When hormone therapy is used to supplement seed implantation (or any other treatment), it is commonly referred to as "neoadjuvant" hormonal therapy, when given before the primary treatment, or "adjuvant" therapy", when given during or after treatment.
To date, the initial medical research has not yielded any strong indication that the addition of hormone therapy to radiation or surgical treatment provides any clear advantage in terms of increased cancer control rates for early stage cancer. There is, however, some evidence that hormone therapy can have a positive effect when it is used with external beam radiation to treat "locally advanced" cancer, that is, cancer which has spread to the tissue just outside the prostate gland.
More research into the use of hormone therapy in early stage prostate cancer will be required to before any firm conclusions can be drawn. In this regard, the Seattle Prostate Institute, along with a number of other brachytherapy centers across the country, is involved in a randomized study to explore the effect of hormone therapy on intermediate and high-risk patients treated with a combination of seeds and external beam radiation.
The guidelines described above for deciding on when to use seed implants alone
or in combination with other therapies have been stated in very broad terms and should not be considered as absolute rules. Clearly, cancer is a complex disease and the array of diagnostic tools and treatment options all have limitations. Moreover, experienced clinicians may differ somewhat in their assessment of patients with
similar characteristics. Clinical judgement, patient preferences and tolerances, and many other factors are considered when making decisions regarding treatment. The chances for the best possible outcomes, therefore, are increased when well-informed patients work in close consultation with experienced physicians.
In general, adding hormone therapy to seed implantation has had to do primarily with the capacity of the chemical agents to shrink prostate cells, both normal and cancerous. When a man has a prostate gland that is too large, part of the gland can end up lodged behind the pubic bone of the pelvis, effectively blocking the insertion of needles into that part of the gland. (Figure 7) In these instances,
several months of hormone therapy can reduce the size of the prostate by
as much as 40%, making the entire gland within reach of the needles. (Figure 8)
