There has been along standing controversy pertaining to the timing of ADT initiation (i.e. early verses late).
However, in 2002 the Cochrane meta-analysis (Nair B, Wilt T, MacDonald R et al., “Early versus Deferred Androgen Suppression in the Treatment of Advanced Prostate Cancer”, Cochrane Database Syst Rev (2002); (1): CD003506) clarified this issue.
Initiating early ADT immediately at the time of diagnosis of metastic disease, rather than delaying the commencement of treatment until symptom development, was associated with significantly higher progression-free survival. In addition, early initiation also demonstrated lower morbidity rates and a significant increase in overall survival at 10 years.
Thoughts of who are recently diagnosed with advanced disease must insist that we start Hormone Suppression immediately upon diagnosis.
Joel T Nowak MA, MSW
i just started my eligard shot today. just adt1 not 2or3. it took the doctor a year to give it to me after failed surgery and failed radiation. he said i should wait longer when my symptoms come on stronger. my staging is t3anomx with gleason 9 and have been asking about androgen deprivation therapy for 7 months. had to go to a known specialist in pc before my doctor would consider giving me adt. my doctor kept giving me the quality of life issue as the reason of not giving it sooner.
Hello Joel,
Although I agree with you the problem continues to haunt those trying to decide. Look at the conclusions of the study mentioned:
REVIEWER’S CONCLUSIONS: The evidence from randomized controlled trials is limited by the variability in study design, stage of cancer and subjects enrolled, interventions utilized, definitions and reporting of outcomes and the lack of PSA testing for diagnostic and monitoring purposes. However, the available information suggests that early androgen suppression for treatment of advanced prostate cancer reduces disease progression and complications due to progression. Early androgen suppression may provide a small but statistically significant improvement in overall survival at 10 years. There was no statistically significant difference in prostate cancer specific survival but a clinically important difference could not be excluded. These outcomes need to be evaluated with the evidence suggesting higher costs and more frequent treatment related adverse effects with early therapy. Additional studies are required to evaluate more definitively the efficacy and adverse effects of early versus delayed androgen suppression in men with prostate cancer. In particular trials should evaluate patients with advanced prostate cancer diagnosed by PSA testing and men with persistent or rising PSA levels following treatment options (e.g. radical prostatectomy, radiation therapy or observation) for clinically localized disease.
PMID: 11869665 [PubMed – indexed for MEDLINE]
Many, many doctors continue to ignore preliminary evidence that supports early versus delayed suppression. “More studies needed” More continue to die. Unfortunate, but true…
Best regards,
RalphV