PSA Rise During Neoadjuvant Hormone Therapy Associated with Poorer
Survival in Prostate Cancer

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.

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.

knowledge is power - growing old is mandatory - growing wise is optional    
"Many more men die with prostate cancer than of it. Growing old is
invariably fatal. Prostate cancer is only sometimes so."
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