Intermittent Hormone Therapy for Prostate Cancer

By Michael A. Smith, MD

Hormone deprivation therapy is a common treatment for prostate cancer. By starving cancer cells of testosterone stimulation, hormone deprivation quickly prevents the cancer from spreading and improves the odds of survival. But it comes with many risks.

Depriving a man of testosterone will naturally result in some unwanted side effects. Think about it like this: In order to treat the cancer, you starve the body of the “vitality” hormone for men.

Muscle tissue and strength can drop along with a whole host of other problems. The reported side effects of Lupron®, a common hormone deprivation drug, include the following:1

  • Loss of libido
  • Erectile dysfunction
  • Fatigue
  • Hot flashes
  • Mood swings
  • Bone loss
However, new research shows that treating prostate cancer with intermittent hormone deprivation works just as well as continuous treatment, and comes with fewer sides effects. This is really good news for men thinking about hormone deprivation therapy.

On-and-Off Hormone Deprivation Treatment Works

Researchers from Canada compared men using on-and-off hormone deprivation therapy with men treated with continuous therapy. The study found that on-and-off treatment was just as effective as treating men continuously.2

The study included 1,386 patients, of which 690 were randomly assigned to intermittent therapy and 696 to continuous therapy. All of the patients failed initial radiation therapy. They were followed for seven years.

The researchers used prostate specific antigen, or PSA, blood testing to determine the effectiveness of both on and off and continuous deprivation therapy. A rise in PSA during or after treatment could mean the cancer is reoccurring.

After the seven year follow-up period, the average survival time in both groups was the same. A total of 524 men died from all causes during the study — 18% of deaths in men receiving intermittent hormone therapy and 15% of deaths in continuous therapy were due to prostate cancer.2

But here’s where it gets interesting. Men receiving on and off deprivation therapy reported fewer specific side effects: Less urinary problems, loss of libido and erectile dysfunction and fewer hot flashes.

Men receiving intermittent therapy also felt physically better than men on continuous therapy. There was no difference between the two groups with other side effects.2

The investigators believe that their findings could change the way patients are treated using hormone deprivation therapy.

An Unanswered Question Remains

This study, however, does not answer the question about whether hormone deprivation therapy is even needed in asymptomatic patients with a rising PSA.

The director of Tulane’s cancer center, Oliver Sartor, told WebMD, “The big debate in the field is whether to even treat patients with rising PSA before there’s evidence of cancer spreading.”

Well, that may be true. But for men with a rising PSA and symptoms, intermittent hormone deprivation therapy might be a viable option.

If you fall into this category, we suggest speaking with your doctor about it.

References:

  1. http://www.lupron.com/important-safety-information.cfm
  2. N Engl J Med. 2012 Sep 6;367(10):895-903.

4 comments :

Anonymous said...

Is intermittent hormone therapy utilized after radical prostate surgery. How is this type of therapy compared to radiation?

Life Extension said...

Anonymous - Good question! Intermittent hormone therapy has only been studied in a population with rise in PSA and symptoms after initial treatment (surgery, radiation). It isn’t considered a primary treatment, but it’s more for prevention and treatment of reoccurrence.

Chris said...

Just found this! Good question indeed ... My onco suggested it in 2004 (I was Stage 3a and Gleason sum 7) and I'm still doing it. Anonymous asks about it "post RP": answer was "if PSA is rising", i.e. in "biochemical failure" after surgery. This is right, enter "Shin Egawa" Intermittent in Google Scholar - #1 is 2000 article in JJCO (sorry, I don't have full citation at my fingertips). His group entered a small number in failure into their cohort. Others report that longevity may be compromised, yet others report better QoL, on intermittent versus continuous LHRH therapy. Maybe need to argue with doctors, so homework advisable. I have had to do this with two new oncos over the years; the last one gave me away to my SpNO until I reach hormone independence. That way I'm not a bad influence on impressionable/mystified registrars. C.

LifeExtension said...

Chris - Thanks so much for providing your personal experience with intermittent hormone therapy! Best wishes. :)

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