Hormonal therapy options for prostate‐specific antigen‐only recurrence of prostate cancer after previous local therapy

Abstract

Prostate cancer recurrence that is detectable only by a rise in PSA level after successful local treatment for prostate cancer is a very common problem facing patients and their clinicians. Recent studies suggest that early hormonal therapy provides a survival benefit in patients with M0 disease and after RP in patients with pelvic lymph node metastases; however, the survival benefit for PSA-only recurrence has yet to be confirmed. As shown by the case histories presented here, unconventional hormonal therapy, e.g. antiandrogen monotherapy, appears to be a reasonable option. The potency-sparing potential of this approach is appealing, as is the reduced degree of other side-effects associated with traditional hormonal (castration) therapies, but the long-term efficacy in patients with early PSA-only progression is unknown. The possibility of breast symptoms during antiandrogen monotherapy may be reduced with the use of prophylactic low-dose breast irradiation. More clinical trials are needed to determine the best treatments, alone and in combination, for these patients.