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“Early Versus Delayed Androgen Deprivation for Prostate Cancer: New
Fuel for an Old Debate” - Charles Ryan and Eric Small
(January 2006)
The article presents a
succinct summary of the three major trials (Bolla, Pilepich, and
Messing,) which each employed 30 plus months of hormone therapy, and the
D’Amico trial using 6 months of androgen suppression (AS). They all
compared immediate AS to delayed use associated with radiotherapy or
surgery for localized disease with high-risk features (Gleason score
> 7, T3 or T4 primary tumor, or lymph node metastasis). In each a
significant benefit in disease specific and overall survival was found.
Since there have been
no randomized trials for the study of timing of androgen suppression at
the time of PSA relapse from primary therapy, retrospective analyses
must serve. The retrospective study by Judd Moul of 4967 surgically
treated men in the CPDR observational database showed that “for the
group as a whole there was no overall advantage in terms
of metastases-free survival for those undergoing early AS. However, a
subset analysis found that patients with Gleason score > 7 or a
PSADT of < 12 months experienced a delay in time to metastasis.
CAPSURE data on 2671
post-RP men found that androgen suppression given at a deferred time
after PSA relapse versus immediately upon relapse increased the
comparative likelihood of death by as high as 10.86 times. Deferred AS
was studied in cohorts of PSA values > 1, or > 10 ng/mL, or a PSA higher
than the median for the group as a whole.
Perspective on the
timing of events after PSA relapse was presented at the 2004 ASCO
meeting by Bianco et al. Of 4958 men treated with AD at the time of a
rising PSA (without metastases) the median time to hormone insensitivity
was 10.9 years, followed by a median period
of 9.5 months to metastatic disease. The median survival after “castrate
biochemical recurrence” was 26.2 months.
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