Table of Contents

Chapter 6: Using Hormone Therapy

e. Early vs Deferred Hormone Therapy

As we’ve noted earlier, hormone therapy is a staple in the management of metastatic prostate cancer. But researchers have been looking into whether there might be an added benefit if hormone therapy is initiated earlier, once the PSA level in the blood starts to rise following prostatectomy or radiation therapy.

The clearest downside to early initiation—outside of the side effects—is the temporary nature of hormone therapy. On average, hormone therapy keeps PSA levels and tumor growth at bay for about two to three years, after which the hormone-independent cancer cells grow enough to start causing trouble and other treatment approaches must be tried. Given this short time span, some have argued that starting hormone therapy early limits the treatment options of men with advancing prostate cancers.

In addition, because it can take some time for prostate cancer metastases to show up on CT or MRI scans, it remains difficult to know whether the additional therapy actually affects the growth of the tumor cells. This, therefore, raises the question of whether it is prudent to subject someone to the effects of the additional therapy if there’s no way to prove whether it’s effective.

Deferring hormone therapy until metastatic disease can be detected might be an appropriate option for some men. In such cases, the goal would be to reserve an effective, albeit temporary, treatment option until it’s clearly needed.

On the other hand, data from other cancer types, such as breast cancer, have shown that using more therapy early on might be able to improve outcomes from primary therapy in some people.

Keeping these opposing views in mind, prostate cancer researchers have tried to identify strategies that minimize the amount of hormone therapy administered in the earliest stages while maximizing its effect on cancer growth. To date, most research has been done with the use of neoadjuvant hormone therapy before primary radiation therapy, and studies have found that its use in this setting might be beneficial for some men.