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Timing and choice of androgen ablation

Prostate Cancer and Prostatic Diseases volume 7, pages 217–222 (2004)Cite this article

Abstract

Hormone therapy remains central to the management of advanced prostate cancer. Evidence has accrued to suggest benefits from earlier treatment. Trials which demonstrate significant improvements in disease-specific survival may be underpowered to show overall survival benefits, due to the effect of mortality from unrelated causes. Toxicity, particularly the risk of osteoporosis, causes increasing concern, particularly where many years of use may be contemplated as in early relapse after curative treatment. Strategies to reduce toxicity include use different drugs, notably antiandrogens and with renewed interest in oestrogens in low dose or administered parenterally, and deferred and intermittent treatment. Further improvements in drug development, reducing toxicity, and identification of the cause of hormone refractory disease and its prevention would revolutionise the use of hormone therapy. Currently, deferred treatment, used selectively and with careful follow-up, remains an option for selected patients.

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References

  1. Rabbini F, Gleave ME . Treatment of metastatic prostate cancer: endocrine therapy. In: Hamdy FC, Basler JW, Neal DE, Catalona WJ (eds.) Management of Urologic Malignancies, Churchill Livingstone, Edinburgh, 2002; pp. 210–226.

  2. Medical Research Council Prostate Cancer Working Party Investigators Group. Immediate versus deferred treatment for advanced prostatic cancer: initial results of the Medical Research Council Trial. Br J Urol 1997; 79: 235–246.

  3. Bolla M et al. Improved survival in patients with locally advanced prostate cancer treated with radiotherapy and goserelin. N Engl J Med 1997; 337: 295–300.

    Article  CAS  Google Scholar 

  4. Nelson JB, Lepor H . Prostate cancer: radical prostatectomy. In follow-up strategies and management in urologic oncology Urol Clin N Am 2003; 30: 703–723.

    Google Scholar 

  5. See WA et al. Bicalutamide as immediate therapy either alone or as adjuvant to standard care of patients with localised or locally advanced prostate cancer: first analysis of the early prostate cancer program. J Urol 2002; 168: 429–435.

    Article  CAS  Google Scholar 

  6. Schröder FH . Endocrine treatment of prostate cancer—recent developments and the future. Part 1: maximal androgen blockade. Early vs delayed endocrine treatment and side effects. Br J Urol Int 1999; 83, (European Urology Update Series) 161–170.

    Article  Google Scholar 

  7. Holberg L et al. A randomised trial comparing radical prostatectomy with watchful waiting in early prostate cancer. N Engl J Med 2002; 247: 781–789.

    Article  Google Scholar 

  8. Prostate Cancer Trialist's Collaborative Group. Meta-analysis of trials of immediate versus deferred hormone therapy in prostate cancer (unpublished data)..

  9. Soloway MS et al. Zoladex versus orchiectomy in treatment of advanced prostate cancer: a randomised trial. Urology 1991; 37: 46–51.

    Article  CAS  Google Scholar 

  10. Kaisary AV et al. Comparison of LHRH analogue (Zoladex) with orchiectomy in patients with metastatic prostate cancer. Br J Urol 1991; 67: 502–508.

    Article  CAS  Google Scholar 

  11. Botto H, Richard F, Mathieu F, Camey M . Decapeptyl in the treatment of metastatic prostatic cancer. Comparative study with pulpectomy. In: Prostate Cancer, Part A: Research, Endocrine Treatment, and Histopathology. Alan R Liss, Inc, 1987; pp. 199–296.

    Google Scholar 

  12. The Leuprolide Study Group. Leuprolide vs diethylstilbestrol for metastatic prostate cancer. N Engl J Med 1984; 311: 1281–1286.

  13. Mahler C . Is disease flare a problem? Cancer 1993; 72: 3799–3802.

    Article  CAS  Google Scholar 

  14. Ellis WJ, Grayhack JT . Sexual function in aging males after orchiectomy and estrogen therapy. J Urol 1963; 89: 895–899.

    Article  Google Scholar 

  15. Radlmier A, Bormacher K, Neumann F . Hot flushes: mechanism and prevention. Prog Clin Biol Res 1990; 359: 131–140.

    Google Scholar 

  16. Morley JE, Kaiser FE, Hajjar R, Perr III HM . Testosterone and frailty. Clin Geriat Med 1997; 13: 655–695.

    Article  Google Scholar 

  17. Gardiner RA et al. Cognition and hormonal manipulation in prostate cancer. Br J Urol Int 2000; 86 (Suppl 3): 218–219.

    Google Scholar 

  18. Daniell HW . Osteoporosis after orchiectomy for prostate cancer. J Urol 1997; 157: 439–444.

    Article  CAS  Google Scholar 

  19. Hamdy NAT . The use of bisphosphonates in prostate carcinoma metastatic to the skeleton. In: Hamdy FC, Basler JW, Neal DE, Catalona WJ (eds). Management of Urologic Malignancies. Churchill Livingstone, Edinburgh, 2002; pp. 244–248.

    Google Scholar 

  20. Goldenberg SL, Bruckovsky N . Use of cyproterone acetate in prostate cancer. Urol Clin N Am 1991; 18: 111–122.

    CAS  Google Scholar 

  21. Iversen P et al. Bicalutamide monotherapy compared with castration in patients with nonmetastatic locally advanced prostate cancer: 6.3 years of follow up. J Urol 2000; 164: 1579–1582.

    Article  CAS  Google Scholar 

  22. Byar DP . The Veterans Administration Cooperative Research Group's studies of cancer of the prostate. Cancer 1973; 32: 1126–1130.

    Article  CAS  Google Scholar 

  23. Bishop MC . Experience with low-dose oestrogen in the treatment of advanced prostate cancer: a personal view. Br J Urol 1996; 78: 921–928.

    Article  CAS  Google Scholar 

  24. Carlstrom K et al. Possible bone-preserving capacity of high dose intramuscular depot oestrogen as compared to orchiectomy in the treatment of patients with prostatic carcinoma. The Prostate 1997; 31: 193–197.

    Article  CAS  Google Scholar 

  25. Hedlund PO et al. Parenteral oestrogen versus combined androgen deprivation in the treatment of metastatic prostate cancer. Scand J Urol Nephrol 2002; 36: 405–413.

    Article  CAS  Google Scholar 

  26. Ockrim JL et al. Transdermal estradiol therapy for advanced prostate cancer—forward to past? J Urol 2003; 169: 1735–1737.

    Article  CAS  Google Scholar 

  27. Prostate Cancer Trialists' Collaborative Group. Maximum androgen blockade in advanced prostate cancer: an overview of the randomised trials. Lancet 2000; 355: 1491–1498.

  28. Goldenberg SL et al. Intermittent androgen suppression in the treatment of prostate cancer: a preliminary report. Urology 1995; 45: 839–844.

    Article  CAS  Google Scholar 

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  1. Gartnavel General Hospital, Glasgow, UK

    D Kirk

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  1. D Kirk
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Kirk, D. Timing and choice of androgen ablation. Prostate Cancer Prostatic Dis 7, 217–222 (2004). https://doi.org/10.1038/sj.pcan.4500733

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