According to an article recently published in the International Journal of Radiation Oncology, Biology and Physics, men with prostate cancer whose prostate specific antigen (PSA) levels rise during hormone therapy given prior to radiation therapy have poorer survival than those whose PSA levels do not rise during this period.

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 PSA test measures proteins that are produced and shed by the prostate. PSA levels tend to be elevated when prostate cancer is present; these levels are also often used to monitor responses to therapy in men with prostate cancer.

Prostate cancer is stimulated to grow from exposure to the male hormone testosterone. One important treatment component of prostate cancer is hormone therapy, also referred to as androgen deprivation therapy (ADT). The purpose of ADT is to reduce levels of testosterone so that the cancer cells receive less stimulation to grow.

Neoadjuvant therapy is treatment given prior to the main treatment. In theory, neoadjuvant therapy reduces the size of the cancer prior to treatment such as surgery or radiation therapy, optimizing the effectiveness of the main treatments. In addition, neoadjuvant therapy can begin to immediately kill cancer cells throughout the body.

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Researchers from British Columbia recently conducted a study to evaluate the association between PSA levels during neoadjuvant hormone therapy and outcomes in men with prostate cancer. This study included 182 men with early prostate cancer who underwent three to 12 months of neoadjuvant hormone therapy followed by radiation therapy. The participants had PSA levels taken at three different times during treatment.

  • At five years only 39% of men who experienced a PSA increase during neoadjuvant hormone therapy were cancer-free compared with 65% of men who did not experience a rise in PSA levels.
  • Overall survival rates at five years were 83% for men whose PSA increased during neoadjuvant therapy compared with 90% among men with no PSA increase during that time period.
  • Significantly more men died of their disease if their PSA levels increased during neoadjuvant therapy compared to those whose PSA levels did not rise during that time.

The researchers concluded that men undergoing neoadjuvant hormone therapy might benefit from having PSA levels monitored during their treatment, as an increase in PSA levels indicates worse outcomes. These patients may benefit from more aggressive or additional therapy.

Reference: Niblock P, Pickles T. Rising Prostate-Specific Antigen Values During Neoadjuvant Androgen Deprivation Therapy: The Importance of Monitoring. International Journal of Radiation Oncology Biology Physics. 2006; 65: 59-64.

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