So how long does it usually take for men undergoing hormone therapy (ADT) to progress from being hormone dependent to hormone independent? Clearly, we should always remember that this is a very individual, case-by-case time. However, there was a recent time analysis published in the February 2009 edition of Urology.
These researchers found that after an average of 18-24 months under ADT, almost all patients with advanced or recurrent prostate cancer show uncontrolled PSA progression despite their therapy. They also found that at this hormone-independent stage, a PSA regression can be achieved by secondary hormonal manipulation in approximately 50% of men for an additional 6-12 months before they become truly hormone-refractory.
They also pointed out that after PSA progression under complete androgen ablation, in 40% of cases a temporary additional regression can be achieved by discontinuing of the anti-androgen drugs. The administration of an alternative anti-androgen results in a PSA decrease in 80% of the patients responding to anti-androgen deprivation. Inhibition of the adrenal testosterone synthesis by oral administration of ketoconazol (secondary hormone blockade) can further delay disease progression.
Transdermal application of estrogen also allows temporary control of tumor activity by modulating the LHRH and testosterone release as well as directly effecting tumor cell apoptosis. Recent therapeutic modalities as for example somatostatin analogues influence the micro environment of tumor cells and thereby intensify the effect of anti-tumor therapy.
Original article written by:
Schilling D, Gakis G, Bökeler U, Stenzl A, Kuczyk MA, Merseburger AS.
Urology A. 2009 Feb;48(2):183-90.
Remember, everyone will progress at different rates, some of us faster than others will.
Joel T Nowak MA, MSW