Posted by Medivizor on Feb 16, 2015 in Prostate cancer |
In a nutshell
The authors reviewed the effect of androgen deprivation therapy in treating patients with advanced prostate cancer.
Some background
Androgen deprivation therapy (ADT) is a form of hormone treatment that targets the male sex hormones involved in prostate cancer, such as testosterone. ADT is the standard treatment for cancer that has spread outside of the prostate.
Androgen annihilation is a second round of ADT used to kill cancer cells that remain after initial ADT or previous cancer treatments have failed. This usually involves using a number of testosterone-targeting drugs simultaneously (normally up to three drugs).
Methods & findings
The aim of this study was to review standard and more complete ADT treatment and its effect in treating prostate cancer patients.
Results from a phase III trial comparing continuous ADT and infrequent ADT showed that overall survival rates (time from treatment that patients diagnosed with prostate cancer are still alive) and cancer-specific mortality rates (patients who did not die from prostate cancer following treatment) were similar across both patient groups. In another study, 52 patients who experienced a failed radical prostatectomy (surgical removal of the prostate) who then underwent ADT all achieved undetectable levels of prostate specific antigen (PSA- protein elevated in the blood in prostate cancer) following treatment, with 9 patients maintaining undetectable levels after 62 months.
These findings led the authors to suggest that ADT should be initiated at the eariest possible time when tumor load (the amount of cancer cells present) is lowest.
A study found that abarelix (Plenaxis – drug that quickly lowers testosterone levels) lowered testosterone levels more rapidly when administered alone than when used in combination with an antiandrogen (e.g. Casodex, Megace), but both treatments had similar effects on maintaining low PSA levels and low testosterone levels.
In a study of 22 patients with cancer that had moved out of the prostate gland or moved to the lymp nodes treated with a combination of finasteride (Fintex/Proscar/Propecia) and flutamide (Eulexin/Flutamin/Cytomid) (drugs that counteract the effect of testosterone), 21 patients experienced reduced PSA levels from 42.9ng/ml to 3.6ng/ml after 3 months while sexual function was maintained in 86% of patients.
Patients treated with a combination of abiraterone (Zytiga) and prednisone (Deltasone, Liquid Pred) had an average overall survival of 14.8 months compared to patients who were given a placebo (fake drug substituted for the real drug being tested) and prednisone who achieved an average overall survival 10.9 months. Patients who took abiraterone and prednisone had longer time periods from treatment until PSA levels increased (10.2 months) compared to placebo (6.6 months). These patients also had a better PSA response to treatment (29%) compared to placebo (6%) and had a longer progression-free survival time (time from treatment that the cancer does not progress; 5.6 months) compared to placebo (3.6 months).
The bottom line
The authors concluded that early application of androgen annihilation may reduce tumor burden and have positive outcomes in men who have experienced failed local treatments.
The fine print
The full effect of androgen annihilation on patient health is still unknown and side-effects may be more severe than normal androgen deprivation therapy.
What’s next?
If you are considering androgen deprivation therapy please consult your doctor for information on potential side effects and health concerns.
Original Title :
Concept and viability of androgen annihilation for advanced prostate cancer.
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