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Medical Forum / Diseases and Disorders / Prostate Cancer / March 2006Early versus Delayed Androgen Deprivation - Another Data Point
Here is another data point relating to this frequently discussed issue. Full text is not yet available for free on-line. If someone interested in this topic does get the full text, I'd be curious to hear back what kind of overall survival benefits they report...Ron J Clin Oncol. 2005 Nov 10;23(32):8225-31 Early versus delayed androgen deprivation for prostate cancer: new fuel for an old debate. Ryan CJ, Small EJ. UCSF Comprehensive Cancer Center, 1600 Divisadero St, San Francisco CA 94143, USA. ryanc@medicine.ucsf.edu The purpose of this review is to discuss the recent increase in data supporting the use of androgen ablation early in the clinical course for patients with nonmetastatic prostate cancer. We systematically reviewed recent publications that report on the use of androgen deprivation (AD) in nonmetastatic prostate cancer patients from the 2003 and 2004 proceedings of the American Society of Clinical Oncology, the 2003 and 2004 proceedings of the American Urological Association as well as published literature from 2003 to 2005. Five recently published mature randomized trials of AD plus local therapy were evaluated plus two large data sets on the use of AD for patients with serologic relapse after local therapy. Four mature randomized studies demonstrate an overall survival benefit to the use of AD in conjunction with definitive local therapy (three with radiation and one with surgery). One retrospective analysis suggests that AD administered early after serologic progression improves overall survival, and one retrospective analysis shows a reduction in metastasis-free survival but has not yet shown an overall survival benefit. For patients with nonmetastatic prostate cancer with high-risk features, as well as those for serologic relapse, the use of AD before the development of metastatic disease is supported by long-term outcomes from a series of clinical trials. Consideration of AD is therefore warranted early in the clinical course of high-risk patients. PMID: 16278477 For what it is worth this is my experience. Nine years ago my prostate was removed after my first every PSA test came back 45.5. Biopsy results were 6's, 7's and an 8. Bone scan was negative and lymph nodes were also clear. PSA tests were quarterly. After three years the PSA went from <0.1 to 1.6. A one month Lupron shot brought it down to 0.8. Another one-month Lupron shot and one month later the PSA was 1.3. Doctor say "Let's wait until it gets to 2." I said "Let's start now. Result 3-month Lupron shot and prescription for Casodex. PSA stayed at <0.1 for three years. PSA was then 0,6 and Dr. stopped Casodex. One month later PSA a <0.1 and has stayed there since with quarterly Lupron shots. It has now been nine years since surgery. My next appointment is April. > For what it is worth this is my experience. Nine years ago my prostate > was removed after my first every PSA test came back 45.5. Biopsy [quoted text clipped - 8 lines] > shots. It has now been nine years since surgery. My next appointment > is April. I don't mean to question your treatment. There are a lot of uncertainties, and no one has definitively proved one way or another that early hormone treatment is beneficial. In such circumstances you have to go with what makes the best sense to you and stick with it unless you learn otherwise. But the scientific question, still unanswered, I think, is whether early hormone therapy delays the development of clinical symptoms of metastatic disease. It will certainly lower PSA, but, according to Walsh and some other experts, that is only because the hormone dependent cancer cells are being controlled. It is thought by these people, based on some evidence, that hormone indepedent cancer cells are there from the beginning and it is those cells that eventually predominate and kill the patient. Others disagree and believe that early hormone therapy can delay the development of hormone indepedent cancer cells. The evidence quoted by ron seems to suggest that the latter theory is more correct, at least for high risk patients: early hormone therapy can slow the development of metastatic cancer. One thing I'm not certain about is that the situation with respect to radiation and surgery may be different. In the case of radiation, the hormone therapy may be helping to kill the original tumor. To answer the scientitic question, it would be better to concentrate on surgical patients. ron quoted: > The purpose of this review is to discuss the recent increase in data > supporting the use of androgen ablation early in the clinical course [quoted text clipped - 18 lines] > Consideration of AD is therefore warranted early in the clinical course > of high-risk patients. Only one word of this surprises me, and I fully agree with its closing advice, with two admonitions: Quantify ADT's benefit and make sure its "consideration" includes its SEs thoroughly -- their severities, likelihoods, treatments, and the SEs and treatments of the ADT SE treatments. The surprising word is "reduction"; I'd think that "[a] retrospective analysis would show an INCREASE in metastasis-free survival". I.P. |
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