Intermittent hormone therapy: its potential in early prostate cancer and intra-epithelial neoplasia

This paper reviews results from a pilot study of 40 patients entered on intermittent hormone therapy having achieved a PSA complete remission. The median time to clinical progression and need for further hormone therapy was 14 month; and 88% of patients retreated are progression-free at 1 year and an overall 88% are alive at 3 years. There was some evidence that there was slower progression to require treatment in older patients and those who had been on treatment for more than 15 months. Since the overall survival in this study is better than that of patients with M0 disease on hormone therapy in the immediate arm of the MRC immediate vs. deferred therapy study, it is thought reasonable to justify progression to a randomised trial. This should also include all patients failing to achieve PSA complete remission in order to examine the issue of whether androgen withdrawal is required in the terminal treatment phase of hormone resistance patients to keep the hormone sensitive clone under control.