[Local recurrence of prostate cancer: hormone therapy].
BACKGROUND
The majority of patients receive HT after biochemical progression despite primary therapy of prostate cancer with curative intent. It is difficult to differentiate at a low rise in PSA level, e.g., <or=1 ng/ml, between local or systemic recurrence.


METHODS
The PSA doubling time (DT) is the most reliable surrogate parameter to decide if HT should be initiated. In practice, however, the trigger PSA is used instead. The latter is closely related to the timing of HT. A high PSA is a contraindication for local salvage therapy. Intermittent HT is apparently as effective as continuous HT and shortens the time of HT exposure.


RESULTS
Traditional HT employs a LHRH agonist, however, the side effect profile is a disadvantage due to the long duration of this treatment, e.g., sarcopenia, osteopenia, or even cognitive impairment. The alternative is nontraditional HT: nonsteroidal antiandrogen (AA) alone such as bicalutamide 150 mg or peripheral androgen blockade (AA plus 5alpha-reductase inhibitor).


CONCLUSIONS
Even after a long duration of the latter HT the side effects are less pronounced (gynecomastia) and treatable. Particularly in patients with high-risk primary tumors [Gleason score 7(4+3)-10 or an initially high PSA], nontraditional HT may be followed by secondary HT.
Altwein
J E
JE
Urologische Abteilung, Krankenhaus Barmherzige Brüder, Akademisches Lehrkrankenhaus, Technische Universität, Romanstrasse 93, 80639, München, Germany. altwein.muenchen@t-online.de
Ebert
T
T
D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects* / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000097:blood* / Q000188:drug therapy*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000628:therapy*; D016896:Treatment Outcome
D018931:Antineoplastic Agents, Hormonal; D017430:Prostate-Specific Antigen