Intermittent Hormonal Therapy

Among the most important quality of life issues for patients with prostate cancer is the loss of sexual function with treatment. For this reason many men delay treatment or take treatment intermittently. There is no evidence whatsoever that intermittent treatment is less successful than continuous therapy. Indeed, if one examines the effects of hormonal treatment on prostate cancer cells growing in culture, then a single exposure to antiandrogen therapy is seen to cause devastating destruction of cell cultures rather akin to the effects of chemotherapy.

There is no rational basis for continuous therapy, and so the intermittent treatment approach can be supported. This point was brought home to me by the clinical course of a patient advo cate on one of the trust boards of the Prostate Cancer Charity. He presented with metastatic disease and took hormonal treatment for a period of 6 weeks. He responded well and discontinued treatment until he suddenly presented 4 years later with cord compression, a course of events that might have occurred if he had taken continuous therapy. This anecdote, though hardly hard science, if taken in context and considered in the light of the many side effects of hormonal therapy, could be used to support the case for a randomized trial of intermittent therapy. Certainly this approach is currently more widely advocated and is under investigation [7].

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