Review: Risk stratification in the hormonal treatment of patients with prostate cancer

Division of Urologic Surgery and Duke Prostate Center, Department of Surgery, Duke University Medical Center, Durham, NC 27710.
rapeutic Advances in Medical Oncology, The (Impact Factor: 2.83). 09/2009; 1(2):79-94. DOI: 10.1177/1758834009340164
Source: PubMed


Prostate cancer (PCa) is the most common type of cancer found in American men, other than skin cancer. The American Cancer Society estimates that there will be 186,320 new cases of prostate cancer in the United States in 2008. About 28,660 men will die of this disease this year and PCa remains the second-leading cause of cancer death in men. One in six men will get PCa during his lifetime and one in 35 will die of the disease. Today, more than 2 million men in the United States who have had PCa are still alive. The death rate for PCa continues to decline, chiefly due to early detection and treatment, and improved salvage therapy such as hormone therapy (HT). HT continues to be a mainstay for primary-recurrent PCa and locally-advanced PCa. However, HT is associated with many undesirable side effects including sexual dysfunction, osteoporosis and hot flashes, all of which can lead to decreased quality of life (QOL). These risks are seen in both long- and short-term HT regimens. Additionally, research in recent years has revealed trends related to clinico pathological variables and their predictive ability in HT outcomes. Awareness of the potential adverse effects, the risks associated with HT and the prognostic ability of clinical and pathological variables is important in determining optimal therapy for individual patients. A rigorous evaluation of the current scientific literature associated with HT was conducted with the goal of identifying the most favorable balance of benefits and risks associated with HT.

Download full-text


Available from: Matthew A Uhlman
  • [Show abstract] [Hide abstract]
    ABSTRACT: In the present study, we aimed to evaluate the prognosis and prognostic factors in patients with advanced prostate cancer treated with endocrine therapy. This study included 110 patients with stage C or D prostate cancer who were treated with endocrine therapy as the primary therapy. Disease-specific survival (DSS) was evaluated using the Kaplan-Meier method and prognostic factors identified by Cox proportional hazard model analysis. In the univariate analysis, we found that patients with prostate-specific antigen (PSA) levels >200 ng/mL, alkaline phosphatase ≥ 350 U/L, Gleason score ≥ 9, extent of disease on bone scan ≥ 1, hemoglobin <12 g/dL or stage D2 disease showed significantly lower DSS rates than their respective counterparts. In the multivariate Cox proportional hazard model analysis, it was noted that Gleason score and PSA were independent prognostic factors. Using these 2 statistically significant factors, patients were stratified into 3 risk groups. The differences in DSS among the 3 groups were significant. These results suggest that Gleason score and PSA are independent prognostic factors and that a combination of these factors can be used to stratify DSS risk in patients with advanced prostate cancer treated with endocrine therapy.
    No preview · Article · Jul 2013
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Androgen-deprivation therapy is a commonly used treatment for men with prostate cancer; however, the adverse effects can be detrimental to patient health and quality of life. Exercise has been proposed as a strategy for ameliorating a range of these treatment-related adverse effects. We conducted a systematic review of the literature regarding the effects of exercise on treatment-related adverse effects in men receiving androgen-deprivation therapy for prostate cancer. An online electronic search of the Cochrane Library, EMBASE, MEDLINE, CINAHL, SPORTDiscus, and Health Source databases was performed to identify relevant peer-reviewed articles published between January 1980 and June 2013. Eligible study designs included randomized controlled trials as well as uncontrolled trials with pre- and postintervention data. Information was extracted regarding participant and exercise intervention characteristics as well as the effects of exercise on bone health, body composition, physical performance, cardiometabolic risk, fatigue, and quality of life. Ten studies were included, with exercise interventions involving aerobic and/or resistance training. Exercise training demonstrated benefits in muscular strength, cardiorespiratory fitness, functional task performance, lean body mass, and fatigue, with inconsistent effects observed for adiposity. The impact of exercise on bone health, cardiometabolic risk markers, and quality of life are currently unclear. Among patients with prostate cancer treated with androgen-deprivation therapy, appropriately prescribed exercise is safe and may ameliorate a range of treatment-induced adverse effects. Ongoing research of high methodologic quality is required to consolidate and expand on current knowledge and to allow the development of specific evidence-based exercise prescription recommendations.
    Full-text · Article · Dec 2013 · Journal of Clinical Oncology