When is Hormone Therapy Used for Prostate Cancer

Farshid Dayyani: Hormone therapy is highly effective and used in all stages of prostate cancer. By hormone therapy, we actually mean antihormonal therapy or reducing the serum testosterone levels. This is highly effective in controlling the growth and progression of prostate cancer cells in early stage as well as advanced stage. So, let's review the indication and use of this therapy for each stage. In localized prostate cancer, meaning prostate cancer that has not spread to other organs. The treatment options include observation of the patients with very low risk disease, radical prostatectomy, or radiation therapy. There are clinical factors that try to predict the risk for this patient to have a recurrence of his cancer after local therapy. Those include a so called Gleason score, the serum PSA level and the size or clinical stage of the tumor at diagnosis. Based on those criteria, we classify patients in low risk, intermediate risk, and higher risk. This is important because if the patient chooses to undergo radiation therapy for an intermediate risk disease, it is recommended to combine the radiation with six-month of hormone deprivation therapy. In big trials, we have seen that patients live longer if they receive six-month of hormone therapy in addition to radiation compared to radiation alone. If the patient is higher risk, for example with a PSA greater than 20 or a Gleason score of 8 or greater and he chooses to undergo radiation then the combination with hormone therapy should be significantly longer. We know that three years of hormone deprivation is superior to six month of hormone deprivation in higher risk patients, but given the scientifics of hormone deprivation, the new trials are tying to see whether we can come down to two years. In the more advanced prostate cancer, meaning when the cancer has spread to other organs, the first line of therapy is actually to reduce the patient's testosterone level with hormone deprivation therapy. More than 8 or 9 out of 10 patients will benefit upfront from this treatment, the pain will get better, the lymph nodes will shrink, and the PSA will come down. Unfortunately, this will last only on an average for 18 to 24 months before other treatments have to be added to that modality. Some prostate cancers are high risk, aggressive, and more likely to spread. Others are low risk, least likely to have bad outcomes. The biopsy says cancer, but current diagnostic tools provide limited information about how aggressive a man's individual disease is, so most men decide to treat prostate cancer immediately. Once treated, many men experience serious long-term side effects like incontinence and *** impotence. Immediate treatment is not always needed, but right now a man can't be sure if his cancer is the kind that is likely to require treatment or if he is okay to wait for now. What if there was a test that could determine how aggressive prostate cancer is. Genomic health is developing a new test to do just that. By reviewing the underlying biology of the tumor and using genes from multiple biologic pathways, the test can predict the aggressiveness of prostate cancer when diagnosed, allowing a man to make a more informed treatment decision with confidence, taking care of himself with more information and greater peace of mind.