Can short-term hormone therapy pinpoint patients who need surgery?

This study investigated the impact of 3 months of androgen deprivation therapy (ADT) in a group of low-risk prostate cancer patients.

For patients with low-risk localized prostate cancer (has not spread beyond the prostate), treatment is not recommended but the patient is carefully monitored for any changes in the cancer.

ADT involves either surgical castration (surgical removal of the testicles) or medical castration (hormonal therapy). The treatment is intended to reduce the production of androgens (male sex hormones such as testosterone), or inhibit their effect on cancer cell growth. It has been suggested that short-term hormonal ADT could help prevent cancer growth, and could help pinpoint low-risk patients who would benefit from surgical removal of the prostate (radical prostatectomy).

This study included 98 men with low-risk localized cancer. All the patients were treated with short-term ADT: leuprolide acetate (Eligard, Lupron Depot) for 3 months and bicalutamide (Casodex) for 15 days. Some adverse events (unfavorable symptoms or disease that may or may not be considered related to the medical treatment) occurred during the treatment. The most common adverse events included hot flashes (49%), weakness (40%), and loss of libido (84%).

At the one year follow-up, prostate biopsies (tissue removed from a living body to discover the presence or extent of cancer) were analyzed. No cancer was found in 46% of the patients (negative biopsy), but cancer was found in the other 54% of patients (positive biopsy). All patients with a positive biopsy result underwent curative surgery: removal of the prostate. Patients with a negative biopsy continued to be monitored for cancer growth.

The authors conclude that short term ADT is useful for pinpointing patients who would benefit from surgical removal of the prostate.

Short-term ADT therapy appears decrease cancer growth, but longer follow-up time would be needed to confirm this. This treatment strategy is still investigational and the authors highlight that it should not be used outside a clinical trial.