New hormonal therapy protocol of for patients with rising PSA after radiotherapy

This study compared intermittent versus continuous androgen deprivation therapy (ADT) for localized (confined) prostate cancer due to prostate-specific antigen (PSA) elevation after radiotherapy. Main findings: Intermittent ADT was not inferior compared to continuous therapy with respect to survival. However, some quality of life measures, such as fatigue, urinary problems, hot flashes, libido and erectile function, showed some improvement.

Radiotherapy is among the standard treatment options for localized prostate cancer. After radiation treatment, rising PSA levels may be an indicator of treatment failure. ADT (hormonal treatment that decreases the body's levels of androgens, thereby slowing the growth of prostate cancer) may provide a treatment option in such patients.

1386 patients were enrolled in this study. 690 patients received intermittent ADT (8-month treatment cycles; PSA monitoring during the non-treatment intervals) and 696 had continuous therapy. Patients were followed up for an average of 6.9 years. Both therapeutic approaches demonstrated similar level of survival rates. Overall survival was 8.8 years in the intermittent therapy group and 9.1 years in the continuous therapy group (statistically non-inferior). However, patients receiving intermittent therapy showed improvement in some of the adverse effects on quality of life, which are usually associated with this hormonal therapy.

In the present study, a protocol consisting of intermittent ADT cycles has demonstrated a similar impact on survival, and a better side effect profile when compared to the standard continuous regimen. Such protocol could therefore be considered for patients with localized prostate cancer in whom PSA levels rise after radiotherapy.

When addressing this article the reader should take into account the fact that, even though considered “non inferior”, survival was longer for patients who received the standard, continuous therapy. Also, the exact treatment protocols are not provided in this study (how long was anti-androgen agent given).