NEW YORK (Reuters Health) - Withdrawing hormonal therapy appears safe for elderly patients with advanced prostate cancer who are asymptomatic and have achieved an undetectable PSA level after prolonged androgen blockade, according to a report in the April issue of Urology.

Dr. Arnold M. Kwart and Dr. Roberto Pedraza from Washington Hospital Center, Washington, DC, examined the hormonal and biochemical response to withdrawal of luteinizing hormone-releasing hormone (LHRH) agonist therapy in four prostate cancer patients, ranging in age from 74 to 83 years, who had an undetectable PSA and had undergone prolonged treatment.

All of the patients achieved and maintained a persistent undetectable PSA level during the period of total androgen blockade. After the androgen blockade was ceased, measurement of PSA and testosterone were taken at baseline and every 6 months for 36 months. In addition, serum LH was measured at baseline, 6, 18 and 36 months.

"At the time hormonal therapy was discontinued, the patients had received LHRH agonist/antiandrogen therapy for a mean of 108 months," Drs. Kwart and Pedraza explain.

"All patients had castrate levels of testosterone at the end of the 3-year follow-up period," the investigators report. Also, LH levels were in the normal range in three patient at 6 and 18 months, and all four were asymptomatic and had undetectable PSA levels throughout follow-up.

The authors note that the patients were elderly, which may have contributed to the persistent suppression of testosterone. Also, they say, their observations suggest that prolonged androgen suppression might result in irreversible impairment of Leydig cell function.

Whatever the mechanism, they point out that withdrawing hormonal therapy has economic advantages, with savings of $10,000 per patient per year.

Urology 2003;61:770-773.

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