Skip to main content

Advertisement

SpringerLink
Log in

Adjuvant hormone therapy after radiation or surgery for localized or locally advanced prostate cancer

  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

Prostate cancer is being diagnosed at an earlier age and earlier disease stage than previously and increasing numbers of relatively young men are receiving potentially curative radical prostatectomy or radiotherapy for early prostate cancer. Although many of these men have an excellent outcome, a significant proportion subsequently experience disease recurrence or cancer-related death. Men with unfavorable tumor characteristics at the time of radical prostatectomy or radiotherapy are particularly at high risk of experiencing disease recurrence. One strategy to improve outcome for these men is adjuvant hormone therapy (hormone therapy administered immediately after therapy of primary curative intent). Surgical castration (bilateral orchiectomy), medical castration using the luteinizing hormone-releasing hormone (LHRH) agonist goserelin, and antiandrogen monotherapy have been investigated as adjuvant hormone therapy to radical prostatectomy and radiotherapy, and each therapy has demonstrated clinical benefits because of a significant improvement in disease-free survival. Furthermore, data are available to indicate that adjuvant hormone therapy achieved by goserelin or bilateral orchiectomy improves overall survival, particularly in men at high risk of progression. Because the effects of LHRH agonists are reversible, they provide a more acceptable method of adjuvant therapy compared to bilateral orchiectomy, particularly in the adjuvant setting, and are preferred by patients. However, the adverse effects on quality of life, in particular on sexual interest and function and bone mineral density, may limit the use of LHRH agonists in some patients. However, these parameters are maintained with nonsteroidal antiandrogens. The first data from the Early Prostate Cancer program indicate that adjuvant bicalutamide 150 mg is associated with a significant improvement in progression-free survival after radical prostatectomy or radiotherapy. Gynecomastia and breast pain are the most common side effects associated with bicalutamide therapy. Medical or surgical castration in combination with an antiandrogen (combined androgen blockade) is another option for use as an adjuvant hormone therapy. However, no study has reported on the use of combined androgen blockade in this setting. Adjuvant hormone therapy provides clinicians with another treatment option for patients with early prostate cancer and unfavorable tumor characteristics.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Mettlin CJ, Murphy GP, Rosenthal DS, Menck HR: The National Cancer Data Base report on prostate carcinoma after the peak in incidence rates in the U.S. The American College of Surgeons Commission on Cancer and the American Cancer Society. Cancer 1998, 83:1679–1684.

    Article  PubMed  CAS  Google Scholar 

  2. Jemal A, Murray T, Samuels A, et al.: Cancer statistics, 2003. CA Cancer J Clin 2003, 53:5–26.

    PubMed  Google Scholar 

  3. D'Amico AV, Whittington R, Malkowicz SB, et al.: Biochemical outcome after radical prostatectomy or external beam radiation therapy for patients with clinically localized prostate carcinoma in the prostate specific antigen era. Cancer 2002, 95:281–286.

    Article  PubMed  Google Scholar 

  4. Kupelian PA, Elshaikh M, Reddy CA, et al.: Comparison of the efficacy of local therapies for localized prostate cancer in the prostate-specific antigen era: a large single- institution experience with radical prostatectomy and external-beam radiotherapy. J Clin Oncol 2002, 20:3376–3385.

    Article  PubMed  Google Scholar 

  5. Huggins C, Hodges CV: Studies on prostatic cancer: the effect of castration, of estrogen and of androgen injection on serum phosphatases in metastatic carcinoma of the prostate. Cancer Res 1941, 1:293–297.

    CAS  Google Scholar 

  6. Pollack A, Zagars GK, Kopplin S: Radiotherapy and androgen ablation for clinically localized high-risk prostate cancer. Int J Radiat Oncol Biol Phys 1995, 32:13–20.

    Article  PubMed  CAS  Google Scholar 

  7. Kirby R: Treatment options for early prostate cancer. Urology 1998, 52:948–962.

    Article  PubMed  CAS  Google Scholar 

  8. Ross RW, Small EJ: Osteoporosis in men treated with androgen deprivation therapy for prostate cancer. J Urol 2002, 167:1952–1956.

