There are different methods of performing ADT; these methods include continuous or intermittent as well as differences in the actual blockade itself. Understanding the superior schedule as well as the superior combination of drugs can both delay the onset to castrate resistance as well as provide for a longer overall survival (OS).
In a research study Combined Androgen Therapy (CAB) with more then one drug having different modes of action was compared to Monotherapy where only one drug was used for the ADT. The researchers defined the time to the on set of Castrate Resistant Prostate Cancer (CRPC) as PSA progression or other disease progression. They stratified the men into three risk groups using JCAPRA score (JCO 2009; 26: 4309). In addition to the time to CRPC, overall survival length (OS) after initiating ADT was analyzed.
They found that the time to CRPC was significantly longer in the CAB group than in the monotherapy group in both the intermediate and high risk groups. They also found that in the intermediate and high risk groups OS was significantly longer for the men with CAB.
Monotherapy can be attractive because it inherently will cause less side effects, however for men with intermediate and high risk prostate cancer that is still hormonally responsive CAB should be considered superior. Men on CAB had a longer duration to developing CRPC as well as a longer OS.
J Clin Oncol 30, 2012 (suppl; abstr e15106): Hideyuki Akaza, Shiro Hinotsu, Japan Prostate Cancer Study Group (J-CaP); Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo, Japan; Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
Joel T Nowak, M.A., M.S.W.