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Importance of continued testicular suppression in hormone-refractory prostate cancer
C D Taylor1, P Elson, D L Trump
1Division of Hematology/Oncology, Lawrence Memorial Hospital of Medford, MA 02155.
Purpose:
Patients in whom prostate cancer progresses despite testicular androgen ablation are generally said to have cancers that have become resistant to hormonal maneuvers. If androgen suppression has been pharmacologic, this therapy is often stopped before consideration of other systemic treatments. This exploratory study sought clinical correlates of experimental evidence that there may be substantial acceleration of tumor growth after cessation of androgen suppression.
Materials And Methods:
A retrospective multivariate analysis was performed on survival data for 341 patients treated on four clinical trials of secondary therapy for hormone-refractory prostate cancer. Factors included in the model were recent weight loss, age, performance status, disease site (soft tissue v bone-dominant), prior radiotherapy, and continued androgen suppression v discontinued exogenous endocrine therapy.
Results:
Recent weight loss, age, performance status, and disease site were important prognostic factors for survival duration in hormone-refractory prostate cancer. Correcting for these factors, continued testicular androgen suppression was also an important predictor of survival duration in all data sets examined.
Conclusion:
This retrospective study showed a modest advantage in survival duration for men with hormone-refractory prostate cancer who continued to receive testicular androgen suppression. The hypothesis that continued hormonal maneuvers can still affect survival in this group warrants examination in prospective trials.
Insights
Continuing testicular androgen suppression in men with hormone-refractory prostate cancer may modestly improve survival. This finding suggests hormonal therapies might still benefit patients even after initial resistance develops.
Area of Science:
- Oncology
- Endocrinology
Background:
- Prostate cancer progression despite androgen ablation suggests hormonal resistance.
- Pharmacologic androgen suppression is often discontinued upon progression.
- Cessation of androgen suppression may accelerate tumor growth.
Purpose of the Study:
- To explore clinical factors associated with survival in hormone-refractory prostate cancer.
- To investigate the impact of continued androgen suppression on survival duration.
Main Methods:
- Retrospective multivariate analysis of survival data from 341 patients.
- Analysis included factors like weight loss, age, performance status, disease site, prior radiotherapy, and androgen suppression status.
Main Results:
- Weight loss, age, performance status, and disease site were significant prognostic factors.
- Continued testicular androgen suppression independently predicted improved survival duration.
Conclusions:
- Men with hormone-refractory prostate cancer continuing testicular androgen suppression showed a modest survival advantage.
- Further prospective trials are warranted to confirm if continued hormonal maneuvers impact survival in this patient group.