Early results of LH-RH agonist treatment with or without chlormadinone acetate for hormone therapy of naive localized or locally advanced prostate cancer: A prospective and randomized study

Background: The majority of patients with localized and some cases of local ly advanced prostate cancer undergo radical prostatectomy. However, radical prostatectomy cannot always be selected for those patients. In this situat ion, primary hormone therapy is an alternative treatment option. We have de signed a prospective randomized study of the effects of primary hormone the rapy for such patients. Methods: A total of 151 patients with T1b, T1c, T2a, T2b or T3a prostate ca ncer who were not scheduled for radical prostatectomy were enrolled into th is study. Patients were randomly allocated into two groups; Group I receive d luteinizing hormone-releasing hormone (LH-RH) agonist monotherapy (leupro relin acetate depot, 3.75 mg monthly) and Group II received LH-RH agonist i n combination with chlormadinone acetate (100 mg/day). Effects on serum pro state-specific antigen level, progression-free survival and survival were o bserved for 2 years. Results: The reasons why radical prostatectomy was not scheduled were poor risk for surgery (38%), patient's wish (32%) and physician's recommendation (30%). After 12 weeks of treatment, 49% of the patients in both groups sho wed a complete response (CR). Of the patients showing a partial response (P R) after 12 weeks of treatment, 25% in Group I and 52% in Group II improved to CR 1 year later (p < 0.05). Group II showed a longer progression-free s urvival (p < 0.05). Progression-free survival rates were 62% (Group I) and 91%(Group II) in T2b patients and 43% (Group I) and 73% (Group II) in T3 pa tients. Only one patient in each group died from prostate cancer. Conclusions: Early primary hormone therapy is a reasonable treatment option for localized or locally advanced prostate cancer patients if radical pros tatectomy was not scheduled. Chlormadinone acetate showed an additive effec t with LH-RH agonist, at least in 2 years' observation.