Dr. Whang Comments:
I have previously reported in my Blogs that there is significant debate regarding intermittent vs. continuous hormonal therapy.
I like the concept of intermittent hormonal therapy. Many of my patients prefer the reduced side effects with intermittent hormonal therapy. However, when the study came out in 2012 that continuous hormonal therapy lead to better survival, some of my patients chose to proceed with continuous hormonal therapy.
This study shows that intermittent therapy is as good as continuous hormonal therapy.
Please discuss with your urologist these options prior to making a decision.
Intermittent ADT has QoL advantage
in advanced prostate cancer
By Kirsty Oswald, medwireNews Reporter
26 August 2013
Urology 2013; 82: 327–334
medwireNews: Researchers say that intermittent androgen deprivation therapy (ADT) may be preferable to conventional continuous treatment for some men with advanced prostate cancer.
The suggestion comes from the results of a meta-analysis, published in Urology, showing that intermittent ADT leads to fewer treatment-related side effects, resulting in improved quality of life (QoL) compared with continuous therapy, with no significant difference in overall survival.
The authors, led by Huei-Ting Tsai (Georgetown University Medical Center, Washington, DC, USA), identified eight randomized trials comparing mortality between intermittent and continuous ADT, involving a total of 4664 men with advanced prostate cancer over a median of 4.8 years of follow-up.
The seven trials reporting all-cause mortality showed a nonsignificant 2% increased risk for mortality in men receiving intermittent therapy compared with those receiving conventional therapy. The authors suggest this may have been driven by a small, but nonsignificant, 4% increase in the risk for prostate cancer-specific death in men receiving intermittent therapy.
However, there was no significant difference in disease progression delay between the two treatment groups, nor was there any difference in all-cause mortality among a subgroup of 2168 men with histologically confirmed metastatic cancer.
The team also found that intermittent therapy was associated with a significant 9% lower risk for hot flashes compared with continuous therapy, and was also linked to fewer treatment-related side effects in several studies. In particular, five studies reported that intermittent therapy resulted in better QoL with regard to hot flashes and sexual function.
Tsai and team explain that while intermittent ADT is recommended first-line in Europe and the UK, uptake has been limited in some places such as the USA, perhaps because of lack of clarity on its impact on survival.
“Our findings suggested that [intermittent] ADT should still be considered as an alternative therapeutic approach to [continuous] ADT but with caveat and cautions,” they say.
The authors believe that for some patients, the advantages of intermitted therapy with regard to QoL and time off therapy could outweigh a potential slight decrease in survival, particularly in men over 75 years of age or those with comorbidities.
“Our data might assist physicians and patients in making more informed clinical decisions regarding the type of ADT to be used for the treatment of advanced [prostate cancer],” they conclude.