Immediate versus deferred initiation of androgen deprivation therapy in prostate cancer patients with PSA-only relapse. An observational follow-up study. By Garcia-Albeniz et al 2015
Key sentence from the paper: “…the addition of ADT to external beam radiation was associated with a significantly increased PSA-free survival in intermediate risk patients… our study did not show a benefit to giving longer than 6 months of ADT.”
For the full abstract, see: http://www.ncbi.nlm.nih.gov/pubmed/25794605
Commentary: Although ADT can reduce the discomfort from prostate cancer metastases, it is not been shown to extend life overall. Furthermore because ADT can reduce the quality of life, it remains an open question as to when it is best to start ADT.
Some patients and their physicians favor beginning ADT with the first sign of a rising PSA. Others argue that the loss of quality of life for patients on ADT is sufficiently high that ADT should be reserved for patients with substantial advanced disease. This paper attempts to address of this problem. To do this, the authors access a US database called "Cancer of the Prostate Strategic Urologic Research Endeavor” (aka the CaPSURE database). Their core data consisted of 2096 patients who were assigned "immediate ADT” and 2058 who went on ADT at a later time; i.e. “deferred ADT” group. The authors found no survival benefit in the early use of ADT compared to those who delayed starting on hormonal therapy until there was clear signs of clinical progression beyond just a rising PSA.
Overall this study suggest that in the absence of any primary treatment for prostate cancer, a rising PSA alone may be scary, but starting on ADT immediately may not provide any long-term survival benefits.
Garcia-Albeniz X, Chan JM, Paciorek A, Logan RW, Kenfield SA, Cooperberg MR, et al. Immediate versus deferred initiation of androgen deprivation therapy in prostate cancer patients with PSA-only relapse. An observational follow-up study. Eur J Cancer. 2015;51(7):817-24.