A recent Finnish study released interim results comparing intermittent androgen deprivation (IAD) to continuous androgen deprivation (CAD) in 856 men. All the men had locally advanced or metastatic prostate cancer and they all were treated at 27 clinics in Finland.
The period of study was between 1997 and 2003 and all men were required to have a life expectancy of at least 12 months to be includer. All men received a 24 week cycle of continuous LHRH agonist therapy. The men were then randomized to IAD or CAD.
Mean age was 72 years and mean PSA at entry was 383ng/ml. The men had either stage T3 tumors (61%) and stage T4 tumors (29%). A total of 564 men completed the initial cycle of therapy and 279 were randomized to IAD and 285 to CAD.
PSA, alkaline phosphatase, proportion of T4 tumors, poorly differentiated tumors, metastatic disease, and skeletal hot spots among men with M1 disease were significantly higher in the IAD group. Baseline testosterone was not significantly different.
A significant proportion of men with the most aggressive and advanced CaP did not respond to the original cycle of androgen deprivation therapy. Men with advanced CaP, with a high PSA, alkaline phosphatase and metastatic disease, with more than 5 skeletal hot spots, did not show adequate biochemical response to ADT and should be considered for alternate treatments.
The investigators concluded that IAD appears feasible for patients with locally advanced, hormone sensitive CaP. A low limit of testosterone at baseline did not select for IAD or CAD.
This research is consistent with prior findings from other studies already conducted. If you are on hormone therapy and responding, talk with your doctor and evaluate if you are a candidate for intermittent treatment.
Salonen AJ, Viitanen J, Lundstedt S, Ala-Opas M, Taari K, Tammela TL
J Urol. 2008 Jul 15. Epub ahead of print.
Joel T Nowak MA, MSW