    Article  PubMed  CAS  Google Scholar 

  9. Green HJ, Pakenham KI, Headley BC, et al.: Altered cognitive function in men treated for prostate cancer with luteinizing hormone-releasing hormone analogues and cyproterone acetate: a randomized controlled trial. BJU Int 2002, 90:427–432.

    Article  PubMed  CAS  Google Scholar 

  10. Fonseca R, Rajkumar SV, White WL, et al.: Anemia after orchiectomy. Am J Hematol 1998, 59:230–233.

    Article  PubMed  CAS  Google Scholar 

  11. Basaria S, Lieb J, Tang AM, et al.: Long-term effects of androgen deprivation therapy in prostate cancer patients. Clin Endocrinol (Oxf) 2002, 56:779–786.

    Article  CAS  Google Scholar 

  12. Granfors T, Modig H, Damber JE, Tomic R: Combined orchiectomy and external radiotherapy versus radiotherapy alone for nonmetastatic prostate cancer with or without pelvic lymph node involvement: a prospective randomized study. J Urol 1998, 159:2030–2034.

    Article  PubMed  CAS  Google Scholar 

  13. Messing EM, Manola J, Sarosdy M, et al.: Immediate hormonal therapy compared with observation after radical prostatectomy and pelvic lymphadenectomy in men with node-positive prostate cancer. N Engl J Med 1999, 341:1781–1788. This trial showed that adjuvant hormone therapy achieved by bilateral orchiectomy or the LHRH agonist goserelin significantly improves disease-free and overall survival after radical prostatectomy in patients with node-positive prostate cancer.

    Article  PubMed  CAS  Google Scholar 

  14. Bolla M, Collette L, Blank L, et al.: Long-term results with immediate androgen suppression and external irradiation in patients with locally advanced prostate cancer (an EORTC study): a phase III randomised trial. Lancet 2002, 360:103–108. A clinical trial showing that adjuvant therapy with the LHRH agonist goserelin, administered for 3 years after external irradiation, improves disease-free and overall survival in patients with locally advanced prostate cancer.

    Article  PubMed  CAS  Google Scholar 

  15. Cassileth BR, Soloway MS, Vogelzang NJ, et al.: Patients' choice of treatment in stage D prostate cancer. Urology 1989, 33(Suppl):57–62.

    Article  PubMed  CAS  Google Scholar 

  16. Bruchovsky N, Goldenberg SL, Akakura K, Rennie PS: Luteinizing hormone-releasing hormone agonists in prostate cancer. Elimination of flare reaction by pretreatment with cyproterone acetate and low-dose diethylstilbestrol. Cancer 1993, 72:1685–1691.

    Article  PubMed  CAS  Google Scholar 

  17. Vogelzang NJ, Chodak GW, Soloway MS, et al.: Goserelin versus orchiectomy in the treatment of advanced prostate cancer: final results of a randomized trial. Urology 1995, 46:220–226.

    Article  PubMed  CAS  Google Scholar 

  18. Prayer-Galetti T, Zattoni F, Capizzi A, et al.: Disease free survival in patients with pathological "C stage" prostate cancer at radical retropubic prostatectomy submitted to adjuvant hormonal treatment. Eur Urol 2000, 38:504.

    Google Scholar 

  19. Lawton CA, Winter K, Murray K, et al.: Updated results of the phase III Radiation Therapy Oncology Group (RTOG) trial 85-31 evaluating the potential benefit of androgen suppression following standard radiation therapy for unfavorable prognosis carcinoma of the prostate. Int J Radiat Oncol Biol Phys 2001, 49:937–946. A clinical trial showing that long-term therapy with the LHRH agonist goserelin after external irradiation improves diseasefree survival in patients with locally advanced prostate cancer. For patients who did not undergo radical prostatectomy and who had a Gleason score of 8 to 10, adjuvant goserelin significantly improved overall and cause-specific survival.

