Adding hormone therapy to brachytherapy: what works best?

A recent report in the International Journal of Radiation Oncology • Biology • Physics suggests that the type of hormone therapy used in combination with brachytherapy for treatment of localized prostate cancer makes no difference to the patients’ long-term outcomes.

Chen et al. conducted a retrospective analysis of data from 223 men in the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) database who had received androgen deprivation therapy (ADT) in combination with brachytherapy for treatment of intermediate- or high-risk prostatic adenocarcinoma: 159 (71 percent) received maximal androgen blockade (MAB) with an LHRH agonist and an antiandrogen, and 64 (29 percent) received hormonal monotherapy (with either an LHRH agonist or an antiandrogen alone).

The results of their analysis show that:

  • Men who received MAB had similar Gleason scores, T stages, and pretreatment PSA levels as those who received monotherapy.
  • After a median follow-up of 49 months, the use of MAB was not associated with a decrease in the risk recurrence.
  • A higher PSA and/or a younger age at diagnosis were associated with increased risk for recurrence.
  • The 3-year recurrence-free survival was 76 percent for patients in both the monotherapy and the MAB groups.

The authors conclude that either MAB or hormonal monotherapy are reasonable choices for use in combination with brachytherapy in the management of men with intermediate- or high-risk prostate cancer.

It should be repeated, however, that this study is only a retrospective analysis of database information. A prospective, randomized clinical trial (which has never been carried out as far as we are aware) might demonstrate a different outcome.

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