What are the benefits and limitations of medical treatment for a protactinoma?
Medical therapy is usually more effective than surgery for this tumor type, particularly for large tumors (macroadenoma, > 10 mm). In patients with large tumors, surgery results in normal prolactin levels in < 20% of patients. Surgery is effective in removing the bulk of the tumor, but prolactin levels remain elevated; surgery does not produce a "cure". In this situation, medical treatment is indicated. In patients who have a small tumor (< 10 mm), the chances of a "cure" with surgery are greater, on the order of 80% to 90%. However, even with successful surgery, there is a risk of recurrence of the tumor at a later date (months, years); approximately 13% to 20% of patients have a recurrence of elevated prolactin within 5 years of surgery.
