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Hormonal therapy for locally advanced prostate cancer
1Division of Hematology and Medical Oncology, Virginia Mason Medical Center, Seattle, WA 98111.
NCI Monographs : a Publication of the National Cancer Institute
|January 1, 1988
Summary
Hormonal therapy offers symptomatic relief for advanced prostate cancer but its impact on overall survival is uncertain. Early use may prolong disease-free survival but does not prevent eventual progression.
Area of Science:
- Oncology
- Urology
Background:
- Locally advanced prostate cancer (stages C and D1) carries a poor prognosis with high risk of distant metastases.
- Hormonal therapy is the primary systemic treatment for metastatic (stage D2) prostate cancer, targeting testosterone stimulation.
Purpose of the Study:
- To evaluate the established benefits and uncertainties of hormonal therapy in different stages of prostate cancer.
- To assess the efficacy of various hormonal therapy approaches, including complete androgen blockade.
Main Methods:
- Review of existing studies on hormonal therapies such as orchiectomy, diethylstilbestrol, luteinizing hormone-releasing hormone agonists, antiandrogens, and surgical interventions.
- Analysis of preliminary results from a multigroup randomized trial comparing complete androgen blockade with single-agent therapy.
Main Results:
- Common hormonal therapies yield 60%-80% response rates, but overall survival benefits remain unclear.
- Complete androgen blockade shows only a minimal advantage over single-agent therapy.
- Early hormonal therapy in stages C and D1 may prolong disease-free survival but not overall survival.
Conclusions:
- The benefit of hormonal therapy for stages C and D1 prostate cancer at diagnosis is not clearly established.
- While early hormonal therapy can improve disease-free survival, it does not prevent ultimate disease progression or prolong overall survival.
- Hormone receptor assays might aid in selecting patients who could benefit from early hormonal intervention.