Hormone therapy: How long should it last?

When it comes to prolonging survival, external beam radiation therapy combined with long-term hormone therapy has been shown superior to radiation therapy and deferred hormone therapy. However, long-term hormone therapy can harm quality of life and increase the risk of heart attacks, fractures, and metabolic syndrome. Could the risks be minimized by replacing long-term hormone therapy, lasting two years or longer, with short-term therapy lasting just six months?

In 1997, the European Organization for Research and Treatment of Cancer (EORTC) launched a trial to find out. After six months of androgen deprivation, which started at the same time as seven weeks of radiation therapy, 970 prostate cancer patients were randomly assigned to either long-term or short-term hormone therapy. The short-term group immediately stopped taking medications while the long-term group continued for another two-and-a-half years. In addition to monitoring disease progression, the researchers gathered data about participants’ quality of life.

Five years later, the rate of death from prostate cancer and overall mortality were higher among men in the short-term therapy group than in the long-term group. As a result, the researchers suggest radiotherapy and three years of hormone therapy for men with locally advanced prostate cancer.

One caveat: the study was conducted in men with relatively large tumors. The results aren’t likely to apply to men with small, early-stage tumors, the kind found most often in American men.

SOURCE: Bolla M, de Reijke TM, Van Tienhoven G, et al. Duration of Androgen Suppression in the Treatment of Prostate Cancer. New England Journal of Medicine 2009;360:2516–27. PMID: 19516032.

Originally published Oct. 1, 2009; last reviewed March 16, 2011.