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PSA rising after prostatectomy. Starting hormone therapy sooner any help?

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Jim Marshall (not a doctor) said ...

If having your prostate out was not enough to control your disease, and your doctor chooses hormone therapy (ADT) for your next treatment, does starting early help?

 

These doctors looked back at their records to find out.

  • Half the men started when their PSA score matched a commonly used rule. In this group hormone therapy was started, on average, when the PSA was 0.42 ng/mL.
  • Half the men started earlier than the rule suggested. In this group hormone therapy was started, on average, when the PSA was 0.12 ng/mL.

 

  • Early starters had a longer time before their disease progressed.
  • Early starters had a longer time before distant metastases were found.
  • Early starters where the cancer was not seen outside the prostate did not change whether prostate cancer was the cause of their death. 
  • Early starters where the cancer was seen outside the prostate did lower the chance that prostate cancer was the cause of their death.

... end Jim

 

 

 

Yonsei Med J. 2018 Jul;59(5):580-587. doi: 10.3349/ymj.2018.59.5.580.

Impact of Early Salvage Androgen Deprivation Therapy in Localized Prostate Cancer after Radical Prostatectomy: A Propensity Score Matched Analysis.

Park JW1, Jang WS1, Koh DH1, Ham WS1, Rha KH1, Hong SJ1, Choi YD2.

Author information

Abstract

PURPOSE:

Androgen deprivation therapy (ADT) is used as a salvage treatment for men with biochemical recurrence (BCR) of prostate cancer (PCa) following initial radical prostatectomy (RP). The optimal time at which to begin salvage ADT (sADT) remains controversial. In this retrospective study, we evaluated the efficacy of initiating sADT in patients before prostate-specific antigen (PSA) values met the clinical definition of BCR.

 

MATERIALS AND METHODS:

We identified 484 PCa patients who received sADT for BCR after RP. Median follow-up was 82 months. Propensity score matching was performed based on preoperative PSA level, pathologic T stage, and Gleason score. Patients were assigned to two groups of 169 patients each, based on PSA levels at the time of sADT: Group A (without meeting of the definition of BCR) and Group B (after BCR). Kaplan-Meier survival analyses and Cox regression analyses were performed.

 

RESULTS:

The median PSA level at sADT initiation was 0.12 ng/mL in group A and 0.42 ng/mL in group B. Kaplan-Meier analyses showed that group A had favorable disease progression-free survival (DPFS) and distant metastasis-free survival (DMFS), but did not have better cancer-specific survival (CSS) than group B. In subgroup analyses, group A showed better CSS rates in the non-organ confined PCa group. In Cox regression analyses, early sADT was associated significantly with DPFS and DMFS rates, however, did not correlate with CSS (p=0.107).

 

CONCLUSION:

Early sADT after RP improved DPFS and DMFS. Furthermore, early sADT patients demonstrated better CSS in non-organ confined PCa.

 

© Copyright: Yonsei University College of Medicine 2018.

 

KEYWORDS:

Radical prostatectomy; androgen deprivation therapy; prostate specific antigen; salvage therapy

 

PMID: 29869455

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