A new randomized study (FinnProstate Study VII) on the merits of intermittent androgen deprivation (IAD) compared to continuous androgen therapy (CAD) contradicts the recent revelations from the last ASCO presentation (Hussain et.al) where the clear conclusion was that CAD was superior to IAD.
At the ASCO conference Dr. Hussain’s study concluded that IAD was significantly less clinically effectve than CAD for the treatment of men with castrate metastatic prostate cancer.
The FinnProstate Study VII has now provided published data in two recent articles: the first deals with relative efficacy and the second with side effects and quality of life.
In the FinnProstate Study VII Salonen et al. initially enrolled 852 men with locally advanced or metastatic prostate cancer who all received therapy with 12.5 days of antiandrogen therapy (using cyproterone acetate) to prevent a flare reaction and 24 weeks (6 months) of androgen deprivation with the LHRH agonist goserelin acetate (Zoladex). These 852 men were enrolled into the study between 1997 and 2003.
Five hundred fifity four men (554) had a significant decline in their PSA scores and were either assigned to receive CAD (n = 280) or IAD (n = 274). All the men were followed until January 2010.
Salonen et al. concluded that, compared to CAD:
• IAD is “a feasible, efficient and safe method to treat advanced prostate cancer.”
• IAD “showed benefits” with respect to quality of life.
• IAD was associated with a similar prevalence of adverse effects.
Salonen did say that men with the most advanced disease were better off having CAD over IAD, but for men with less advanced castrate resistant prostate cancer IAD remains an excellent choice.
So, the debate continues and arguments for both CAD and IAD can be competently made, but as I have already stated I will continue on IAD myself.
Joel T Nowak, M.A., M.S.W.
After 9 months of Zoladex, my PSA reached a nadir of 0.9 and I chose to have a holiday as I was one who suffered badly from the side effects.
Another 9 months passed without the ADT until my PSA began to rise. After 3 more implants I was classed castrate resistant and the ADT was stopped again.
My Urologist wanted me to remain on the Zolodex but upon questioning its value, he conceded that it no longer worked but it was the only thing he could offer. In other words, he had to be seen to be offering the best treatment available.