Prostate cancer cells are dependent on testosterone for their survival, so when testosterone is removed, they shrivel and die. Radiation and surgery can’t cure cancer that has already spread outside the prostate. Only hormone therapy, otherwise known as testosterone inactivating pharmaceuticals (TIP), circulates throughout the whole body attacking potential micro-metastasis in the lymph nodes or bones.
Over the years, we have treated hundreds of men with newly-diagnosed disease with TIP. Twelve-year outcomes evaluating 73 men who embarked on TIP as primary therapy have been published. After treatment, 29% never needed any further therapy; 33% required periodic retreatment with TIP to keep their PSA levels under 5, and 38% underwent delayed local therapy such as surgery, seeds, or radiation a median of 5 years after their first dose of TIP. Out of the 28 men who had delayed local therapy, only 3 developed a PSA relapse. Upon review of this data set, we found that older men tended to have longer remissions after TIP. Less durable remissions occurred with higher starting PSA levels and higher Gleason scores.
One of the advantages of TIP is how easily treatment can be monitored with PSA and scans. Normally, the PSA will decline to less than 0.05 within 8 months of starting therapy. Primary TIP, therefore, is an effective way to smoke out the rare but serious types of prostate cancer in those patients whose PSA fails to decline below 0.05. Such patients should consider a more aggressive treatment with some form of radiation.
Considering the rapid improvements occurring in the medical world, delaying radiation or surgery keeps the option open for a better type of treatment down the line. So, what is the catch? First, TIP is not curative. Most men eventually require additional treatment. Second, while TIP’s side effects are manageable and reversible, they are not trivial (Chapter 29). Despite these drawbacks, with TIP, men can “test the water” without risking the irreversible side effects commonly associated with immediate surgery and radiation.
ABOUT THE AUTHOR
Mark Scholz, MD is the executive director of the Prostate Cancer Research Institute. He is also the medical director of Prostate Oncology Specialists Inc. He received his medical degree from Creighton University in Omaha, NE. Dr. Scholz completed his Internal Medicine internship and Medical Oncology fellowship at University of Southern California Medical Center. He is co-author of Invasion of the Prostate Snatchers. He has authored over 20 scientific publications related to the treatment of prostate cancer.