Prostate Cancer: Who Needs Chemical Castration?
Difficult Hormone Treatment Best for More Advanced Prostate Cancer
June 12, 2009 - There's no shortcut to three years of difficult "chemical castration" hormone therapy for men receiving radiation treatment for locally advanced prostate cancer.
But there are silver linings to the finding, from European clinical trials led by Michel Bolla, MD, of the University of Grenoble, France.
Most men with newly diagnosed prostate cancer in the U.S. have an earlier stage of prostate cancer than the men in the Bolla study. If they need hormone therapy at all, they are likely to get by with a six-month treatment course.
Bolla explored whether this might work for men treated with radiation for what doctors call locally advanced prostate cancer -- that is, prostate cancer that has spread beyond the inside of the prostate but not throughout the body.
In a study of 970 men, the researchers compared six months of hormone treatment -- with additional treatment if men relapsed -- to immediate assignment to three years of hormone treatment.
"The increase of overall survival in men given three years of treatment is superior," Bolla tells WebMD.
Because hormone therapy blocks male hormones, it causes loss of sexual function and severe hot flashes. The good news, Bolla says, is that after three years, these side effects go away.
"We can see a modification of quality of life with respect to decrease of sexual activity during the three years of treatment," he says. "But once the treatment is completed, the quality of life is like the quality of life prior to treatment."
For most men in the U.S. -- who, because of prostate-cancer screening have their cancers detected at an earlier stage than the men in the Bolla study -- three years of hormone therapy would be "overkill," says prostate cancer researcher Peter Albertsen, MD, of the University of Connecticut, Farmington.
"In many parts of the country, these men are automatically getting hormonal therapy just because doctors figure if it works for the more aggressive cancers it can work for the more localized cancers," Albertsen tells WebMD. "The radiation therapy itself may be overkill -- so then when you add three years of hormonal therapy, you are really overtreating these men."
Unfortunately, it's still not known for sure whether men with more limited disease than those in the Bolla study get a benefit from hormone therapy.
It's not really an issue for many men whose prostate cancer is diagnosed before age 70. That's because most such men in the U.S. opt for surgery to remove the prostate. At least for now, there's no convincing evidence that men treated with prostatectomy benefit from hormone therapy.
"We are learning step by step when hormonal therapy seems to be effective and when it is not," Albertsen says. "For men with relatively localized disease, we have no evidence that the additional hormonal therapy adds any value whether it is six months or three years or any permutation in between. That is because the radiation therapy may itself be sufficient."
Bolla's study -- and editorial comments by Albertsen -- appear in the June 11 issue of the New England Journal of Medicine.