Comparing Intermittent To Continuous Androgen Deprivation For Advanced Prostate Cancer

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Cancer / Oncology
Article Date: 16 Aug 2008 - 0:00 PDT

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UroToday.com - Dr. Arto Salonen and Finnish colleagues compared intermittent androgen deprivation (IAD) to continuous androgen deprivation (CAD) in 856 patients with locally advanced or metastatic prostate cancer (CaP) treated at 27 clinics in Finland. This report represents an interim analysis of their data.

The patients were accrued between 1997 and 2003 and had a life expectancy of at least 12 months. A 24 week run in of continuous LHRH agonist therapy preceded randomization for those who had a PSA decrease to <10.0ng/ml, or at least 50% if the baseline value at the initial visit was <20.0ng/ml. Patients were then randomized to IAD or continuous therapy.

Mean patient age was 72 years and mean PSA at entry was 383ng/ml. Patients had stage T3 tumors (61%) and stage T4 tumors (29%). A total of 564 men completed the run-in period and 279 were randomized to IAD and 285 to CAD. PSA, alkaline phosphatase, proportion of T4 tumors, poorly differentiated tumors, metastatic disease, and skeletal hot spots among patients with M1 disease were significantly higher in the IAD group. Baseline testosterone was not significant in the analysis.

A significant proportion of patients with the most aggressive and advanced CaP did not respond to androgen deprivation therapy. The investigators concluded that IAD appears feasible for patients with locally advanced, hormone sensitive CaP. A low limit of testosterone at baseline did not select for IAD or CAD. Patients with advanced CaP, with a high PSA, alkaline phosphatase and metastatic disease, with more than 5 skeletal hot spots, did not show adequate biochemical response to ADT. Thus, they are not good candidates for IAD and other modalities should be considered.

Salonen AJ, Viitanen J, Lundstedt S, Ala-Opas M, Taari K, Tammela TL
J Urol. 2008 Jul 15. Epub ahead of print.
doi:10.1016/j.juro.2008.05.009

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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