**6. References**


PDE5 inhibitors.11 HIFU therapy can, therefore, preserve erectile function better than RRP

RRP and interstitial brachytherapy continuously decreased health-related QOL. External beam radiotherapy for localized prostate cancer aggravates the bowel function. Healthrelated QOL was significantly improved in patients treated with HIFU therapy at 24 months

Urinary incontinence is the most prominent side effect of radical prostatectomy. But, RALP might improve incontinence rates of patients. The urinary function of patients after brachytherapy and cryotherapy were similar. In HIFU, however maximum flow rate and residual urine volume were significantly impaired at 6 months after treatment, and data on maximum flow rate and residual urine volume recovered to baseline at 12, 24 months

Generally, potency rate was aggravated by injury to NVB after radical prostatectomy. Consequently, using RALP to preserve the NVB and prostatic fascia is important for preserving erectile function. Approximately 40% of patients in the external and interstitial brachytherapy groups preserved their pretreatment sexual status. In cryoablation, 3.7% and 14.3% of patients had partial erections at 6 weeks and 9 months after treatment. And, 21% and 24% of the patients had regained full potency at 18 and 24 months after cryosurgical ablation. After HIFU, 52%, 63% and 78% of patients who did not undergo NADT had regained full potency at 6, 12, and 24 months after treatment therapy. Furthermore, the potency rates were 39%, 62%, and 67% at 6, 12, and 24 months, respectively, without the use of PDE5 inhibitors. HIFU therapy can, therefore, preserve erectile function better than RRP,

[1] Litwin MS, Gore JL, Kwan L, et al. Quality of life after surgery, external beam irradiation, or brachytherapy for early-stage prostate cancer. *Cancer* 2007; 109: 2239-47. [2] Davis JW, Kuban DA, Lynch DF, et al. Quality of life after treatment for localized prostate cancer: differences based on treatment modality. *J Urol* 2001; 166: 947-52. [3] Brandeis JM, Litwin MS, Burnison CM, et al. Quality of life outcomes after brachytherapy for early stage prostate cancer. *J Urol* 2000; 163: 851-7. [4] Hamada Y, Kitani K, Kawano T, et al. Assessment of Quality of life in men treated for

[5] Clark JA, Inui TS, Silliman RA *et al*. Patients' perceptions of quality of life after treatment

for early prostatic cancer. *J. Clin. Oncol.* 2003; 21: 3777–84.

localized prostate cancer: before and after radical prostatectomy. *Nishinihon J Urol* 

and cryotherapy, and is similar to RALP.

**5. Conclusion** 

**5.1 QOL** 

after HIFU.

after HIFU.

**5.2 Urinary function** 

**5.3 Erectile function** 

radiotherapy, or cryotherapy.

2004; 66: 241-8.

**6. References** 


**18** 

*Austria* 

*2LKH Kittsee, Burgenland* 

**Intermittent Androgen Suppression** 

*1Ludwig Boltzmann Cluster of Translational Oncology, Vienna* 

**Therapy for Prostate Cancer Patients:** 

**A Choice for Improved Quality of Life?** 

Gerhard Hamilton1, Ulrike Olszewski-Hamilton1 and Gerhard Theyer2

Prostate cancer is among the most common types of malignancies and causes of cancerrelated deaths in men worldwide (Fitzpatrick, *et al*., 2009). Primary tumor involvement outside the prostatic capsule or relapse following radical prostatectomy results generally in incurability (Lassi & Dawson, 2009). Androgen deprivation therapy has progressed since attempts in 1941, when surgical castration had been shown to improve outcomes for the first time. Palliative treatment consists of hormonal manipulation to deprive the cancer cells of androgenic stimulation by orchidectomy or use of LHRH analogs and steroidal or nonsteroidal antiandrogens (Kollmeier & Zelefsky, 2008). Although continuous androgen suppression therapy (CAS) has been a cornerstone of the management of prostate cancer for more than 50 years, controversy remains regarding its optimum application. Generally, androgen suppression (AS) is performed as continuous treatment, resulting in apoptotic regression of the tumor cells in a high percentage of cases. However, surgical or medical castration results in median progression-free survival of only 2–3 years, with no other effective treatment left (Mellado, *et al*., 2009). Responses to cytotoxic therapy are low and only recently several studies revealed a possible benefit of incorporating chemotherapeutic agents in treatment regimen for prostate cancer (Chang & Kibel, 2009). Taxanes like docetaxel and cabazitaxel, therapeutic cancer vaccines and newly developed agents targeting androgen receptor signaling are expected to

Following experimental research using animal models, intermittent androgen suppression (IAS) was introduced as new clinical concept, assuming that during limited regrowth in the treatment cessation periods tumorigenic cells are residing in an androgen-responsive state (Goldenberg, *et al*., 1995). Since induction of androgen independence may occur early after treatment initiation, cessation of antiandrogen therapy prior to this switch is expected to maintain the apoptotic potential of the tumor cells and keep them sensitive to retreatment. Providing an easy method for selection of the type of treatment and early assessment of tumor growth during the off-periods serial serum PSA determinations made IAS feasible. In detail, IAS consists of an initial androgen suppression period of up to nine months combining LHRH antagonists and antiandrogens, which is followed by treatment cessation

**1. Introduction** 

improve therapy (Madan *et al*., 2011).

