Current status of endocrine therapy in localized prostate cancer: cure has become a strong possibility

Abstract

It is clear that all available means should be taken to diagnose prostate cancer early and to use efficient therapy immediately in order to prevent prostate cancer from migrating to the bones where treatment becomes extremely difficult and cure or even long-term control of the disease is an exception. The only means of preventing prostate cancer from migrating to the bones and becoming incurable is efficient treatment at the localized stage of the disease. In fact, since radical prostatectomy, radiotherapy and brachytherapy can achieve cure in about 50% of cases, these approaches are all equally valid choices as first treatment of localized prostate cancer. However, in view of the current knowledge and available data, nowadays, androgen blockade should also be considered as first line treatment. While showing the high efficacy of hormonal therapy in localized prostate cancer, present knowledge clearly indicate that long-term treatment with the best available hormonal drugs, somewhat similar to the 5 years of Tamoxifen in breast cancer, is required for optimal control of prostate cancer. It is also clear from the data analyzed that combined androgen blockage alone could well be an efficient therapy of localized prostate cancer while it has already been recognized as the best therapy for metastatic disease. This paper presents and discusses the current knowledge available on the use and results of endocrine therapy in localized prostate cancer.

Complete androgen blockade safely allows for delay of cytotoxic chemotherapy in castration refractory prostate cancer

“…Prior to initiation of CAB, all patients were evaluated with testosterone levels (had to be < 50 ng/dl), alkaline phosphatase, PSA, lactic dehydrogenase, bone and computer tomography (CT) scans. Disease progression was defined as previously published (13): evidence of progressive soft tissue or lymph-node metastasis, evidence of new bone lesions or an increase in at least 25% of PSA above the nadir level. PSA, alkaline phosphatase, and lactic dehydrogenase were measured at two-month intervals or shorter.…”

“…In localized prostate cancer, CAB has led to long-term remissions, even raising discussion about possible cure (13,14). In metastatic disease, although more toxic than castration alone, data show that CAB prolongs survival when used as first-line manipulation (5).…”

Acne, dairy and cancer

“…9 There are in addition some indirect lines of research and thinking that point toward the influence of hormones. The mechanism of stimulation of prostate gland activity has been well-defined by Labrie and the enzymatic pathways (the intracrine system) present in the pilosebaceous unit are also present in prostate gland, 10 leaving it open to stimulation by the same milk/dairy-sourced hormones and DHT precursors that likely stimulate acne. We are learning that reducing the amount of DHT produced in a prostate cancer patient through inhibition of the action of 5α-reductase will control the disease to a certain extent.…”