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Endocrine therapy: where do we stand and where are we going?
1Department of Urology, Academic Hospital Rotterdam, The Netherlands.
Cancer Surveys
|January 1, 1991
Summary
Endocrine therapy for prostate cancer, based on androgen withdrawal, effectively manages symptoms and prolongs progression-free survival. While newer methods like LHRH agonists exist, their long-term survival benefits over traditional castration require further proof.
Area of Science:
- Endocrinology
- Oncology
- Urology
Background:
- Endocrine management, utilizing androgen withdrawal, is a cornerstone palliative therapy for prostate cancer.
- Historically, Huggins and associates pioneered this approach in the 1940s, based on androgen's role in prostate cancer growth.
- While initially believed to prolong life, this remains unproven, possibly due to hormone-independent cancer cell populations.
Purpose of the Study:
- To review the efficacy of endocrine management in prostate cancer palliation.
- To discuss established and novel treatment modalities for androgen deprivation.
- To evaluate the impact of endocrine therapy on symptom control and survival outcomes.
Main Methods:
- Review of clinical and experimental research on androgen withdrawal in prostate cancer.
- Comparison of traditional castration and estrogen therapy with newer agents like Luteinizing Hormone Releasing Hormone (LHRH) agonists and anti-androgens.
- Investigation into the potential benefits of total androgen suppression (testicular and adrenal) versus partial suppression.
Main Results:
- Endocrine treatment significantly alleviates prostate cancer symptoms, particularly bone pain and urinary obstruction.
- It has been shown to prolong time to disease progression and survival.
- Newer treatments like LHRH agonists offer testosterone suppression without estrogen's side effects, but long-term survival advantages over castration are not yet definitively proven.
Conclusions:
- Endocrine therapy remains a vital palliative strategy for prostate cancer, improving symptom burden and disease control.
- While advanced therapies offer improved side effect profiles, their superiority to established methods like castration requires further substantiation.
- Further research is ongoing to optimize androgen deprivation strategies, including total androgen suppression and agents mitigating side effects like impotence.