Cancer Program Annual Report - St. Clair Hospital

Hormone Therapy Compliance Study
Fall 2011
Kevin P. Bordeau, MD, FACS
Introduction
Prostate Cancer remains the second most common form of cancer in men
worldwide, with approximately 2.6 million men being diagnosed since 1995, and nearly
375,000 have lost their lives to the disease from 1995 to 2007. Although prostate cancer is
often thought of as a slow growing disease, it still has some fairly aggressive variants which
can cause not only death, but significant morbidity. The recent controversy over PSA
screening does not highlight this fact and therefore it is the opinion of the urologic
community that PSA testing can be a valuable tool in diagnosing and treating men with
prostate cancer.
Once a diagnosis of prostate cancer has been determined, disease factors such as
the pre-treatment PSA, Gleason score and digital rectal exam can be combined with patient factors such as age,
body habitus and co-morbidities to determine an appropriate treatment plan. The disease factors are used to
stratify patients as low, intermediate or high risk according to the following parameters:
Low Risk: PSA< 10 ng/mL and a Gleason score of 6 or less
Intermediate Risk: PSA >10 to 20 ng/mL or a Gleason score of 7 or
palpable disease on DRE
High Risk: PSA> 20 ng/mL or a Gleason score of 8 to 10
The treatment of the disease will vary according to the risk stratification. Options range from active
surveillance (i.e. monitoring the PSA without any form of active treatment), LHRH agonist therapy only, which
reduces the PSA and shrinks the cancer but does not definitively cure the cancer, radiation options including
brachytherapy and intensity modulated radiation therapy, and surgical removal. Randomized controlled studies
have shown that the combination of radiation therapy and LHRH agonist therapy is superior to radiation alone for
intermediate and high risk patients. It is, therefore, standard practice to give LHRH agonist therapy prior, during
and after radiation for these patients.
In an effort to strive to achieve excellent outcomes in our prostate cancer patients, we have undertaken this
study to look at our compliance with accepted treatment guidelines.
Methods
A retrospective chart review was performed by the staff from our office and the cancer registry, looking at
charts from 2009 and 2010, with an initial diagnosis of prostate cancer. These patients were then stratified based
on the above risk levels, and it was determined whether the patients that received radiation therapy did in fact
receive LHRH agonist therapy in accordance with accepted guidelines.
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