Dilemmas and contradictions in the treatment of prostatic cancer

Abstract

INTRODUCTION. There are dilemmas and contradictions in the therapeutic approach to each stage of prostatic cancer, and particularly in the application of hormonal therapy during the disseminated stages of the disease, where the crucial dilemma is: whether to apply constant or temporary (intermittent) hormonal therapy. OBJECTIVE. The objective was to compare different hormonal procedures, to reach a conclusion about which mode of hormonal therapy or hormonal control of disseminated prostatic cancer is best, as well as about which tumour characteristics have an effect on the outcome of the treatment. METHOD. Two groups of patients with disseminated prostatic cancer were treated using two different methods. One group, of 102 patients, was treated using constant hormonal therapy, while the other group, of 80 patients, was treated with intermittent antiandrogen therapy with a total androgenic blockade (TAB). Statistical analysis was used to examine the relative therapeutic effectiveness in these two groups. RESULTS. The effectiveness of hormonal therapy depends upon the malignancy potential of the tumour, i.e., therapy is the least-effective in tumours with the highest malignancy potential, where primary hormonal resistance was recorded in 35.7% of the patients, and secondary resistance in 100% of the patients, during the follow-up period of 39.1 months. In the group that was administered intermittent antiandrogen therapy during nearly the same time period, secondary resistance was reported in 20% of the patients, while in the group covered by constant therapy, it was reported in 50% of the patients, which represented a significant difference (p<0.05). CONCLUSION. The hormonal resistance of prostatic cancer relates directly to the malignant potential of the tumour, i.e., its grade and stage of malignancy. Intermittent antiandrogen application with Thas a significant effect on the time it takes for a tumour to develop hormonal resistance. Therefore, such a procedure reduces the side-effects and treatment costs of hormonal therapy.