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Intermittent ADT not good for metastatic disease


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Urol Oncol. 2011 May 9. [Epub ahead of print]

Continuous vs. intermittent androgen deprivation therapy for metastatic prostate cancer.

Langenhuijsen JF, Badhauser D, Schaaf B, Kiemeney LA, Witjes JA, Mulders PF.


Department of Urology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.



To analyze the predictive value of PSA for progression and the role of testosterone for quality of life (QOL) in patients with androgen deprivation therapy (ADT) for metastatic prostate cancer.


PSA and testosterone data were used from a phase III trial randomizing patients without progression and PSA < 4 ng/ml (n = 193), after 6 months induction course, between continuous (CAD) (n = 96) and intermittent (IAD) (n = 97) ADT. The 2-year risk of progression was calculated for baseline PSA, 'fast' and 'slow' PSA decline to < 4 ng/ml (60 days cut-off), PSA nadir, performance status and pain. Testosterone kinetics and QOL were also evaluated. Univariate Kaplan Meier survival analysis and log rank tests were used to compare the risk of progression.


For progression analysis, 173 patients' data were available. The 2-year risk of progression for baseline PSA < 50 ng/ml, 50 to <500 ng/ml, and ≥500 ng/ml was

25%, 55%, and 76% (P = 0.03) in CAD, and

38%, 64%, and 85% (P = 0.006) in IAD, respectively.

The 2-year risk of progression for PSA nadir ≤ 0.2 ng/ml, and > 0.2 to 4 ng/ml in CAD was 31% and 70% (P < 0.001), respectively.

In the IAD group, a similar trend was seen. Patients with PSA nadir ≤ 0.2 ng/ml, though had significantly higher 2-year risk of progression compared to CAD (53% vs. 31% (P = 0.03), respectively. PSA decline showed no predictive value. Patients without pain had a significantly lower 2-year risk of progression in both groups. Without ADT testosterone remained at castrate level for 4 months. After the first and second IAD cycle 92% and 46%, respectively, had a normalized testosterone. No QOL difference was found, although more side effects occurred in CAD.


Metastatic prostate cancer patients with high baseline PSA, pain, and high PSA nadir have a poor prognosis with ADT. Patients with low PSA nadir do significantly worse with IAD compared with CAD. Low testosterone after ADT and incomplete testosterone recovery may explain similar QOL. Therefore, IAD is not a good treatment option for many metastatic prostate cancer patients.

Copyright © 2011 Elsevier Inc. All rights reserved. PMID: 21561791

Forum: Metastatic prostate cancer Title: Intermittent not good for metastatic disease

If you are metastatic, your doctor will take many factors into account when advising you whether or not to take a break in ADT.

This paper does not address why you might be advised to take a break.

It does report what happened with a group of metastatic men some of whom were intermittent, some continuous.

Generally, metastatic men with:

  • high PSA at diagnosis
  • pain
  • PSA that did not go very low with treatment (high PSA nadir)

had a poor prognosis on ADT.

Metastatic men with:

  • PSA that went low with ADT (low PSA nadir)

did significantly worse with intermittent ADT compared to men on continuous ADT.

Your doctor's advice will balance the above considerations, modified by

  • knowledge of other studies;
  • judgement the quality of this study; and
  • whether the ADT treatment, and the intermittent regime for these men matches or varies from your regime

with the particular reasons for giving you a break from ADT.

This extract can be found on http://PubMed.com, and is in the public domain.

On PubMed.com there will be a link to the full paper (often $30, sometimes free).

Any highlighting (except the title) is not by the author, but by Jim Marshall. In this extract he also made extra paragraph breaks.

Jim is not a doctor.

This page was found on the Advanced Prostate Cancer Community for Australian men at http://advancedprost...lia.ipbhost.com.

The link is hard to remember.

An easier way to find it is to go to JimJimJimJim.com and click on Prostate.

That's the word Jim four times, no spaces, followed by .com.

If you need other help - to perhaps find someone to talk to or a local support group:

Click on the Contact Jim button at http://JimJimJimJim.com.

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