    Article  PubMed  CAS  Google Scholar 

  20. Hanks GE, Lu J, Machtay V, et al.: RTOG protocol 92-02: a phase III trial of the use of long term androgen suppression following neoadjuvant hormonal cytoreduction and radiotherapy in locally advanced carcinoma of the prostate [abstract]. Proc Am Soc Clin Oncol 2000, 19:327a.

    Google Scholar 

  21. Pilepich MV, Caplan R, Byhardt RW, et al.: Phase III trial of androgen suppression using goserelin in unfavorable- prognosis carcinoma of the prostate treated with definitive radiotherapy: report of Radiation Therapy Oncology Group protocol 85-31. J Clin Oncol 1997, 15:1013–1021.

    PubMed  CAS  Google Scholar 

  22. Bolla M, Gonzalez D, Warde P, 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  PubMed  CAS  Google Scholar 

  23. Neymark N, Adriaenssen I, Gorlia T, et al.: Cost effectiveness of the addition of early hormonal therapy in locally advanced prostate cancer: results decisively determined by the cut-off time-point chosen for the analysis. Eur J Cancer 2001, 37:1768–1774.

    Article  PubMed  CAS  Google Scholar 

  24. Persad R: Leuprorelin acetate in prostate cancer: a European update. Int J Clin Pract 2002, 56:389–396.

    PubMed  CAS  Google Scholar 

  25. Parmar H, Edwards L, Phillips RH, et al.: Orchiectomy versus long-acting D-Trp-6-LHRH in advanced prostatic cancer. Br J Urol 1987, 59:248–254.

    PubMed  CAS  Google Scholar 

  26. Brogden RN, Chrisp P: Flutamide: a review of its pharmacodynamic and pharmacokinetic properties and therapeutic use in advanced prostatic cancer. Drugs Aging 1991, 1:104–115.

    PubMed  CAS  Google Scholar 

  27. Schröder FH, Collette L, De Reijke TM, et al.: Prostate cancer treated by anti-androgens: is sexual function preserved? Br J Cancer 2000, 82:283–290.

    Article  PubMed  Google Scholar 

  28. Gillatt DA, Bolton CH, Chadwick D, et al.: Lipoprotein levels following treatment with cyproterone acetate or LHRH analogues. Br J Urol 1993, 71:728–730.

    PubMed  CAS  Google Scholar 

  29. de Voogt HJ, Smith PH, Pavone-Macaluso M, et al.: Cardiovascular side effects of diethylstilbestrol, cyproterone acetate, medroxyprogesterone acetate and estramustine phosphate used for the treatment of advanced prostatic cancer: results from European Organization for Research on Treatment of Cancer trials 30761 and 30762. J Urol 1986, 135:303–307.

    PubMed  Google Scholar 

  30. Pinganaud G, Chaslerie A, Bourdel Marchasson I, et al.: Cyproterone-induced hepatotoxicity. Ann Pharmacother 1995, 29:634.

    PubMed  CAS  Google Scholar 

  31. Kolvenbag GJ, Iversen P, Newling DW: Antiandrogen monotherapy: a new form of treatment for patients with prostate cancer. Urology 2001, 58(Suppl 2A):16–23.

    Article  PubMed  CAS  Google Scholar 

  32. Iversen P, Tyrrell CJ, Kaisary AV, 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  PubMed  CAS  Google Scholar 

  33. McLeod DG: Tolerability of nonsteroidal antiandrogens in the treatment of advanced prostate cancer. Oncologist 1997, 2:18–27.

    PubMed  CAS  Google Scholar 

  34. See WA, Wirth MP, McLeod DG, et al.: Bicalutamide as immediate therapy either alone or as adjuvant to standard care of patients with localized or locally advanced prostate cancer: first analysis of the Early Prostate Cancer program. J Urol 2002, 168:429–435. This is the first report of the Early Prostate Cancer program involving bicalutamide 150 mg, the largest treatment program in early prostate cancer. At this first analysis, adjuvant bicalutamide 150 mg after radical prostatectomy or radiotherapy significantly reduced the risk of objective disease progression in men with localized or locally advanced prostate cancer.

