Early versus Deferred Hormonal Treatment for Asymptomatic Prostate Cancer

Abstract

There are two different clinical scenarios in which a decision on hormonal therapy either initially after diagnosis of deferred until the occurrence of signs and symptoms for presently asymptomatic prostate cancer is needed: A more recently described cohort of men with prostate cancer who underwent definitive therapy for putatively curable disease experiencing a rising PSA (biochemical relapse / progression), and a more classical group of men with prostate cancer who were unwilling or unfit to undergo local therapy with curative intent. Long-term hormonal treatment will expose patients to the risk of substantial adverse side effects such as muscle wasting, chronic fatigue, osteoporosis and others, in addition to an overall increase in treatment costs. On the other hand, a potential prolongation of survival and a delay in the development of clinical symptoms may serve as arguments for early treatment. A number of studies have been conducted in which early hormonal treatment delays the time to progression and reduces the cancer-related complication rate such as urinary obstruction and bone fractures. However, results on overall survival remain inconclusive and quality-of-life issues will become more and more important in light of the extended life span of patients with asymptomatic prostate cancer in recent years. Ongoing clinical trials such as EORTC 30991 are needed to provide further information on this important issue.

Penile Metastasis from a T1b Prostate Carcinoma

“…However, in this case, pelvic irradiation aided reduction of the PSA levels, even if it was unable to prevent disease progression. The same results were obtained with MAB, performed after radiotherapy, which achieved a favourable PSA response, but without any effect on disease progression, as reported by other authors [27]. The presence of lymph node and bone metastasis may be explained by the fact that TUR-P may cause a mechanical dissemination of tumour, as proposed by Sandler [28] in patients with known prostatic adenocarcinoma.…”

Use of artificial androgen receptor coactivators to alter myoblast proliferation

“…Finding of a cytosolic androgen receptor in skeletal muscle provided further support for a direct effect of androgens on muscle [13]. Additionally, muscle wasting is noted in patients undergoing androgen deprivation therapy due to prostate cancer [14] and age-related sarcopenia may be attributed to the decline in circulating growth hormone and testosterone [15]. Therefore, androgens and their cognitive receptors may provide a mechanism to manipulate skeletal muscle growth properties.…”

Leuprorelin Acetate in Prostate Cancer: A European Update

“…The potential to prolong survival and delay the development of clinical symptoms are arguments for early treatment. Several studies have now shown that early hormonal treatment can delay the time to progression and reduce the rate of cancer‐related complications such as urinary obstruction and bone fractures 45,46 …”

“…Other data also support immediate treatment versus deferred treatment in advanced disease, 45,46 including Study 30846 of the European Organisation for Research and Treatment of Cancer (EORTC) 46 . This prospective randomised study included 412 patients with positive lymph nodes who did not undergo a previously planned radical prostatectomy, but were instead randomised to immediate or deferred hormone therapy.…”