Harvard Perspectives on Prostate Disease

Intermittent hormone therapy: A patient's story

In 1995, Patrick Kirby,* an elite runner, went to his doctor for a routine check-up. During the digital rectal exam, the physician felt a suspicious nodule on Mr. Kirby's prostate gland. A subsequent blood test showed an elevated PSA of about 10 ng/ml, well above the normal range of 0 to 4 ng/ml. Concerned, the physician sent him for a prostate biopsy, which came back negative. When the PSA continued to rise, Mr. Kirby endured a second biopsy in 1996 and was disheartened by the results: he had prostate cancer. The cancer was scored 3 + 3 on the Gleason scale, indicating a moderately aggressive cancer. In an effort to determine the extent of the tumor, doctors performed an endorectal MRI, but the test didn't definitively determine whether the cancer had spread beyond the prostate capsule.

*Editor's note: To protect his privacy, the patient's name and some biographical details have been changed. All medical details are as reported. In keeping with editorial policy, the patient's physicians are not named.

While Mr. Kirby debated whether to have surgery or radiation, a specialist prescribed hormone therapy to keep the cancer in check. (See "Neoadjuvant hormone therapy.") Ultimately, Mr. Kirby opted for a radical prostatectomy in 1997. Unfortunately, his PSA then began to rise "" from undetectable to 0.7 ng/ml in less than a year "" prompting treatment with radiation therapy and a second round of hormone therapy. Once again, his PSA dropped to undetectable levels.

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