Timing of Androgen Deprivation Treatment for Men with Biochemical Recurrent Prostate Cancer in the Context of Novel Therapies

[maley2711]

auajournals.org/doi/10.1097...

Published September, 2021

Conclusions

Men with biochemically recurrent prostate cancer, who defer hormone therapy until metastasis have overall survival that is quite long and the early initiation of continuous androgen deprivation therapy for biochemical relapse, may not meaningfully improve overall survival. Adequately designed prospectively randomized studies in patients with BCR testing the role of early vs deferred ADT remain critical to inform treatment decisions in this population and enhance patients’ and physicians’ understanding of the clinical significance of the nmCRPC pivotal studies.

Editorial Commentary........

auajournals.org/doi/10.1097...

These data provide context for patients with BCR and providers on whether to undergo ADT for years despite unproven benefit and quality of life impact. New imaging may help or further add to the controversy, since BCR patients may have metastases on newer imaging. Until definitive data are available, men with BCR should be counselled regarding the lack of data to support ADT benefit in nonmetastatic BCR.

[Tall_Allen]

Another worthless retrospective study. You can easily see the selection bias- the single biggest factor predicting metastasis was whether patients were treated at Johns Hopkins (5 times as likely to be met-free) and African-Americans had twice the rate of metastases vs Caucasians - In fact, African-Americans were twice as prevalent in the Walter Reed cohort.

Three randomized trials have now proven the value of short-term early intervention with advanced hormone therapy (Zytiga, Xtandi, and Erleada). I expect that PSMA PET scans will virtually eliminate the category of non-metastatic castration-resistant PCa.