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The Role of Hormone Therapy in Prostate Cancer

Hormone therapy provides a therapeutic option for patients who have failed local treatments.

• PSA (Prostate Specific Antigen) can help detect treatment failure,¹ and may also be predictive of the patient's pretreatment risk for treatment failure.²
• Consider immediate intervention with hormonal therapy for advanced prostate cancer.³
• Patients with apparent hormone-refractory prostate cancer may still benefit from continuing hormonal treatment.⁴

Monitoring for Treatment Failure

Serum PSA can be an indicator for treatment failure, provided that certain precautions are considered:

• After radical prostatectomy failure, detectable serum PSA does not always indicate persistent or progressive disease. Consider using a defined cutpoint. In a retrospective analysis involving 2,782 men who had undergone radical prostatectomy, more than 70% of patients who reached or exceeded the threshold of 0.4 ng/mL PSA level progressed (n=323).⁵ Patients with Gleason scores >8 and initial PSA elevations within 2 years of radical prostatectomy were more likely to develop metastatic disease.⁶ The rate of PSA increase (time to initial PSA elevation and/or PSA doubling time) can be predictive of the probability and time to disease progression.⁶
• After radiation therapy failure, serum PSA declines more slowly than after radical prostatectomy, and may not reach undetectable levels.⁷ Patients with PSA nadir values >0.5 ng/mL may be most at risk for recurrence,⁸ as are patients in whom PSA values fail to decline by more than 50% within 6 months.⁹ Biochemical treatment failure is defined as 3 consecutive rises in PSA levels postradiotherapy.⁷

The potential risk of treatment failure following either radical prostatectomy or radiotherapy may be determined from the patient's pretreatment Gleason score, PSA, and/or prostate cancer stage.²

Consider Immediate Intervention with Hormonal Therapy When Definitive Treatment Fails

Patients with advanced prostate cancer may benefit from prompt intervention with hormonal therapy. (The Memorial Sloan-Kettering Cancer Center has a prostate nomogram to help patients and their physicians weigh treatment options.)

Risk of major complications decreases with immediate hormonal intervention

Incidence of major complications in patients with advanced prostate cancer treatment: immediate vs. deferred hormonal treatment³

In patients with advanced prostate cancer, immediate treatment with hormone therapy may reduce the incidence of pathological fractures, cord compression, ureteric obstruction, and extraskeletal metastases compared to deferred treatment.³

Data favor immediate vs. deferred hormonal treatment

Percent of deaths due to prostate cancer among all deaths: immediate vs. deferred hormonal treatment^3*

* In patients with M0 disease
† (p<0.001 two-tailed) for immediate vs. deferred treatment

The percentage of deaths due to prostate cancer was lower in patients who receive immediate versus deferred treatment.³

Hormone Refractory Prostate Cancer

Prostate cancer resistant to hormones may retain a certain degree of hormonal sensitivity, and thus patients with hormone-refractory prostate cancer may still benefit from continued hormonal treatment.⁴ According to Hussain, et al., in Oncology, 2000, "Approximately 20% to 40% of patients who progress on total androgen suppression [LHRHa plus antiandrogen] respond to antiandrogen withdrawal for a duration of 3 to 5 months."¹⁰

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