One of our biggest disputes around hormone deprivation (ADT) concerns the question of scheduling. Traditionally, ADT involved staying on the therapy drug forever. However, ADT causes significant side effects that negatively impacts both the quality of life as well as posing potential significant medical problems.

Over the last five or so years there has been a move to alter the schedule of using ADT drugs allowing men to have a resting period “off” the drugs (Intermittent ADT). Most men experience an improvement in their quality of life during theses “off” periods and there is also evidence that some of the negative medical problems are also mediated. However, it remains unclear if there is a significant difference in the eventual outcomes of the different dosing schedule, with some doctors expressing concern that intermittent use of ADT drugs are much less effective.

There has also been a small group of doctors have also experimented scheduling ADT drugs based on strict monitoring of testosterone levels (T-Based) where on and off dosing was reliant upon careful monitoring of the testosterone levels with the goal of always keeping the testosterone level below a predetermine level (ideally <20 ng/dl). Questions and debates have been raised about the comparative efficacy of theses different scheduling paradigms. A recent paper in by Blumberg et. al., published in Urology has suggested that intermittent and T-based regimens are less likely to be associated with early onset of castration resistances when compared to traditional continuous therapy.