Hormonal therapy in prostate cancer: historical approaches

Abstract

Hormonal therapy has been the standard of care for advanced prostate cancer for over 6 decades. Treatments to suppress testosterone have expanded beyond surgical castration and estrogens to include steroidal and nonsteroidal antiandrogens, luteinizing hormone-releasing hormone agonists, and, most recently, gonadotropin-releasing hormone antagonists. Yet, despite this extensive therapeutic armamentarium, long-term survival of patients with advanced prostate cancer remains poor. Many issues regarding hormonal treatment of prostate cancer continue to be controversial, including the benefits of combined androgen blockade versus monotherapy, the optimal timing of treatment, and the value of new therapeutic approaches and strategies, such as intermittent androgen deprivation and adjuvant chemotherapy.

Figure 1

Abarelix as monotherapy achieves medical castration significantly more rapidly than combination therapy and without the testosterone surge associated with luteinizing hormone-releasing hormone agonist therapy. T, testosterone.

Figure 2

In Study INT 0036, conducted by the Southwest Oncology Group, patients who received combination therapy with leuprolide and flutamide experienced a 26% increase in survival compared with patients receiving leuprolide plus placebo (35.6 months vs 28.3 months, respectively). NCI, National Cancer Institute.