Intermittent androgen deprivation for biologic recurrence after radical prostatectomy: long-term experience

To analyze the oncologic results of intermittent androgen deprivation (IAD) for biochemical recurrence after radical prostatectomy (RP).

A total of 57 patients with biochemical recurrence after RP have been treated with IAD at our institution. The 57 patients were divided into two groups: group 1 comprised 29 patients who received salvage radiotherapy after RP; group 2 comprised 28 patients who did not receive salvage radiotherapy. Hormonal therapy during the first treatment phase consisted of an antiandrogen alone. This treatment was maintained for 3 months after the prostate-specific antigen (PSA) level had become undetectable and was then discontinued. Hormonal therapy was resumed when the PSA level exceeded 4 ng/mL; treatment was discontinued when the PSA level dropped to less than 1 ng/mL.

The patients in group 1 had less favorable characteristics than those in group 2 in terms of pathologic stage and Gleason score. Overall, the median follow-up after starting hormonal therapy was 92 months (range 36 to 176). The percentage of each cycle that was spent "off" treatment decreased from 60% to 50%. During follow-up, 38.6% of patients required a luteinizing hormone-releasing hormone analog for nonresponse to the antiandrogen alone, and 15.8% experienced metastatic progression. The cancer-specific mortality rate was 12.3%; all patients who died of prostate cancer were from group 1. The median interval between initiation of hormonal therapy and cancer-related death was 86 months.

In our experience, IAD for biochemical recurrence after RP provided satisfactory long-term oncologic results. Our data suggest that IAD can be initiated with an antiandrogen alone.