Is there any reason to continue hormone therapy (ADT) while I have become castrate resistant and I’m starting chemotherapy? This is a common question that is asked by many of us.
The real underlying question we are asking is: I feel so terrible now and I am getting ready to add chemotherapy with all of its potential side effects, why do I have to also continue to feel terrible from ADT?
Standard care usually continues ADT along with chemotherapy, but is there really a benefit? Can we give someone a break and save some money by stopping ADT?
A 78 man retrospective review was performed at the Asian Medical Center, University of Ulsan College of Medicine, Seoul, Korea. The goal of the study was to assess the impact of continued ADT in men with castration-resistant prostate cancer (CRPC) receiving first-line docetaxel-based chemotherapy.
Thirty-nine men received concurrent ADT (ADT group), while 39 men discontinued ADT (No-ADT group).
1- PSA response rates were 66.7% for ADT patients and 48.7% for No-ADT patients (P = 0.27).
2- The median progression-free survival and overall survival were 5.0 months and 24.8 months for ADT patients and 4.9 months and 22.1 months for No-ADT patients, respectively (P = 0.57, P = 0.94).
3- Follow-up testosterone levels were available in 13 men of the No-ADT group and none of them recovered a normal serum testosterone level over a median follow-up duration of 8.3 months from ADT discontinuation.
4- ADT was recommenced in 21 of 39 men in the No-ADT group and, of these, 6 (29%) achieved a PSA response.
Clinical outcomes were not significantly different when men with CRPC received concurrent ADT, or were not so treated, when receiving first-line docetaxel-based chemotherapy.
Despite ADT withdrawal, serum testosterone level did not recover to the non-castrated level during the period of chemotherapy, and re-induction of hormone sensitivity occurred in about one-quarter of the men.
Reference: Am J Clin Oncol. 2010 Aug 3. Epub ahead of print. Lee JL, Eun Kim J, Ahn JH, Lee DH, Lee J, Kim CS, Hyuk Hong J, Hong B, Song C, Ahn H
Joel T Nowak, M.A., M.S.W.