Dec. 8, 1999 (Baltimore) -- Men with prostate cancer that has spread to the lymph nodes may benefit from castration (depriving the body of testosterone) by drugs or surgery, says a study in the Dec. 8 issue of TheNew England Journal of Medicine. "The use and timing of hormonal therapy in men with prostate cancer have been a subject of considerable debate for many years," Edward Messing, MD, tells WebMD in an interview.
"Our study shows that in a very specific group of men, early hormonal therapy is beneficial," Messing says. Messing is professor of urology at the University of Rochester Medical Center in New York and the lead author of the study.
Patrick Walsh, MD, professor of urology at Johns Hopkins University and author of an editorial accompanying the article, is not so sure. In an interview with WebMD, he says, "The side effects of [anti-testosterone therapy] can be quite devastating. "These can include weight gain, loss of muscle mass, impotence, and decreased [mental abilities]. We must be quite sure of the benefits of such therapy before we begin it, and this study suggests an advantage, but the conclusion is not definitive." Messing says the side effects experienced by men in his study were minimal.
The men in this study had prostate cancer that had spread only to the lymph nodes around the gland. After undergoing surgical removal of the prostate and surrounding lymph nodes, the men were assigned to one of two groups. The first group received either monthly injections of a drug to block the production of testosterone in the body (called "chemical castration") or underwent surgical castration. Both procedures significantly decrease the amount of testosterone in the body, thus removing one of the main factors that stimulates prostate cancer to grow. The second group was watched and examined on a regular basis for recurrence of prostate cancer.
After seven years following removal of the prostate, 77% of the treatment group and 18% of the observation group were alive and had no evidence of recurrence of their prostate cancer. There was no difference between the men who underwent chemical vs. surgical castration.
Walsh expresses concern that the number of men enrolled in the study was rather small, and that one very important indicator of how advanced prostate cancer is, called a Gleason score, was not done by all in one place. "The use of hormonal therapy in men with prostate cancer is a very important question," he says. "Now that we're picking up so many men so much earlier in their disease, it may take some time before we have the answer."
- In men with prostate cancer that has only spread to local lymph nodes, immediate treatment with chemical or surgical castration decreased cancer recurrence and improved survival.
- Hormonal therapy included either injections of a drug or removal of the testicles, and both types of treatment were equally effective.
- One expert is unconvinced by the benefits of early hormone treatment due to the side effects.