Timing of Initiation of Therapy : Prostate
By prostate Doc at 9 September, 2008, 3:09 pm
The optimal time to begin either monotherapy or CAB has not been settled. Earlier therapy results in more toxicity and increased costs. Loss of libido and muscle mass, impotence, anemia, hot flashes, hair loss, acceleration of osteoporosis, and fatigue are all potential toxicities of therapy.
When combined with radiation therapy, androgen deprivation appears to improve survival in patients with T3 or T4 lesions, as shown in the two studies in Table 2.2. In patients with metastatic disease, early androgen deprivation is associated with improved symptom control and survival (Table 2.3). The most convincing data come from a study performed by the Medical Research Council. This study ran- domized 934 patients with locally advanced prostate cancer or asymptomatic me- tastasis to either immediate treatment (orchiectomy or LHRH agonist) or the same treatment initiated at the time of symptomatic progression. Results showed a more rapid local and distant disease progression in the deferred group and a two-fold increase in serious complications.
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