Endocrine therapy can be used to treat prostate cancer in a number of different ways, including:
As adjuvant therapy after radiation or surgery
Endocrine therapy after other primary treatments to reduce the risk of prostate cancer recurrence is called “adjuvant endocrine therapy.
Patients with early-stage prostate cancer who are at moderate or high risk of recurrence may receive adjuvant endocrine therapy after radiation therapy or prostatectomy (surgery to remove all or part of the prostate). Determinants of risk of prostate cancer recurrence include tumor grade (as measured by the Gleason score), the extent of tumor spread to surrounding tissues, and whether lymph node infiltration occurs.
- Men who received adjuvant endocrine therapy after prostatectomy had longer recurrence-free survival than men who underwent prostatectomy alone, but overall survival was not significantly altered.
- Patients with prostate cancer who received adjuvant endocrine therapy after external radiation therapy had a longer recurrence-free survival time and overall survival time than those who received external radiation therapy alone.
As neoadjuvant therapy prior to radiotherapy
Endocrine therapy given before other treatments is called “neoadjuvant endocrine therapy.
Patients with early-stage prostate cancer with a moderate or high risk of recurrence often need endocrine therapy not only after radiation, but also before or during radiation therapy. Patients who receive radiotherapy combined with endocrine therapy have a longer survival time than those who receive radiotherapy alone.
However, the use of neoadjuvant endocrine therapy before prostatectomy does not prolong patient survival and is therefore not the standard of care.
As monotherapy for prostate cancer
- Endocrine therapy is sometimes used alone to relieve or prevent local symptoms in patients with limited prostate cancer who often cannot receive surgery or radiation because of limited life expectancy, local progression of prostate cancer, or other serious health problems.
- Endocrine therapy alone is the standard of care in patients whose cancer is found to have recurred by CT, MRI scan, or bone scan after radiation therapy or surgical resection of prostate cancer.
- Endocrine therapy is also often recommended for patients with “biochemical” recurrence – that is, a rapid increase in prostate-specific antigen (PSA) levels, especially if PSA levels double within 12 months. The PSA level doubles within 12 months. However, a rapid increase in PSA levels does not necessarily mean that prostate cancer has recurred, so the use of endocrine therapy in patients with biochemical recurrence remains controversial.
- Endocrine therapy alone is also the standard of care for patients with metastatic prostate cancer.
For some patients who are newly diagnosed with progressive prostate cancer but have not yet developed symptoms, it is unclear whether endocrine therapy can prolong their survival. In addition, because endocrine therapy can cause some serious side effects, some patients choose to wait for symptoms to appear before starting endocrine therapy.
How long should endocrine therapy last?
The duration of endocrine therapy for patients with prostate cancer depends on the degree of risk of recurrence, including clinical stage (the number and distribution of tumors in the body), Gleason score (the pathological grading of prostate cancer tissue under the microscope), and PSA level. Endocrine therapy typically lasts 4 to 6 months for patients with intermediate risk prostate cancer and 2 to 3 years for patients with high risk.
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