An informative and comprehensive analysis of existing research studies evaluating the merits of early vs. deferred commencement of hormone therapy in men with advanced prostate cancer was recently published. The analysis (Wilt T, Nair B, MacDonald R, Rutks I. Early versus deferred androgen suppression in the treatment of advanced prostatic cancer. Cochrane Database of Systematic Reviews 2001, Issue 4. Art. No.: CD003506. DOI: 10.1002/14651858.CD003506,) concluded that early androgen therapy for men dealing with advanced prostate cancer reduces disease progression and complications due to the progression. Additionally, it concluded that early androgen therapy may provide a small but statistically significant improvement in overall survival at 10 years, but not sooner.

The researchers felt that the results of this analysis were not always clear-cut. Many of the reviewed studies had a great variability in design, stage of cancer in the enrolled men, interventions utilized by the study, definitions and reporting of outcomes and the lack of PSA testing for diagnostic and monitoring purposes, (the studies predated the use of PSA).

The studies evaluated came from both general and specialized databases (MEDLINE, EMBASE, CancerLIT, Cochrane Library, VA Cochrane Prostate Disease register) and by reviewing bibliographies including those of the Blue Cross and Blue Shield Association Technology Evaluation Center/Evidence-based Practice Center of the Agency for Healthcare Research and Quality (BCBS/TEC-AHRQ) report No.4.

Four trials involving 2167 patients were ultimately included in this review. There was a large variability between studies regarding the treatments used and the requirements for when treatment was initiated.

When the data showing the difference in overall survival was pooled, it favored (not statically significant) early therapy but was significant only at 10 years when few patients in either cohort were still alive. Each study defined differently progression free survival, but all studies found progression free survival was consistently better in the early intervention group at all time points.

Joel T Nowak MA, MSW