Hormone therapy for patients with prostate carcinoma

Area of Science:

• Oncology
• Urology

Background:

• Androgen ablation therapy for prostate carcinoma has a 60-year history, yet its optimal use remains controversial.
• Monitoring prostate-specific antigen (PSA) levels has shifted treatment initiation, impacting patient populations and treatment concepts.
• Rising PSA levels after local therapy indicate recurrent disease with a longer life expectancy, increasing the importance of treatment side effects and quality of life.

Purpose of the Study:

• To critically review the literature on androgen ablation therapy for prostate carcinoma.
• To emphasize the impact of treatment on quality of life and incorporate recent publications.
• To address controversies regarding the timing, intermittent use, and total blockade of androgen ablation therapy.

Main Methods:

• A critical literature review was performed.
• Emphasis was placed on quality of life and recent publications.

Main Results:

• Early androgen ablation is supported for locally advanced or lymph node-positive prostate carcinoma.
• No specific PSA trigger point or doubling time is established for initiating therapy post-local treatment failure.
• Total androgen blockade offers a modest survival benefit (3% absolute 5-year improvement), with intermittent therapy improving quality of life during off-treatment intervals.

Conclusions:

• Androgen ablation therapy is effective for advanced prostate carcinoma but not curative and impacts quality of life, especially with prolonged use.
• Intermittent androgen ablation therapy may reduce adverse quality of life impacts, though long-term survival effects are under investigation.
• Developing strategies to prevent hormone-refractory prostate carcinoma and improve treatments for this advanced stage remains a critical challenge.