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Intermittent = continuous, but READ THE FINE PRINT again


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Jim Marshall (not a doctor) said ...

Another study showing no significant survival difference between intermittent and continuous hormone treatment for men with locally advanced or metastatic prostate cancer.

One very important thing to note – the authors removed the men with the most advanced cancers, and the men with the most aggressive cancers from the study before it began. Surprisingly this was 35% of the men in the study.

So what this study actually telling us is that in the 65% of men with less advanced, less aggressive cancers, intermittent hormone treatment and continuous hormone treatment are equivalent.

So if your doctor is taking only this study into account, you will only be offered the choice if your PSA drops to half its original level (or to 10 if has started at 20 or more) in 6 months.

When talking about intermittent hormone treatment, there are many different regimes. This study used:

  • If the original PSA was less than 20 ng/mL, treatment was given for 24 weeks, then continued until the PSA dropped to less than 10 ng/mL. Hormone treatment was started again when the PSA became greater than 20 ng/mL.
  • If the original PSA was more than 20 ng/mL, treatment was given for 24 weeks, then continued until PSA was half the original PSA. Hormone treatment was started again when the PSA became greater than the original PSA.

It may be important to note that this protocol, like some others, does not stop just when the PSA drops to the target – time on hormone treatment is at least half a year at a time in this study.

Note too that the authors say "patients on IAD need more careful followup while off therapy". The extract does not say how more often their PSA etc is assessed off therapy, but USA medical oncologist Stephen Strum says he uses monthly review.

The conclusions of this study should be compared with the following three topics found on this site:

Intermittent not good for metastatic disease

After surgery failure IAD not good for GS 8-10

CAD better for higher Gleason score

... end Jim

J Urol. 2012 Apr 11. [Epub ahead of print]

The FinnProstate Study VII: Intermittent Versus Continuous Androgen Deprivation in Patients With Advanced Prostate Cancer.

Salonen AJ, Taari K, Ala-Opas M, Viitanen J, Lundstedt S, Tammela TL; FinnProstate Group.


Department of Urology, Kuopio University Hospital, Kuopio, Finland.



We conducted a randomized trial to compare intermittent and continuous androgen deprivation in patients with advanced prostate cancer. We studied time to progression, overall and prostate cancer specific survival, and time to treatment failure.


Between May 1997 and February 2003, 852 men with locally advanced or metastatic prostate cancer were enrolled to receive androgen deprivation therapy for 24 weeks. Patients in whom prostate specific antigen decreased to less than 10 ng/ml, or by 50% or more if less than 20 ng/ml at baseline, were randomized to intermittent or continuous androgen deprivation. In the intermittent therapy arm androgen deprivation therapy was withdrawn and resumed again for at least 24 weeks based mainly on prostate specific antigen decrease and increase.


There were 298 patients who did not meet the randomization criteria. The remaining 554 patients were randomized, with 274 (49.5%) to intermittent androgen deprivation and 280 (50.5%) to the continuous androgen deprivation arm. Median followup was 65.0 months. Of these patients 392 (71%) died, including 186 (68%) in the intermittent androgen deprivation arm and 206 (74%) in the continuous androgen deprivation arm (p = 0.12). There were 248 prostate cancer deaths, comprised of 117 (43%) in the intermittent androgen deprivation and 131 (47%) in the continuous androgen deprivation arm (p = 0.29). Median times from randomization to progression were 34.5 and 30.2 months in the intermittent androgen deprivation and continuous androgen deprivation arms, respectively. Median times to death (all cause) were 45.2 and 45.7 months, to prostate cancer death 45.2 and 44.3 months, and to treatment failure 29.9 and 30.5 months, respectively.


Intermittent androgen deprivation is a feasible, efficient and safe method to treat advanced prostate cancer compared with continuous androgen deprivation.

Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

PubMed ID: 22498230

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.

Jim is not a doctor.

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