Benefits of intermittent/continuous androgen deprivation in patients with advanced prostate cancer.

[pjoshea13]

New study below [1].

From a meta-analysis published in December [2]:

"Intermittent androgen deprivation was not inferior to continuous therapy with respect to the overall survival. Some quality-of-life criteria seemed improved with intermittent therapy. Intermittent androgen deprivation can be considered as an alternative option in patients with recurrent or metastatic prostate cancer."

However, in the new study:

"Evolution towards castrate resistant prostate cancer: 12.5% from the intermittent androgen deprivation group and 23.8% from the continuous androgen deprivation group. Mortality rate: 15% of patients from the intermittent androgen deprivation group; 19% of patients from the continuous androgen deprivation group."

"Our principal aim was to demonstrate longer survival rates on prostate cancer patients with intermittent androgen deprivation."

Only 82 patients, & no indication as to how/why they ended up in IADT versus CADT.

A Romanian study published in Clujul Med. No doubt read with avid interest by doctors in Cluj-Napoca & throughout Romania.

-Patrick

[1] ncbi.nlm.nih.gov/pubmed/275...

Clujul Med. 2016;89(3):419-22. doi: 10.15386/cjmed-594. Epub 2016 Jul 28.

Benefits of intermittent/continuous androgen deprivation in patients with advanced prostate cancer.

Muresanu H1.

Author information

1Vasile Goldis West University, Faculty of Medicine, Pharmacy and Dentistry, Arad, Romania.

Abstract

BACKGROUND AND AIMS:

In 1941 Huggins described the effect of castration on prostate cancer. gonadotropin-releasing hormone (GNRH) analogues were introduced in 1985. Complete androgen blockade (association of GNRH analogue with antiandrogen) was introduced by Fernand Labrie to achieve suppression of suprarenal testosterone. Long time androgen deprivation lead to androgen independence of the prostate cancer cell. Our principal aim was to demonstrate longer survival rates on prostate cancer patients with intermittent androgen deprivation.

METHODS:

82 patients in the Urology Department of Vasile Goldis West University Arad were included into two groups, with continuous and intermittent androgen deprivation.Treatment efficiency was assessed by the level of testosterone and PSA.Adverse events (AE) and serious adverse events were reported according to Common Terminology Criteria of Adverse Events (CTCAE) of the National Cancer Institute (NCI).

RESULTS:

Evolution towards castrate resistant prostate cancer: 12.5% from the intermittent androgen deprivation group and 23.8% from the continuous androgen deprivation groupMortality rate: 15% of patients from the intermittent androgen deprivation group; 19% of patients from the continuous androgen deprivation group.

CONCLUSIONS:

Better quality of life (Qol) in periods without treatment due to testosteron recovery;Less AE's and metabolic syndrome (MS) related complications;Better survival and longer time of disease control andCost reduction.

KEYWORDS:

GNRH antagonist; Qol; androgen deprivation

PMID: 27547063 DOI: 10.15386/cjmed-594

[PubMed]

[2] ncbi.nlm.nih.gov/pubmed/263...

[Hidden]

That's good to know. I am going to request that from my urologist and see how he reacts.

[Burnett1948]

@+Burnett1948. Thanks for this info. I have had a Urologist tell me I should start hormone now when my PSA was .87 for 12 months: he said that's all it will need; a Radiation Oncologist(now retired) previously suggested Intermediate hormone when my PSA reached 3 and his Replacement Oncologist now plans on starting hormone treatment when my PSA reaches 8 (I understand continuous treatment). My latest PSA is 1.4.

I am thinking, as I write this I should have taken the Urologist's advice.

Has anybody got any advice/experience please?

[JoelT in reply to Burnett1948]

I have written a lot about the pros and cons of intermittent v continuous ADT on the advanced prostate cancer blog (advancedprostatecancer.net). I suggest that you go to the blog and search ADT, etc.

In brief, there are conflicting studies about the survival differences between the two types of ADT schedules. Some studies have indicated that neither is superior or inferior and some have shown that continuous is superior.

The largest of the studies that showed that intermittent was inferior was performed by Dr. M.Hussein when she was at the Univ of Michigan. My opinion is that there was a design issue that could have effected the result. My issue with the study is that it did not accurately reflect how intermittent ADT is practiced in the real world.

For the purpose of standardization in the trial she had fixed points that were predetermined for starting and stopping the therapy regardless of the individual's disease (no consideration of Gleason grade, doubling time, etc.). In the real world starting and stopping PSA numbers are not standard and are usually adjusted based on an individual clinical situations.

On the other hand there have been European studies that clearly show that neither therapy schedule is better (based on survival times) than the other.

What is universally clear and understood is that the quality of life is superior with intermittent ADT.

Not all men are good candidates for intermittent therapy. Men with more aggressive disease (higher Gleason grades, faster doubling times etc.) should not consider intermittent therapy.

If you do decided on intermittent therapy, due to the question of inferiority of this schedule you should decide how comfortable you are with additional risk. Given today's knowledge you should still think about how much risk you are prepared to take on. This type of decision involves knowing your disease and knowing your personal tolerance for risk.

Using intermittent therapy, or making decisions about when to start, how long to continue and when to stop should be made with careful consultations with experienced prostate cancer oncologists. A very experienced oncologist who is a specialist in prostate cancer should help guide you, don't rely on a general oncologist, get a specialist.

Joel

[BigRich in reply to JoelT]

"Not all men are good candidates for intermittent therapy. Men with more aggressive disease (higher Gleason grades, faster doubling times etc.) should not consider intermittent therapy." Everyone should be aware of your statement.

You gave a very valuable insight to the reluctant brotherhood.

Thank You,

Rich

[JoelT in reply to BigRich]

Thank you Rich

Joel

[Burnett1948 in reply to BigRich]

@+Burnett1948. BigRich thanks for your comment. I am still to read JoelT's blog keeping your advice in mind.

[Burnett1948 in reply to JoelT]

@+Burnett1948. JoelT, thank you very much for your information and your work/research; much appreciated . Based on what you have said I take it that a radiation Oncologist is not a Specialist Oncologist. My Radiation Oncologist has told me she will refer me to General Oncologist at her Hospital at the time my PSA reaches 8. I will check to find out if he is a experienced prostate cancer oncologist. Based on your information I will ask for continuous hormone treatment. My prostate cancer is recurrent I have had the operation in 2005 and Salvation radiation in 2009. I still intend reading your blog. Again thank you.

[JoelT in reply to Burnett1948]

A radiation oncologist is a specialists in the use of radiation. Anyone with advanced prostate cancer should have a MEDICAL oncologist who specializes in the treatment Of prostate cancer as their main doctor. A general oncologist might not be as versed in the current treatment modalities and will not have developed the art part of treatment given that they treat many other cancers.

The rule in medicine is the more experienced a doctor the better the outcomes.

Joel

[wellness in reply to JoelT]

Thanks for this. Can you recommend anyone to consult with who takes Medicare? I am in N CA near the oregon border, willing to travel on W coast. My oncologist is NOT a prostate cancer expert.

[JoelT]

If you would go to LA I would recommend Mark Scholtz, MD.