March 16, 2009 -- Question: When is chemotherapy combined with other treatments or medications such as hormone therapy?
Answer: When patients develop disease that is metastatic to their bone or lymph nodes, the standard of care has always been to put them on hormonal therapy. As a requisite to maintain levels of testosterone that are at, quote, "castrate" levels, in other words, to remove the testosterone that can be causing the tumor to grow, we recommend that patients remain on a GnRH agonist, meaning Lupron or Zoladex, for an indefinite period of time, the reason being that, if we remove it too soon, testosterone will return, and, therefore, the cancer will once again be stimulated.
So it's really by convention that we keep people on the GnRH agonist for an indefinite period of time, usually for their entire life. It is not a contraindication giving chemotherapy. In fact, we always combine other drugs along with the Lupron or Zoladex in an effort to maintain that castrated state.