Men with advanced prostate cancer receiving androgen-deprivation therapy (ADT) may be better off being treated intermittently rather than on a continuous basis, show study findings.
Although intermittent ADT (IAD) did not particularly make a difference to the occurrence of adverse events (AEs) compared with continuous ADT (CAD), it did significantly improve men's quality of life, especially in terms of activity limitation, physical capacity, and sexual functioning.
The findings, published in European Urology, come from a comparison of 554 patients randomly assigned to receive IAD or CAD as part of The FinnProstate Study VII.
The men, who all had advanced prostate cancer and a prostate-specific antigen (PSA) level of less than 20.0 ng/mL, were initially administered monthly doses of 3.6 mg goserelin acetate every 28 days over 24 weeks until their PSA levels had reduced to less than 10.0 ng/mL. They were then randomly assigned to either continue with CAD (n=280) or start IAD (n=274).
In the IAD group, the goserelin acetate treatment was withheld after randomization, was only resumed (again for 24 weeks) whenever PSA increased above 20.0 ng/mL, and was then withheld again once it had returned to less than 10.0 ng/mL.
Over a median follow-up period of 65 months, significant differences in quality of life between the two groups were detected using a 30-item self-reported questionnaire that addressed 10 domains.
Arto Salonen (Kuopio University Hospital, Finland) and team found that the most frequently detected differences were greater improvements in relation to activity limitation, physical capacity, and sexual functioning, among the IAD group compared with the CAD group.
A nonsignificant trend in favor of IAD was also found in all but one of the other domains tested including pain, bed disability, social and sexual functioning, emotional wellbeing, vitality, and overall health, with the exception of sexuality.
The team also reports that no significant differences were found in the prevalence of AEs.
Cardiovascular (CV) events were the most prevalent, at 154 in the IAD group and 162 in the CAD group. And 78 (14.1%) of the entire study population died from CV causes, 35 from the IAD group (12.8%), and 43 from the CAD group (15.4%).
As ASD is associated with a loss of bone mineral density, the team also monitored the prevalence of fractures in the two groups, but again no significant differences in incidence occurred.
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