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Comparison of intermittent and continuous androgen deprivation and quality of life between patients with locally advanced and patients with metastatic prostate cancer: a post hoc analysis of the randomized FinnProstate Study VII.

Scand J Urol. 2014 Dec;48(6):513-22.

Scand J Urol. 2014 Dec;48(6):513-22.

Abstract

OBJECTIVE:

The aim of the study was to compare intermittent (IAD) and continuous (CAD) androgen deprivation therapy (ADT) between locally advanced (M0) and metastatic (M1) prostate cancer, and the effect of ADT on the quality of life.

MATERIAL AND METHODS:

In total, 852 men with advanced prostate cancer were enrolled to receive goserelin acetate for 24 weeks. Of these, 554 patients whose prostate-specific antigen (PSA) decreased to less than 10 ng/ml or by at least 50% (<20 ng/ml at baseline) were randomized to IAD or CAD. In the IAD arm, ADT was resumed for at least 24 weeks whenever PSA increased to greater than 20 ng/ml or above baseline.

RESULTS:

Median follow-up time was 65 months. Median times from randomization to progression, death, prostate cancer death and treatment failure in M0 and M1 patients were 46.8 and 21.4, 57.6 and 40.3, 59.5 and 40.7, and 41.9 and 20.0 months, respectively (p < 0.001). No significant differences emerged between IAD and CAD. ADT showed a beneficial effect on pain, activity limitation and social functioning in M1 patients, and a deleterious effect on physical capacity in M0 patients and on sexual functioning in both groups. IAD offered extra benefit for activity limitation, social functioning and recovery of sexual functioning.

CONCLUSIONS:

IAD is as efficient as CAD in treatment of locally advanced and metastatic prostate cancer. ADT improves quality of life in M1 patients, with IAD offering extra benefit.

KEYWORDS:

androgen deprivation; intermittent therapy; metastatic status; prostate cancer; quality of life

Comment from Henk van der Poel: Earlier analyses did not show a significant difference in overall survival between continuous and intermittent ADT (IAD). The EAU-guidelines state that IAD should be widely offered to patients with PCa in various clinical settings after a standardized induction period. IAD should be the standard of care for those relapsing after radiotherapy (if some form of ADT is required). It might be an option in metastatic situations, even if the benefits are fewer compared to those with less advanced PCa. This non-planned analysis of data from the The FinnProstate study, of which data were published in 2012 showed no difference in progression-free or overall survival in men with advanced and metastasized prostate cancer treated with continuous androgen ablation or ADT. Quality of life data now show that androgen ablation ablation improved pain in M+ patients but decreased physical capacity in M0 patients. IAD improved social and sexual functions in both groups.

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