Open Access

ARTICLE

Intermittent androgen deprivation therapy for prostate cancer: translating randomized controlled trials into clinical practice

Shawn Dason, Christopher Brian Allard, Jing Gennie Wang, Jen Hoogenes, Bobby Shayegan

Division of Urology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
Address correspondence to Dr. Bobby Shayegan, McMaster Institute of Urology, 50 Charlton Ave E, Room G339A, Hamilton, ON L8N 4A6 Canada

Canadian Journal of Urology 2014, 21(Suppl.2), 28-36.

Abstract

instruction: Introduction: Intermittent androgen deprivation therapy (IADT) for prostate cancer involves cycles of androgen deprivation therapy (ADT) with a period between cycles where testosterone is allowed to rise above castrate levels. A number of recent randomized controlled trials (RCTs) have compared survival and health-related quality-of-life (HRQOL) between IADT and continuous ADT (CADT). This review seeks to critically analyze these published trials for their relevance to clinical practice.
instruction: Materials and methods: Published trials were retrieved from a systematic search of MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials databases using relevant keywords. Recent systematic reviews published on this topic were hand-searched for additional applicable references. The evidence was then synthesized for this review.
instruction: Results: A number of phase III trials have been recently published. IADT was found to be non-inferior in the primary setting for non-metastatic prostate cancer as well as in treatment of biochemical recurrence following radiotherapy. However, these studies overrepresented low risk patients in whom consideration may be given to deferred ADT rather than early treatment with IADT. In the metastatic prostate cancer setting, IADT was not found to be non-inferior to CADT. In most trials, castration-related symptoms improved with IADT and overall HRQOL results were mixed. Little data are available on the effect of IADT on long-term complications of ADT.
instruction: Conclusions: IADT remains a treatment with uncertain outcomes in metastatic prostate cancer and uncertain value over deferring ADT entirely in other prostate cancer clinical states.

---

Keywords

---