Sept. 12, 2000 — Combining drugs that suppress male sex hormones along with radiation might be just the treatment for men who are fortunate enough to catch prostate cancer in its early stage.

The term “early stage” can still be deceptive, though. It means the cancer has not spread beyond the prostate, and remains “localized.” But the cancer can still vary in its aggressiveness, and can be broken down into low risk, delivery generic overnight viagra risk, and high risk, even while in the early stage.

New research published in the Sept. 13 issue of The Journal of the American Medical Association shows that treating intermediate- and high-risk early-stage prostate cancer by giving drugs to suppress the male sex hormones, or androgens, in addition to traditional radiation therapy, can improve survival above and beyond radiation alone.

The researchers tell WebMD that their results confirm that such a combined therapy will benefit patients not only with advanced prostate cancer, as has been previously shown, but also those with the early stage of the disease.

A recognized way to help gauge whether a case of prostate cancer is more or less aggressive is to test for evidence of something called prostate-specific antigen, or PSA. At their annual prostate cancer screening, men should receive both a PSA blood test (the lower the score, the better) and a digital rectal examination in which the doctor physically checks for cancer and can feel whether or not any tumor that may be present remains confined to the prostate capsule, or if it has advanced to other parts of the body.

According to study leader Anthony V. D’Amico, MD, PhD, the recent findings show that “men with high PSA scores would benefit from the addition of six months of hormone therapy [along with] standard radiation even if the rectal exam shows that the cancer is localized to the prostate, and, therefore, in an early stage.” D’Amico is associate professor of radiation oncology at Harvard Medical School and chief of genitourinary radiation oncology at Brigham and Women’s Hospital and Dana Farber Cancer Institute in Boston.

Between January 1989 and August 1999, D’Amico’s team reviewed records of more than 1,500 men who had received standard radiation therapy with or without hormone therapyfor early-stage prostate cancer.

Prior to beginning treatment, patients had undergone testing and were organized into low-, intermediate-, and high-risk groups based on PSA scores, tumor biopsy results, and other variables. Although all the men had cancer confined to the prostate, “the risk measures the aggressiveness of the cancer,” D’Amico says. The men were checked regularly for the next five years, and then annually thereafter.

At five years, the outcomes were similar in both groups for low-risk patients, but were significantly better for both intermediate- and high-risk patients given combination therapy compared with those treated with radiation alone. The risk of having a significantly high PSA test score was two-and-a-half to five times higher for men who had received only radiation than for those who received radiation plus hormone suppression.

“This study doesn’t rule out the 2004 daily jan levitra order statistics that hormones may be useful in low risk patients,” D’Amico tells WebMD, “only that five years isn’t long enough to assess low-risk early-stage patients.” In fact, he says, the same benefit might be seen in the low-risk group after 10 years of follow-up.

There are three important points that men should take from the study, D’Amico says. “First, they should be getting annual PSA testing starting at the age of 50.” Black men and those with a family history of prostate cancer should get tested from age 40 because of higher risks, he adds.

Second, those who may be frightened by cancer treatment horror stories should know that “these hormones are not chemotherapy,” he says. “This is not a dysfunction erectile impotence treatment. There is no throwing up or hair loss, and it does not require alternative treatment for erectile dysfunction. Patients can continue working while undergoing the treatments.”

In general, D’Amico says, the hormone therapy side effects are similar to what a woman can experience during menopause. “Some mild [low blood cell count], maybe some weight gain, hot flashes, possibly breast tenderness. For the most part, they are reversible. “Although there is a chance that sexual function will be permanently affected by hormone therapy or radiation, Viagra can help about two-thirds of those patients who were sexually active beforehand,” D’Amico says.

And third, patients should learn what risk group they’re in, he says. “It’s not enough to know that your cancer is confined to the prostate.” With the advent of PSA testing, D’Amico tells WebMD, “almost everybody [diagnosed with] prostate cancer has [a] confined disease,” but some cases of cancer may be more aggressive, and these higher risk patients are perfect candidates for this combined therapy.

After reviewing the research for WebMD, Richard Valicenti, MD, says that the findings are not sufficient to dictate what treatment a patient should receive. Although he agrees that annual PSA screening is a good idea, “the whole premise here is that low PSA numbers equate with longer survival, and that’s not necessarily the case. That hasn’t been proven [definitively].”

Also, says Valicenti, who is assistant professor and director of clinical research at the Bodine Center for Cancer Treatment at Thomas Jefferson University Hospital in Philadelphia, “hormonal therapy is not a treatment that should be looked at lightly. It has risks — not only for sexual dysfunction, but also [for] muscular [soft viagra tablet], bone mineral loss, fatigue, overall reduction in quality of life. I do not view it as benign.”

According to Valicenti, when deciding on the best course of treatment, “a patient’s overall health, age, and other risk factors, as well as the patient’s treatment preference and willingness to accept a certain affect on their overall quality of life should all be taken into consideration.” Given this study’s “design and very short follow-up [period],” he tells WebMD that as a clinician, he “would use this data very cautiously for advising patients.”