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Hormone Therapy Before Radiation Seed Implants May Shorten Life for Older Prostate Cancer Patients E-mail
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Men over 70 years of age with early-stage prostate cancer have 20 percent higher mortality if they are treated first with hormone therapy before being treated with radiation seed implants (brachytherapy), compared to men who are treated with brachytherapy alone, according to the largest cohort study of its kind presented September 23, 2008, at the American Society for Therapeutic Radiology and Oncology's 50th Annual Meeting in Boston.

New research shows that hormone therapy can have negative effects on survival, in addition to many other previously known side affects from this treatment. This is important to consider when weighing treatment options, especially since hormone therapy (called neoadjuvant hormone therapy or NHT) is sometimes used to shrink the prostate before brachytherapy treatment of localized prostate cancer but does not improve the patient's chance of being cured. Localized prostate cancer means it has not spread outside of the prostate.

"Our study shows that for men over 70 with early-stage prostate cancer, androgen deprivation therapy as a form of treatment may do more harm than good," Amy Fox, M.D., lead author of the study and a radiation oncology resident at the Harvard Radiation Oncology Program in Boston, said. "In older patients, the risks of androgen deprivation need to be carefully weighed by doctors when designing the proper treatment plan."

Androgen deprivation therapy is hormone therapy used to treat prostate cancer by lowering the level of male hormones (androgens) to shrink the prostate or slow down the growth of prostate cancer. Brachytherapy is a procedure where a radiation oncologist places small radioactive seeds into the prostate to kill the cancer cells while the man is sedated.

"These results are particularly interesting, since two previous studies that examined similar populations contradicted each other in terms of how hormone therapy impacts the risk of death among prostate cancer patients in this age group," Dr. Fox said.

The cohort study involved 1,709 men at least 70 years of age with localized prostate cancer who were treated with either NHT and brachytherapy or with brachytherapy alone at centers within the 21st Century Oncology consortium between 1991 and 2005. Findings show that men in this age group with localized prostate cancer who were treated with both NHT and brachytherapy had a 20 percent increased risk of dying, compared to men who were not treated with NHT.

The abstract, "Mortality in Men Age 70 or more with Localized Prostate Cancer Treated with Brachytherapy with or without Neoadjuvant Hormonal Therapy," was presented September 23, 2008, at the American Society for Therapeutic Radiology and Oncology's 50th Annual Meeting in Boston.

About Prostate Cancer

Prostate cancer is a disease in which cancer develops in the prostate, a gland in the male reproductive system. It occurs when cells of the prostate mutate and begin to multiply out of control. These cells may spread (metastasize) from the prostate to other parts of the body, especially the bones and lymph nodes.

Many factors, including genetics and diet, have been implicated in the development of prostate cancer. Prostate cancer develops most frequently in men over fifty. This cancer can occur only in men, as the prostate is exclusively of the male reproductive tract. It is the most common type of cancer in men in the United States, where it is responsible for more male deaths than any other cancer, except lung cancer.

Early prostate cancer usually causes no symptoms.  Many men who develop prostate cancer never have symptoms, undergo no therapy, and eventually die of other causes. Often it is diagnosed during the workup for an elevated PSA noticed during a routine checkup.  
Sometimes, however, prostate cancer does cause symptoms, often similar to those of diseases such as benign prostatic hypertrophy. These symptoms may include:
  • difficulty starting and maintaining a steady stream of urine,
  • frequent urination,
  • increased urination at night,
  • blood in the urine,
  • painful urination and

Advanced prostate cancer can spread to other parts of the body and this may cause additional symptoms. The most common symptom being bone pain, often in vertebrae (bones of the spine), pelvis or ribs. Spread of cancer into other bones such as the femur is usually to the proximal part of the bone. Prostate cancer in the spine can also compress the spinal cord, causing leg weakness and urinary and fecal incontinence. 

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