Early hormonal therapy may cut risk of local progression in men with conservatively managed tumors.


Nearly 15% of men with clinical localized prostate cancer treated without curative intent experience local progression within 10 years of diagnosis, according to a study. 

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The study also showed that hormonal therapy administered within six months of diagnosis significantly lowers the risk of local progression. Additionally, data suggest that the risk of progression is associated with PSA level at diagnosis and Gleason score of the diagnostic tissue. Findings appear in European Urology (2008;53:347-354).


Among patients who have local progression, the need for treatment is common, even among men diagnosed with transurethral resection of the prostate (TURP), the researchers concluded. “When counseling men who are candidates for management without curative intent, the likelihood of symptoms from local progression must be considered,” they wrote.


James A. Eastham, MD, of Memorial Sloan-Kettering Cancer Center in New York, and his colleagues studied 2,333 prostate cancer patients in the United Kingdom who had a median follow-up of 85 months (range 6-174 months). Of these men, 1,255 (54%) were diagnosed by TURP and 1,039 were diagnosed by needle biopsy (45%). The means of diagnosis was unspecified in 39 (2%). Fifty-four percent of the men had a PSA level of 10 ng/mL or less at the time of diagnosis, and 13% had a PSA level of 50 ng/mL or higher.


During the study period, 335 men experienced local progression, defined as an increase in clinical stage from T1/2 to T3/T4 disease, T3 to T4 disease, and/or the need for TURP to relieve local symptoms more than six months after the prostate cancer diagnosis. Although 54% of men had been diagnosed by TURP, 212 required TURP to control local symptoms during follow-up. Twenty-nine percent of men received hormonal therapy within six months of diagnosis.


Compared with patients with a PSA level of 4 ng/mL, those with a PSA level of 10 ng/mL had a 31% increased risk of local progression. A PSA level of 20 ng/mL was associated with a 44% lower risk of progression. A PSA level of 30 ng/mL carries the maximum risk for local progression whereas a PSA level of 90 ng/mL has about the same risk as a PSA of 4 ng/mL.


“This is probably because patients with a low PSA level tend not to progress rapidly, and patients with a very high PSA likely progress to distant disease and death before experiencing local progression,” the authors noted.


As diagnostic Gleason scores increased, so did the risk of local progression. Men who received early hormonal therapy had a 59% lower risk of local progression compared with men who did not. “Data suggest that earlier initiation of androgen-deprivation therapy is protective,” the authors said.