Despite the fact that we have had good research for well over 15 years that show that early hormone therapy increases over all survival, some doctors still insist on delaying the start of hormone therapy.
A UK randomized trial done in 1997 demonstrated a slight impact of immediate versus deferred hormone suppression in advanced prostate cancer. In this trial the majority of patients had locally advanced disease (55%) at the time of randomization. Men assigned to the deferred treatment group were started on hormone therapy when clinically significant progression occurred.
All events occurred more rapidly in the deferred treatment group including :
Progression from M0 to M1 disease
Development of pain
The need of transuretheral resection from local progression
Spinal cord compression
Development of visceral metastases
Despite this research and other similar studies some doctors recommend a delay to the start of hormone therapy. I understand a man deciding to delay with the goal of extending the quality of their life, but it should be the man making this decision, not the doctor.
Make sure you tell your doctor that you are the captain of your healthcare. Your doctor should be your navigator and first mate, but you are the captain.
The Medical Research Council Prostate Cancer Working Party
Investigators Group. Immediate versus deferred treatment for
advanced prostatic cancer: initial results of the Medical Research
Council Trial. Br J Urol 1997; 79: 235–246.
Joel T Nowak, M.A., M.S.W.