Recovery of hormone sensitivity after salvage brachytherapy for hormone refractory localized prostate cancer.
OBJECTIVE
Recent work has demonstrated the return of hormone sensitivity after palliative chemotherapy in androgen independent prostate cancer. We wished to establish whether a similar phenomenon existed in patients with no exposure to chemotherapy.


METHODS
A review of "hormone resistant" patients who had received salvage brachytherapy for localized prostate cancer after previous external beam radiotherapy was undertaken. Three patients with subsequent biochemical relapse responded to the rechallenge with hormonal treatment.


RESULTS
The series of patients presented here demonstrates this phenomenon occurs after salvage brachytherapy with no exposure to chemotherapy. Recovery of sensitivity is demonstrated both to androgen deprivation and to androgen receptor antagonism. The recovery of hormone sensitivity was surprisingly durable, ranging from eight months to over twenty-one months.


CONCLUSIONS
Hormone sensitivity may be recovered after salvage brachytherapy. Potential mechanisms underlying these observations are discussed and the likely central role of the activity of the androgen receptor highlighted. The relevance of these findings to the management of advanced prostate cancer is considered including thoughts on the practice of intermittent anti-androgen therapy.
Smith
Dan
D
Department of Radiotherapy, St Bartholomew's Hospital, West Smithfield, London, UK.
Plowman
P Nick
PN
D000368:Aged; D000726:Androgen Antagonists / Q000009:adverse effects; D001918:Brachytherapy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*; D011944:Receptors, Androgen / Q000502:physiology; D016879:Salvage Therapy
D000726:Androgen Antagonists; D011944:Receptors, Androgen; D017430:Prostate-Specific Antigen