Efficacy of Intermittent Androgen Deprivation Therapy vs Conventional Continuous Androgen Deprivation Therapy for Advanced Prostate Cancer: A Meta-analysis

Abstract

OBJECTIVE To compare the efficacy of intermittent androgen deprivation therapy (IADT) vs continuous androgen deprivation therapy (CADT) for the treatment of advanced prostate cancer; we performed a meta-analysis of randomized controlled trials (RCTs), assessing the risks of disease progression, all-cause, and disease-specific mortality. MATERIALS AND METHODS We conducted a systematic search of several bibliographic systems to identify all RCTs of IADT in men with newly diagnosed metastatic or biochemical only prostate cancer. We abstracted outcome data, study characteristics, and participant demographics. We performed heterogeneity tests and calculated the summarized risk differences (RD) and risk ratios at 95% confidence intervals (CI), using inverse variance methods in random-effects approaches. RESULTS We identified 8 RCTs (N = 4664) comparing mortality between IADT and CADT. For all men combined, we observed small but nonsignificant differences in all-cause mortality (RD = 0.02, 95% CI = −0.02, 0.06), disease-specific mortality (RD = 0.04, 95% CI = −0.01, 0.08), and disease progression (RD = −0.03, 95% CI = −0.09, 0.04). Among the prespecified subgroup with histologically confirmed, newly diagnosed metastatic disease, we found no difference in overall survival (RD = 0.00, 95% CI = −0.09, 0.09). CONCLUSION We found no difference in overall survival, but a small increased risk in disease-specific survival for men treated with IADT relative to CADT was observed. IADT could be considered as an alternative to CADT because of better quality of life outcome. Patients should be informed of the possible risks and benefits of both therapies. More research confirming the benefits of IADT vs CADT is needed to inform treatment decisions.

Uroncor consensus statement: Management of biochemical recurrence after radical radiotherapy for prostate cancer: From biochemical failure to castration resistance

“…30,31 The results show a small and non-significant decrease in cause-specific mortality, overall mortality, and disease progression with the use of IHT, but a significant reduction in the emergence of hot-flushes. The authors of that meta-analysis conclude that IHT is a reasonable option for well-informed patients who want to avoid these side-effects.…”

Conversion to monotherapy with luteinizing-hormone releasing hormone agonist or orchiectomy after reaching PSA nadir following maximal androgen blockade is able to prolong progression-free survival in patients with metastatic prostate cancer: A propensity score matching analysis

“…During the management of advanced prostate cancer, previous studies have demonstrated that IADT is at least as effective as continuous treatment with regard to disease progression and overall survival (12)(13)(14). However, IADT should be considered as an alternative therapeutic approach to CADT, accounting for the caveats and cautions suggested by meta-analysis of eight randomized controlled trials of intermittent vs. continuous ADT (12)(13)(14).…”

“…However, IADT should be considered as an alternative therapeutic approach to CADT, accounting for the caveats and cautions suggested by meta-analysis of eight randomized controlled trials of intermittent vs. continuous ADT (12)(13)(14).…”

“…In these patients, continuous ADT must remain the standard treatment approach (14). Continuous ADT comprises surgical castration, LHRH agonist with/without anti-androgen and LHRH antagonist (14).…”

Spatial and nonspatial evolutionary games and their applications

“…We shall refer to this cancer cell type as having strategy T + . To target these cancer cells' need for testosterone, androgen deprivation therapy (ADT) stops normal production of testosterone in the patient -a treatment termed "chemical castration" (Yao et al, 2008;Hussain et al, 2013;Tsai et al, 2013). Virtually all patients initially respond to ADT.…”