Urologists, medical oncologists address the role of hormones in PCa at annual materclass
Thursday, 2 June 2009- The role of hormones in prostate cancer management and the most recent developments in this field have been discussed as part of a teaching module at the 4th Annual ESU Masterclass on Medical treatment of urological cancer.
Presented by Prof. Hans-Peter Schmid of Urology Department at Kantonsspital St. Gallen, Switzerland, the lecture aimed to provide the attending urologists, medical oncologists and radiologists with the most essential updates on the topic. The masterclass took place on 27-28 June in Barcelona.
In his lecture, Schmid attempted to cover a wide range of issues related to hormones’ application in the treatment of prostate cancer, at the same time pointing out that "this field is extremely wide and there are many unanswered questions - unfortunately also those the answers to which would be of great help to specialists, who have to deal with less 'straightforward' cases on a daily basis."
While discussing the many available techniques for hormones control and manipulation, Prof. Schmid reviewed orchiectomy, LHRH analogues and antagonists, oestrogens, anti-androgens, 5ARIs and various combinations of these drugs. Much attention was paid to the working mechanism and the benefits of maximal androgen blockade (MAB), a technique that allows to minimise androgen levels by targeting both of its main sources, the adrenal gland and the testes. He said that MAB offers a small survival benefit in younger patients with a good performance status, warning that in all other cases there is no survival advantage at two years.
"There are many and severe side-effects associated with MAB – loss of libido, ED, obesity, osteoporosis, cardiovascular morbidity – and 10% of patients withdraw from this treatment," Schmid told Urosource. "Considering that and the fact that there is only marginal benefit to this approach, I would recommend to be cautious when considering it for your patient."
"Timing is very important when it comes to delivering hormonal therapy, and there are many variables to take into account," he added. "Practitioners should consider age, presence of symptoms and the patient’s prognosis among other things."
During his lecture Schmid reviewed the existing evidence on the possible schemes of hormonal therapy administration, including immediate vs. deferred regimens, continuous vs. intermittent and HT as sequential, second and third line alternatives.
In the conclusion Schmid mentioned, that despite a long list of options available to urologists and medical oncologists today, there are still situations where there is no definitive recommendation or common solution. "What should you do, when the patient’s PSA levels continue to rise after he had undergone active treatment?" according to Schmid this is one common clinical scenario which needs to be addressed in the future. "At this point, we simply don’t know."
