A recently previewed (prior to the upcoming ASCO Annual Meeting) of a large study shows that men with prostate cancer who had a PSA-based relapse (Biochemical Recurrence) could delay starting androgen deprivation therapy (ADT) until they started experiencing symptoms from the cancer. They found that this delay would not affect the men’s long-term survival.

The study was a large (2,022 men) prospective, observational study that was a part of the national prospective registry CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor).

They found that an estimated 5-year overall survival among the group of men who had delayed ADT was 87.2% compared with 85.1% for those who had immediate ADT following a PSA-based relapse.

The ten-year survival was 71.6% for both groups.

The prostate cancer-specific mortality was also similar for the two groups: the 5-year survival for the immediate and delayed ADT groups was 96% and 93.3%, respectively, and the 10-year survival was 90.2% and 89.4%, respectively.

In the study all the subject men had either a radical prostatectomy or radiotherapy previously treated all of the men.

There has been an ongoing debate on when ADT should be started. ADT has many side effects, so if it could be delayed without limiting a man’s survival it would make no sense to start the therapy earlier then necessary.

The results of this study will provide additional information for a dialogue between a man and his doctors about when to start ADT.  The study does not answer if men already on ADT could safely stop their treatment and delay its onset until such time as they experience symptoms.

Joel T. Nowak, M.A., M.S.W.