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Intermittent androgen suppression in patients with prostate cancer
Author(s) -
De La Taille A.,
Zerbib M.,
Conquy S.,
AmsellemOuazana D.,
Thiounn N.,
Flam T.A.,
Debré B.
Publication year - 2003
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1046/j.1464-410x.2003.04015.x
Subject(s) - medicine , prostate cancer , prostatectomy , androgen deprivation therapy , urology , biochemical recurrence , prostate specific antigen , androgen , prostate , radiation therapy , oncology , stage (stratigraphy) , androgen suppression , multivariate analysis , cancer , hormone , paleontology , biology
OBJECTIVES To evaluate intermittent androgen suppression (IAS) in patients with prostate cancer and to try to define predictive factors for biochemical progression. PATIENTS AND METHODS From 1989 to 2001, 146 patients received IAS as a primary treatment for localized, advanced or metastatic prostate cancer (72 men) or as a treatment for prostate‐specific antigen (PSA) recurrence after radical prostatectomy (RP) and/or radiation therapy (74 men). Androgen‐deprivation treatment (ADT) was continued up to 6 months after PSA became undetectable or a nadir PSA level was reached. ADT was then re‐instituted when the PSA level was> 4 ng/mL for patients who had RP or> 10 ng/mL for the others. RESULTS After a mean (range) follow‐up of 45.6 (12–196.9) months, 24 patients had biochemical progression. These patients were younger than those with no biochemical progression (67 vs 72 years, P = 0.004) and had a statistically higher Gleason score (7.21 vs 6.52, P = 0.01) and PSA level (111.1 vs 32.1 ng/mL, P = 0.05), and a shorter first phase without treatment (7.6 vs 11.2 months, P = 0.05). Overall 5‐year metastatic disease free survival of 91.3%. The overall 5‐year biochemical recurrence‐free survival was 68%. Using multivariate analysis, a Gleason score of ≥ 8 ( P = 0.021), first‐phase duration with no treatment of < 1 year ( P = 0.044), positive lymph nodes or metastatic disease at the time of starting IAS ( P = 0.023) and age < 70 years ( P = 0.037) were the strongest predictors of biochemical progression. CONCLUSION IAS appeared to be a feasible treatment; the best candidates being those aged> 70 years with localized prostate cancer and a Gleason score of ≤ 7.