Endocrine-Related Cancer March 2007 [antikvár]

REVIEW Endocrine-Related Cancer (2007) 14 1-11 Early versus delayed endocrine therapy for prostate cancer Fritz H Schröder Erasmus MC, University Medicai Center, PO Box 2040, 3000 CA, Rotterdam, Ttie Nettieriands (Requests for ollprints stiould be addressed to F H Schroder; Email: e.vandenberg«erasmusmc.nl) Abstract Etidocrlne treatment (ET) has in the past been shown to be beneficial in delaying clinical progression in all stages of prostate cancer, leading to an improvement of progression free survival in virtually all trials ever conducted. The first observations on this issue date back to the studies of the Veterans Administration Cooperative Urological Research Group in the 1960s. The period of time during which ET and the resulting side effects can be avoided is strongly dependent on the clinical stage of the disease. This treatment period is long in men who have minimal disease, such as a rising prostate-specific antigen after potentially curative management; however, it is considerably shorter in men who initially present with metastatic disease. In these situations, the potential benefit in quality of life, and avoidance of adverse events must be matched against the benefit in terms of gaining progression free time for the individual patient. This difficult task is supported by information supplied in this review. Locally advanced and regional (lymph node positive; stage T3N0-1M0Gx) disease is the domain of adjuvant ET. In this field, important progress has recently been made due to trials, which combine aggressive treatment of the primary tumor with adjuvant ET initiated at the same time. Therefore, in locally advanced and regional disease, radiotherapy or surgery combined with adjuvant ET must be considered state-of-the-art. Endocrine-Related Cancer {2007) 14 1-11 Introduction Endocrine treatment (ET) of prostate cancer (PC) is more than 60 years old (Huggins & Hodges 1941, Huggins rt a/. 1941). Huggins and coworkers were awarded the Nobel Prize m 1966 for their studies in endocrine dependence of the prostate, which led to die development of endocrine management for the treatment of PC. ET of advanced PC is recognized as being palhative and is ahnost invariably used in men with the metastatic condition. The use of early treatment in the course of the disease is discussed in this paper. Important side effects are associated with ET and the desire to reach an optimal balance between adverse events and clinical effectiveness is the mam reason for considering delay of ET. Why delay ET in PC? At the time of diagnosis even advanced PC is often asymptomatic. Patients are therefore confronted with the adverse effects of ET as the only 'symptom' of their cancer. Furthermore, depending on the extent of the disease at the time of diagnosis, the natural history may be very Endocrine-Related Cancer (2007) 14 1-11 1351-0088/07/014-001 © 2007 Society for Endocrinology Printed in Great Britain long, and avoiding long-term adverse events by delaying ET is desirable. Clearly, there is a need to achieve a balance between the impact of ET on the general well-being and quality of life against the potential clinical benefit. This review will analyse data from randomized controlled trials of early versus delayed ET (EET versus DET) in various stages of the disease. Some trials utilizing ET in adjuvant settings are included because clinically effective early and delayed ETs are compared. EET versus DET-evidence of effectiveness Staging of PC In this paper, the union international centre le cancer (UICC) classification of PC is used (UICC Intemational Union Against Cancer 1997). In this system, locally confined and locally extensive PC is classified as TI-2 and T3-4 respectively. Regional node positive disease is Mia disease. Metastases to bone are Mlb, and other sites are classified at Mlc disease. DOI:10.1677/ERC-06-0022 Online version via http://www.endoctinology-iournais.org