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Intermittent androgen suppression for rising PSA level after radiotherapy
Juanita M Crook1, Christopher J O'Callaghan, Graeme Duncan
1British Columbia Cancer Agency, Cancer Centre for the Southern Interior, 399 Royal Ave., Kelowna, BC V1Y 5L3, Canada. jcrook@bccancer.bc.ca
The New England Journal of Medicine
|August 31, 2012
Summary
Intermittent androgen deprivation (IAD) is as effective as continuous therapy for overall survival in prostate cancer patients with rising PSA after radiotherapy. IAD also showed improvements in quality of life and testosterone recovery.
Area of Science:
- Oncology
- Urology
- Clinical Trials
Background:
- Rising prostate-specific antigen (PSA) after radiotherapy for prostate cancer can indicate recurrence or resistance.
- Intermittent androgen deprivation (IAD) is a treatment strategy that may improve quality of life and delay hormone resistance compared to continuous therapy.
Purpose of the Study:
- To assess overall survival in patients with PSA elevation after radiotherapy using intermittent versus continuous androgen deprivation.
- To evaluate secondary endpoints including quality of life and time to castration-resistant disease.
Main Methods:
- A noninferiority randomized trial enrolled 1386 patients with PSA > 3 ng/mL post-radiotherapy.
- Patients received either intermittent (8-month cycles with PSA-guided breaks) or continuous androgen deprivation therapy.
- Primary endpoint was overall survival; secondary endpoints included quality of life and time to castration-resistant disease.
Main Results:
- No significant difference in overall survival between intermittent (median 8.8 years) and continuous (median 9.1 years) androgen deprivation (HR 1.02).
- Intermittent therapy showed improvements in quality of life, including physical function, fatigue, libido, and erectile function.
- Testosterone recovery occurred in 35% of patients with full recovery and 79% with recovery to baseline threshold in the intermittent group.
Conclusions:
- Intermittent androgen deprivation is noninferior to continuous therapy for overall survival in men with rising PSA after prostate cancer radiotherapy.
- Intermittent androgen deprivation offers potential quality-of-life benefits and improved testosterone recovery without compromising survival outcomes.
