It is generally believed that combination hormone therapy (ADT 2, 3 or 4) is superior to mono-therapy (with just one drug). With this in mind researchers investigated the survival of hormone-naïve prostate cancer survivors diagnosed with prostate-specific antigen (PSA) over 500 ng/ml.

They extracted data of prostate cancer survivors from the Japan Study Group of Prostate Cancer database who had a PSA score over 500 ng/ml and who was diagnosed between 2001 and 2003.

Cancer-specific survival and overall survival were assessed according to PSA levels (500–999, 1000–4999 and greater than 5000 ng/ml) and type of therapy.

The median follow-up was 27 months and a total of 1961 men were included in the anaylisis. Five-year cancer-specific and overall mortalities were 39.0 and 33.0%, respectively.

There was a significant inverse relationship between overall survival and prostate-specific antigen magnitude among combination therapy patients, but not mono-therapy patients (log-rank test, P = 0.034 and 0.558, respectively).

The median overall survival in combination therapy patients with low-, intermediate- and high prostate-specific antigen and mono-therapy patients with any PSA were 79, 59, 45 and 43 months, respectively.

Multivariate analysis showed that combination therapy in patients with low- and intermediate prostate-specific antigen was significantly associated with a favorable overall survival compared with mono-therapy (hazard ratios 0.66 and 0.75, respectively, both P < 0.001).Similar results were obtained for cancer-specific survival. There are major survival differences in extremely high PSA cases according to the PSA level and hormone therapy type and those patients would benefit notably from combination androgen blockade.The take home- Combination therapy in all men and especially in men with very high PSA levels is improved with combination hormone therapy (ADT).

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