determine if specific groups of patients achieve greater benefit from androgen deprivation therapy than others. Optimal dose and timing of both radiation therapy and androgen deprivation therapy for this group of patients also must be determined.
Patients diagnosed with locally advanced prostate cancer may wish to speak with their physician regarding their individual risks and benefits of androgen deprivation therapy or the participation in a clinical trial further evaluating androgen deprivation therapy or other promising treatment approaches. Two sources of information regarding ongoing clinical trials include the National Cancer Institute (www.cancer.gov) and www.cancerconsultants.com.
Reference: Denham J, Steigler A, Lamb D, et al. Short-term androgen deprivation and Radiotherayp for Locally Advanced Prostate Cancer: Results from the Trans-Tasman Radiation Oncology Group 96.01 Randomised Controlled Trial. Lancet Oncology. 2005; 6:841-850.
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