Hormonal Treatment For Localized And Advanced Prostate Cancer

Data was presented on the outcome of patients with positive surgical margins following radical prostatectomy(RP) treated with observation vs. immediate radiation-hormonal therapy selection criteria identified. Of 60 patients with positive surgical margins following RP, 27 were started on XRT-hormonal therapy post-op and the remainder underwent active observation.

Criteria for initiating therapy included positive seminal vesicles, Gleason score >8, multiple positive surgical margins or positive prostatic bed biopsy. In the observation arm, 27/33 patients (82%) were free from recurrence at 2-8 years (median 4 years). 6/33 patients (18%) recurred at a median of 2 years. All received adjuvant therapy and are alive. In the treatment arm, 22/27 patients (81%) are without recurrence at a median of 5 years, while 5/27 men (19%) recurred 6-18 months post completion of therapy. One has died and the remaining patients are undergoing additional therapy. The authors suggest that their selection criteria stratify those patients with only positive surgical margins from others with more adverse pathological features warranting adjuvant therapy. This approach results in comparable short term (4-5 year) results.Dr. Morote, Barcelona Spain presented a paper on “The serum testosterone level with clinical relevance”. Serum testosterone was measured 3 times at 6 month intervals in 73 patients with nonmetastatic CaP under medical castration. Twenty-eight of these men were also on bicalutamide. With a mean follow-up of 51 months, 38% of men had androgen independent progression. Serum testosterone was under 20ng/dL in 32 men (43.6%) and breakthrough elevations between 20-50ng/dL occurred in 23 men (32%) and over 50ng/dL in 18 men (25%). The lowest testosterone level found to have impact on the survival time free of AICaP was 32ng/dL. The survival in those without development of AICaP was 137 months, compared to 88 months in AICaP patients with testosterone elevations over 32ng/dL. Bicalutamide was not stated to be related with breakthrough elevations of testosterone, but in those with elevation of testosterone over 32ng/dL, men on maximal androgen blockade had longer survival free of AICaP (p<0.02). The presentation suggests that serum testosterone castrate levels that increase to over 32ng/dL are associated with a lower survival free of AICaP.(Source : University of Beirut : April 2007.)