According to a recent article published in the Journal of Clinical Oncology, long-term hormone therapy following radiation therapy appears beneficial in the treatment of locally advanced prostate cancer, particularly those considered to be high risk.

One out of every 6 men will be diagnosed with prostate cancer in the United States. Prostate cancer is the second leading cause of cancer deaths in the U.S. for men. The prostate is a walnut-sized male sex gland that is located between the bladder and rectum. The prostate is responsible for secreting a substance that forms a component of semen. Treatment options are varied for patients with prostate cancer, often depending upon the stage, or extent, of the disease. Locally advanced prostate cancer refers to cancer that has spread locally outside the prostate, but not to distant sites in the body. Standard treatment options for locally advanced prostate cancer may include radiation, hormone therapy, surgery, chemotherapy or watchful waiting. Pathologists will determine the aggressiveness of the cancer when evaluated under a microscope. The aggressiveness is graded on a scale of 1 to 10 and given a “Gleason score”. The higher the Gleason score, the more aggressive the cancer, and the higher the probability the cancer will recur. Physicians often take into account the Gleason score when deciding upon treatment options.

One component of therapy for prostate cancer is called hormone therapy, also referred to as androgen deprivation therapy, in which levels of male hormones, particularly testosterone, are reduced in the body. Testosterone has growth stimulatory effects on prostate cancer cells. Researchers continue to evaluate optimal timing of hormone therapy in the sequence of treatment, as well as the optimal duration of its use, weighing side effects against effectiveness.

Researchers affiliated with the Radiation Oncology Study Group (RTOG) recently conducted a clinical trial to evaluate the duration of hormone therapy in patients with locally advanced prostate cancer. This trial involved over 1,500 men who received radiation therapy with either long-term androgen deprivation (LTAD) or short-term androgen deprivation (STAD). STAD consisted of 2 months of androgen deprivation before and 2 months following radiation therapy with the hormone agents flutamide and goserelin. LTAD consisted of an additional 24 months of goserelin following STAD. Cancer recurrences occurred in 54% of patients treated with LTAD, compared to 72% of patients treated with STAD. At 5 years, the overall survival rates were nearly equivalent (approximately 80%). However, in the subset of patients with a Gleason score of 8 to 10, (considered to high-risk), those treated with LTAD had a 81% survival rate at 5 years, compared to 71% for those treated with STAD.

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The researchers concluded that LTAD in addition to radiation therapy appears to provide survival benefit, compared to STAD, for high-risk patients with locally advanced prostate cancer. However, with the emergence of newer radiation techniques that may allow for safe, higher doses of radiation to be administered, optimal duration and timing of hormone therapy may vary. Patients with locally advanced prostate cancer who choose to receive radiation therapy may wish to speak with their physician about the risks and benefits of specific regimens of hormone therapy, or the participation in a clinical trial evaluating other novel therapeutic options. Two sources of information regarding ongoing clinical trials include the National Cancer Institute (cancer.gov) and www.cancerconsultants.com. Personalized clinical trial searches are also performed on behalf of patients at cancerconsultants.com.

Reference: Hanks GE, Pajak TF, Porter A, et al. Phase III Trial of Long-Term Adjuvant Androgen Deprivation After Neoadjuvant Hormonal Cytoreduction and Radiotherapy in Locally Advanced Carcinoma of the Prostate: The Radiation Therapy Oncology Group Protocol 92-02.

Journal of Clinical Oncology. 2003;21:3972-3978.

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