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Relapse on endocrine treatment in patients with stage D2 prostate cancer. Does second-line hormonal therapy affect
H Matzkin1, M C Rangel, M S Soloway
1Department of Urology, University of Miami School of Medicine, Florida.
Abstract:
Patients with Stage D2 prostate cancer relapsing on endocrine treatment have a grim prognosis. The role of a second-line hormonal treatment is debatable. We analyzed retrospectively, response and survival among 119 men (57 black, 62 white) progressing on a variety of first-line hormonal therapy. Sixty-one received a second-line hormonal treatment. Fifty-eight received only supportive therapy after first line therapy was discontinued. Age and race were not a factor in survival. Based on this retrospective study the optimal management for progressive metastatic prostate cancer cannot be delineated. However, the best results were in patients treated with diethylstilbestrol (DES) as a single treatment or when employed as either first or second treatment in patients receiving two therapies. The other modalities, e.g., bilateral orchiectomy, LH-RH analogues, and anti-androgens resulted in comparable outcomes when used either as single treatment or in combinations. Further clarification of the trends shown in this report require randomized controlled studies.
Insights
For advanced prostate cancer relapsing on endocrine therapy, diethylstilbestrol (DES) showed promising results. Other hormonal treatments had comparable outcomes, but further studies are needed.
Area of Science:
- Oncology
- Urology
- Endocrinology
Background:
- Patients with Stage D2 prostate cancer experiencing relapse after endocrine treatment face a poor prognosis.
- The efficacy of second-line hormonal therapy in this patient group remains uncertain.
Purpose of the Study:
- To retrospectively analyze the response and survival rates of patients with advanced prostate cancer progressing on first-line hormonal therapy.
- To evaluate the effectiveness of various second-line hormonal treatments and supportive care.
Main Methods:
- Retrospective analysis of 119 men (57 black, 62 white) with progressive metastatic prostate cancer.
- Comparison of outcomes between patients receiving second-line hormonal treatment (n=61) and those receiving only supportive therapy (n=58).
- Evaluation of treatments including diethylstilbestrol (DES), bilateral orchiectomy, luteinizing hormone-releasing hormone (LH-RH) analogues, and anti-androgens.
Main Results:
- Age and race did not significantly impact survival outcomes.
- Diethylstilbestrol (DES) demonstrated the best results, whether used as a single agent or in combination therapy.
- Other modalities like bilateral orchiectomy, LH-RH analogues, and anti-androgens showed comparable outcomes when used alone or in combination.
Conclusions:
- Optimal management for progressive metastatic prostate cancer after initial endocrine therapy cannot be definitively determined from this retrospective study.
- Diethylstilbestrol (DES) appears to be a highly effective treatment option.
- Randomized controlled trials are necessary to validate these findings and clarify treatment trends.