Current practice has been to immediately begin hormone therapy (ADT) as soon as a man has a bio-chemical (PSA only) relapse. A recent presentation at ASCO 2014 has shown that immediate ADT actually offers little or no survival benefit over deferred ADT to advanced prostate cancer survivors who experience a PSA only relapse after radical prostatectomy or radiotherapy failure.
In this presentation, Xabier Garcia-Albeniz, MD, Harvard School of Public Health, Boston, and colleagues studied 2,022 men in the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE), a national, prospective registry. All the men evaluated had either a radical prostatectomy or radiotherapy and then experienced PSA-only relapse. Researchers defined PSA relapse as a PSA level greater than 0.2 ng/mL after radical prostatectomy or 3 PSA rises one month apart after radiotherapy.
Their subjects had a median age of 69 years, and 33.8% had a Gleason score greater than 7. The investigators defined immediate ADT as ADT started within 3 months after PSA relapse and deferred ADT as ADT started 2 or more years after the PSA relapse or when they presented with metastasis, symptoms, or a short PSA doubling time. Following their recurrences, men had a median follow-up of 53.2 months.
The researchers found that compared with deferred ADT, immediate ADT was associated with a 6% increased risk of all-cause mortality and a 48% increased risk of prostate cancer-specific mortality, which corresponded to a -5.5% and -5.6% survival difference at 5 years, respectively.
THE CONCLUSION: Immediate ADT offers little or no survival advantage over delayed ADT
Joel T. Nowak, M.A., M.S.W.