Withdrawal of LHRH therapy in selected prostate cancer patients

Abstract

4763 Background: LHRH agonists therapy was discontinued after achieving complete response in 61 selected prostate cancer patients. Patients were then followed clinically and serum PSA level was obtained periodically. Treatment was restarted if disease activity was evident and considered significant by doctor or patient. Methods: In a retrospective analysis the withdrawal period was correlated with clinical disease parameters. Results: The median patient’s age was 77 years (55–92). All patients had non metastatic prostate cancer, 67% had Gleason =< 6, 22% Gleason 7 and 11% Gleason 8–10 disease. 72% had hormonal therapy as their first treatment and 28% failed after radical prostatectomy or radiotherapy. They had LHRH agonists therapy for 7–86 months (median 23) and the median serum PSA level was 0.04 ng/ml (0.01–2.61) when treatment was withdrawn. The median length of the withdrawal period was 28 months (7–72+).It correlated with LHRH agonists therapy period being 21 months (7–72) in patients treated for less than two years and 28 months (9–66+) in patients treated more than two years. Patients with Gleason score =< 6 disease had longer withdrawal period, (median 28 months, 7–72+) than those with Gleason score 7–10, (median 21 months, 5–66). No correlation was found between the length of withdrawal period and patient’s age. LHRH agonists treatment was restarted in 34 patients after median withdrawal of 16 months (7–57) at a median PSA level of 6.4 ng/ml (0.65–20.8). All patients responded to the secondary hormonal manipulation with secondary serum PSA level decrease. Conclusions: We concluded that LHRH agonists therapy withdrawal in prostate cancer patients in complete response is possible and safe. Patients with prolonged therapy (> two years) and Gleason score =< 6 are more likely to benefit from longer withdrawal period. No significant financial relationships to disclose.