Intermittent androgen suppression for prostate cancer: rationale and clinical experience

Area of Science:

• Oncology
• Urology
• Endocrinology

Background:

• Current maximal androgen ablation for prostate cancer increases side effects and expense without prolonging time to androgen-independent progression.
• Androgen ablation is palliative, not curative, necessitating a focus on patient quality of life.

Purpose of the Study:

• To review the rationale behind intermittent androgen suppression (IAS) for prostate cancer.
• To compare published observations of IAS therapy.
• To discuss potential indications and treatment strategies for IAS.

Main Methods:

• Review of existing literature on androgen suppression therapies for prostate cancer.
• Analysis of animal model studies on androgen deprivation and replacement.
• Examination of clinical data from non-randomized patient groups using IAS with serum PSA as a trigger.

Main Results:

• Animal models suggest intermittent androgen replacement can modulate adaptive responses to androgen deprivation, potentially delaying progression to androgen independence.
• Feasibility studies in non-randomized patient groups indicate prostate cancer is amenable to control with IAS.
• IAS may balance the benefits of androgen ablation (delayed progression, prolonged survival) with reduced side effects and costs.

Conclusions:

• IAS presents a potential strategy to improve quality of life for prostate cancer patients undergoing hormonal therapy.
• Further randomized, prospective studies are needed to definitively assess the impact of IAS on time to progression and survival.
• IAS warrants consideration as a treatment strategy, balancing efficacy with patient well-being.