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Optimal Duration of Hormonal Therapy for Prostate Cancer

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Hormonal therapy plays a crucial role in the treatment of prostate cancer, but its side effects can be burdensome. Men undergoing testosterone-blocking drugs often experience fatigue, loss of muscle mass, and an increased risk of cardiovascular diseases. Therefore, physicians and patients are motivated to use hormonal therapy for only the necessary duration. However, determining the optimal treatment duration has remained a challenge. Hence, a recent study provides valuable clarity in this regard.

The Study Process and Results

A group of researchers from 10 hospitals in Spain conducted a study involving 355 men recently diagnosed with prostate cancer that was confined to the prostate and seminal vesicles. The participants were divided into two groups: one group received a four-month course of hormonal therapy, while the other group underwent treatment for a longer duration of 24 months. Additionally, all patients received high-dose radiation alongside hormonal therapy.

After a follow-up period of 10 years, the study revealed that only men initially diagnosed with high-risk prostate cancer benefited significantly from the longer-term treatments. Specifically, 67.2% of these individuals avoided subsequent increases in prostate-specific antigen (PSA), a marker indicating worsening cancer. In contrast, 53.7% of men with high-risk cancer who received four months of hormonal therapy managed to avoid similar PSA increases. Importantly, among high-risk individuals who had long-term hormonal therapy, 78.5% were still alive after a decade, compared to 67% of those treated with hormonal therapy for four months.

In contrast, the duration of hormonal therapy had less impact on men with intermediate-risk prostate cancer. Only four individuals with intermediate-risk cancer experienced cancer progression to other parts of the body. Of these cases, two were from the short-term treatment group, and two belonged to the 24-month hormonal therapy group. Moreover, regardless of the duration of hormonal therapy, no deaths occurred due to prostate cancer among the intermediate-risk patients during the 10-year follow-up.

Expert Opinions

According to Dr. Nima Aghdam, a radiation oncologist at Harvard-affiliated Beth Israel Deaconess Medical Center in Boston who was not involved in the research, "This study settles the question of hormonal therapy duration for most patients with high-risk prostate cancer who also receive radiation treatment. It presents a robust comparison of options and, in my opinion, enables patients to make informed decisions based on high-level evidence."

Dr. Aghdam further suggests that for certain patients with specific high-risk features, there may be an ideal duration between four and 24 months. He encourages patients to discuss this option with their healthcare providers. However, Dr. Aghdam points out that the study doesn't address the optimal hormonal therapy duration for all intermediate-risk patients. He believes that further refinement is necessary for this commonly encountered scenario.

Notably, the study did not include men with low-risk prostate cancer, for whom the current standard recommendation is to avoid hormonal therapy altogether, as stated by Dr. Anthony Zietman, a professor of radiation oncology at Harvard Medical School, who also did not participate in the research.

William H. McDaniel, MD

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School.

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