    Article  PubMed  CAS  Google Scholar 

  35. See W, McLeod D, Iversen P, Wirth M: The bicalutamide Early Prostate Cancer program: demography. Urol Oncol 2001, 6:43–47.

    Article  PubMed  Google Scholar 

  36. See W, Wirth M, McLeod D, et al.: Immediate treatment with bicalutamide reduces the risk of disease progression in early non-metastatic prostate cancer irrespective of primary therapy. Eur Urol Suppl 2002, 1:136.

    Article  Google Scholar 

  37. Wirth M, Frohmüller H, Marx F, et al.: Randomized multicenter trial on adjuvant flutamide therapy in locally advanced prostate cancer after radical surgery: interim analysis of treatment effect and prognostic factors [abstract]. Br J Urol 1997, 80(Suppl 2):1033a.

    Google Scholar 

  38. Wirth M, Froehner M: A review of studies of hormonal adjuvant therapy in prostate cancer. Eur Urol 1999, 36(Suppl 2):14–19.

    Article  PubMed  CAS  Google Scholar 

  39. Tyrell C, Morris T, Carroll K: Prophylactic breast irradiation significantly reduces the incidence of bicalutamide- induced gynaecomastia. Eur Urol 2002, 1:136.

    Google Scholar 

  40. Saltzstein D, Cantwell A, Sieber P, et al.: Prophylactic tamoxifen significantly reduces the incidence of bicalutamide-induced gynaecomastia and breast pain. BJU Int 2002, 90(Suppl 2):120–121.

    Google Scholar 

  41. Decensi AU, Boccardo F, Guarneri D, et al.: Monotherapy with nilutamide, a pure nonsteroidal antiandrogen, in untreated patients with metastatic carcinoma of the prostate. J Urol 1991, 146:377–381.

    PubMed  CAS  Google Scholar 

  42. Schmitt B, Wilt TJ, Schellhammer PF, et al.: Combined androgen blockade with nonsteroidal antiandrogens for advanced prostate cancer: a systematic review. Urology 2001, 57:727–732.

    Article  PubMed  CAS  Google Scholar 

  43. Klotz L: Combined androgen blockade in prostate cancer: meta-analyses and associated issues. BJU Int 2001, 87:806–813.

    Article  PubMed  CAS  Google Scholar 

  44. Trachtenberg J, Gittleman M, Steidle C, et al.: A phase 3 multicenter open label randomized study of abarelix versus leuprolide plus daily antiandrogen in men with prostate cancer. J Urol 2002, 167:1670–1674.

    Article  PubMed  CAS  Google Scholar 

  45. Byar DP, Corle DK: Hormone therapy for prostate cancer: results of the Veterans Administration Cooperative Urological Research Group studies. NCI Monogr 1988, 7:165–170.

    PubMed  Google Scholar 

  46. Hedlund PO, Henriksson P: Parenteral estrogen versus total androgen ablation in the treatment of advanced prostate carcinoma: effects on overall survival and cardiovascular mortality. Urology 2000, 55:328–333.

    Article  PubMed  CAS  Google Scholar 

  47. Ockrim JL, Lalani EN, Laniado ME, et al.: Transdermal estrogen therapy for advanced prostate cancer: forward to the past? J Urol 2002, 167:175.

    Google Scholar 

  48. Waymont B, Lynch TH, Dunn JA, et al.: Phase III randomised study of zoladex versus stilboestrol in the treatment of advanced prostate cancer. Br J Urol 1992, 69:614–620.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Urology, Medical College of Wisconsin, Froedtert Memorial Lutheran Hospital, 9200 West Wisconsin Avenue, 53226, Milwaukee, WI, USA

    William A. See MD

Authors
  1. William A. See MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

See, W.A. Adjuvant hormone therapy after radiation or surgery for localized or locally advanced prostate cancer. Curr. Treat. Options in Oncol. 4, 351–362 (2003). https://doi.org/10.1007/s11864-003-0036-5

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11864-003-0036-5

Keywords

Search

Navigation