A Small study suggests that alternating testosterone levels may make hormonal therapy work longer

A recent very small study was published that might lend a new light on hormone therapy for advanced prostate cancer, Bipolar ADT. This study suggests that a new treatment strategy might be effective where men alternate between low and high levels of testosterone to make prostate tumors more responsive to standard hormonal therapy (ADT).

We know that the primary treatment for advanced prostate cancer is hormonal therapy, which lowers levels of testosterone to control tumor growth. Inevitably, over some time period ADT fails as the prostate cancer cells devise methods to continue their growth in the low testosterone environment.

This Bipolar strategy forces the tumor to respond again to higher testosterone levels, helping to reverse its resistance to standard therapy, the researchers say.
If confirmed in additional larger clinical trials this protocol could change the face of how ADT is delivered as well as extend the life of ADT

A note of caution was provided by Dr. Michael Schweizer, an assistant professor of oncology at the University of Washington School of Medicine in Seattle. He said that “It needs to be stressed that bipolar androgen therapy is not ready for adoption into routine clinical practice, since these studies have not been completed.”

In the study 16 men with hormone therapy-resistant prostate cancer received bipolar androgen therapy. Of these men, seven had their cancer go into remission, in four men their tumors shrank, and in one man the tumors disappeared completely.

Additionally, “50 percent of the men in the study had declines in their prostate specific antigen (PSA) and 50 percent had shrinkage of their cancer tumors.

Senior study author Dr. Samuel Denmeade, co-director of the prostate cancer program at Johns Hopkins University in Baltimore, believes this new approach has benefits beyond its effect on the prostate cancer cells. The said that restoring a man’s testosterone levels also reduced the side effects of hormone therapy, which include mood swings, hot flashes, impotence and possible coronary effects.

“For the most part, men said they felt great,” Denmeade said. “Most of the men felt like they had more energy. Men on hormone treatment who couldn’t have sex could have sex again, so they were very happy about that.”

This treatment is not a cure, but a way to make men feel better and extend the time standard hormonal therapy remains effective. “Maybe men will live longer, but we don’t know that yet,” he said.
He also said that Bipolar androgen therapy is probably not for “men who have not

[yet] had any treatment for prostate cancer.” Moreover, the long-term effects or dangers of the therapy aren’t yet known, he said. Only longer, larger trials will help uncover any risks associated with the treatment.

Some detractors to this protocol have expressed concern that alternating testosterone levels could actually shorten men’s life. “A cancer cell could escape and grow, as happened in breast cancer when this method was tried with estrogen, causing early death,” said Dr. Anthony D’Amico, chief of radiation oncology at Brigham and Women’s Hospital in Boston.

SOURCES: Michael Schweizer, M.D., assistant professor, oncology, University of Washington School of Medicine, Seattle; Samuel Denmeade, M.D., co-director, prostate cancer program, Johns Hopkins University, Baltimore; Anthony D’Amico, M.D., Ph.D., chief, radiation oncology, Brigham and Women’s Hospital, Boston; Jan. 7, 2015, Science Translational Medicine

The report was published Jan. 7 in the journal Science Translational Medicine.