Hidoc Bulletin

Prostate cancer (PCa), one of the current world’s major health concerns has the highest incidence of any type of cancer. It is the 2nd most common type of cancer and the 5th most frequent cause of cancer-related death in men worldwide. PCa develops after the age of fifty in men. Unfortunately, many patients do not have indications, they don’t take treatment & 2/3rd of cases of PCa grow slowly. High-risk tumour predicts prostate-specific antigen (PSA) levels ≥20ng/mL, stage T3-T4 disease, or Gleason scores ≥7. These characteristics are represented by 20-30% of PCa patients.

Current treatments

Hormone therapy & external beam radiotherapy alone are found to be effective and acceptable methods in locally advanced PCa. Both methods have certain side effects

Radiation therapy

• Frequent urge to urinate, dysuria, nocturia & genitourinary irritation

• Enhanced desire to defecate & rectal mucus passage or bleeding

• Raise in risk of development of secondary malignancies in 10-15 years

Hormone therapy

• Palpitation, hot flashes, headache, tiredness, fatigue & gynecomastia

• Libido loss & erectile dysfunction

• Weight gain or loss of muscle mass

• Mood swings, depression & impaired vision

• Cardiac attack & stroke

Why is radiation therapy & hormone therapy combination beneficial?

Treatment of high-risk PCa is not easy due to its poorer interpretation. One of the chief therapies for enlarged prostrate (>60 mL) is a combination of radiation therapy and hormone therapy.

The rationale of radiation therapy with hormone therapy

Neoadjuvant therapy includes hormone therapy, simultaneously adjuvant therapy of percutaneous radiation is provided. Androgen receptor blockers like bicalutamide or gonadotropin-releasing.

hormone & agonists like goserelin or antagonists like degarelix are also prescribed. Hormone therapy sterilizes occult metastases & radiation kills tumour cells irrespective of hormone sensitivity in cumulative cooperation. This unique combination offers 1. Increasing dose allowance with low toxicity offers prostatic volume debulking 2. Enhanced radiosensitivity due to tumour hypoxia reduction 3. Decrease cell repopulation during radiation therapy because of cell cycle slowing 4. Immunomodulation-induced apoptosis and direct effect on tumour cells 5. Supra-additive effect The advantages of combination therapy include better biochemical regulation, up to 50% drop in prostate volume, cancer-specific & relapse-free survival & overall improved survival benefits & lowered cancer reappearance and positive influence on total mortality & disease-specific mortality rate.

Conclusion

Combination therapy of radiation & hormone therapy in PCa requires more focused clinical trials in order to make it more suitable & usable. Simultaneously detailed patient investigation records including the onset of PCa, evolution, statin intake, diet habits & patterns, daily lifestyle, weight & body mass index, smoking and PCa screening type needs to be maintained. A combination of radiation & hormone therapy can be used as a remedy choice for moderate to high-risk localized PCa patients but the benefit is still not very clear in low-risk PCa patients. While using the combination therapy side effects should be managed efficiently and promptly.