Long-Term Hormonal Therapy: Who Would Benefit?

Abstract

Traditionally, the role of hormonal therapy (HT) for prostate cancer (PCa) has been the palliative treatment of advanced and metastatic disease. Recently, advances in the development of androgen-deprivation therapy (ADT) with luteinising hormone-releasing hormone (LHRH) agonists have made LHRH agonists the standard of care for 90% of men with advanced or metastatic PCa. Although the role of ADT is historically well defined, recent studies demonstrate that the treatment of advanced or metastatic PCa with ADT can be tailored to the needs of the patient. This may be achieved by the immediate or deferred initiation of ADT (orchiectomy or LHRH agonist treatment) depending upon the nature of the disease and the patient's age. Patients who are likely to die of non-PCa-related causes prior to an indication for treatment initiation, for example, may benefit from deferred treatment, which may spare them the burden of treatment-related adverse events. In contrast, patients who are likely to die of PCa-related causes may benefit from immediate treatment because this option may delay disease progression and reduce symptom burden. Additionally, recent studies have shown that prognostic disease markers such as prostate-specific antigen (PSA) and PSA doubling time (PSA DT) can be used as indicators of who may receive the greatest benefit from treatment. Patients with a high baseline PSA level or a short PSA DT (markers of aggressive and/or advanced disease), for example, are more likely to die of disease-related causes than patients with low baseline PSA levels or long PSA DT. Furthermore, recent studies have shown that HT may be used successfully in adjuvant settings for patients in earlier stages of the disease and/or who require radical treatment. This paper reviews which patients can benefit from HT in terms of treatment timing, baseline prognostic indicators, disease stage, and adjuvant use.