On June the 4th I reported on the SWOG-9346 study presented at the ASCO Meeting in Chicago (http://advancedprostatecancer.net/?p=3264). In the presentation by principal investigator, Maha Hussain, M.D., F.A.C.P., from the University of Michigan Comprehensive Cancer Center, Dr. Hussain reported that intermittent androgen-deprivation (IAD) therapy is not as good as continuous hormone therapy with regard to a man’s longevity!
Since the release of the study many other commentators have discussed the study and I too have had a chance to mull over these results. Immediately after the June 4th post, I became engaged in a conversation on the Advanced Prostate Cancer On-Line Support Group about the significance of the study and what changes, if any, I would make going forward (I am currently on an off period of IAD).
At that time I said I would need to think about what my future plans would be going forward. Although I have not yet had the required conversation with my doctor, I have tentatively decided to continue with an intermittent schedule.
I first wish to explain that I do wish to extend my life, despite this I am strongly leaning to stay on the intermittent schedule. Here is my reasoning:
1- In the SWOG study they used the PSA cut off number of 4.0 ng/mL or less to determine who could qualify to be in the trial. Anyone who cannot get their PSA numbers to become undetectable, or near to undetectable, is not having a success with their hormone therapy. Men with an unsuccessful round of ADT cannot yield clinical trial results that are valid for men who have had a successful round of ADT.
2- The trial also confirmed that IAD allows for a better quality of life (QOL). I do believe that my QOL is a factor to be considered when I make treatment decisions.
3- The trial was set up with a pre-determined PSA number which served as a trigger for a return to ADT. I believe that in reality the trigger number for a return to ADT should depend on the man and his cancer. Since my doubling time is usually under 6 months I do not allow my PSA to raise over five. Men with a longer doubling time could easily let their PSA number go a little higher.
4- The speed that the PSA number responds to the start of ADT should also be considered in the decision of when to re-start ADT. In my case the PSA responds quickly and dramatically telling me that the bulk of my cancer is still very responsive to hormones.
5- Previous research has indicated that both IAD and continuous hormone therapy are equals.
Currently, I plan on staying on an intermittent schedule. Again, this is my personal opinion for my own treatment of my advanced prostate cancer.
Joel T Nowak, M.A., M.S.W.