Recovery of hormone sensitivity after salvage brachytherapy for hormone refractory localized prostate cancer

Abstract

Purpose: Recent work has demonstrated the return of hormone sensitivity after palliative chemotherapy in androgen independent prostate cancer. We wished to establish whether a similar phenomenon existed in patients with no exposure to chemotherapy. Materials and Methods: A review of "hormone resistant" patients who had received salvage brachytherapy for localized prostate cancer after previous external beam radiotherapy was undertaken. Three patients with subsequent biochemical relapse responded to the rechallenge with hormonal treatment. Results: The series of patients presented here demonstrates this phenomenon occurs after salvage brachytherapy with no exposure to chemotherapy. Recovery of sensitivity is demonstrated both to androgen deprivation and to androgen receptor antagonism. The recovery of hormone sensitivity was surprisingly durable, ranging from eight months to over twenty-one months. Conclusions: Hormone sensitivity may be recovered after salvage brachytherapy. Potential mechanisms underlying these observations are discussed and the likely central role of the activity of the androgen receptor highlighted. The relevance of these findings to the management of advanced prostate cancer is considered including thoughts on the practice of intermittent anti-androgen therapy.

Permanent 125I prostate brachytherapy for castration‐resistant prostate cancer

“…Therefore, antiandrogen drugs are still valid for CRPC patients . Another study found brachytherapy might resume CRPC sensitivity to the hormone . Hence, in the present study, we took CRPC patients receiving endocrine therapy alone as the controls, and compared them with brachytherapy combined with endocrine therapy to analyze the efficacy of brachytherapy in CRPC patients.…”

“…21 Another study found brachytherapy might resume CRPC sensitivity to the hormone. 22 Hence, in the present study, we took CRPC patients receiving endocrine therapy alone as the controls, and compared them with brachytherapy combined with endocrine therapy to analyze the efficacy of brachytherapy in CRPC patients. The research showed that the PSA-PFS survival and CSS of patients in the TG compared with patients in the CG were extended for 16 months and 19 months, respectively, and there were significant differences between the two groups (P < 0.05).…”

Reinduction of Hormone Sensitivity to Goserelin following Chemotherapy with Vinorelbine in Castration-Resistant Prostate Cancer

“…This, in turn, would manifest itself clinically as an apparent restoration of hormone sensitivity. Other possible mechanisms cannot be ruled out and these include the possibility that certain chemotherapeutic agents may activate pathways that lead to a restoration of hormone sensitivity within the androgen receptor itself, or that they may induce changes in nonandrogen receptor activation influencing downstream survival pathways [15].…”