Timing of ADT for Men With Biochemical Recurrent Prostate Cancer
abstract
This abstract is available on the publisher's site.
Access this abstract nowPURPOSE
There were 3 recent U.S. Food and Drug Administration approvals for drugs to be used in nonmetastatic castration resistant prostate cancer, a state that arises from the unproven start of continuous androgen deprivation therapy (ADT) for biochemical recurrent prostate cancer (BCR), before metastatic disease is evident. This report examines the outcome of men with BCR who defer ADT until time of metastasis.
MATERIALS AND METHODS
Retrospective review of men diagnosed with clinically localized prostate cancer who underwent radical prostatectomy at Johns Hopkins Hospital and Walter Reed National Military Medical Center and developed BCR with a prostate specific antigen doubling time of not more than 10 months (806 patients). The primary end points were metastasis-free survival and overall survival from time of local treatment among men who delayed ADT until time of metastasis.
RESULTS
The median metastasis-free survival of men with BCR and a prostate specific antigen doubling time <6 months and 10 months who delay ADT until metastasis is 144 months (95% CI 48-not reached) and 192 months (95% CI 72-not reached), respectively, with a median overall survival of 168 months (95% CI 96-276 months) and 204 months (95% CI 120-276), respectively.
CONCLUSIONS
Metastasis-free survival and overall survival of men with BCR who delay hormone therapy is long. This underscores the need to reevaluate when to start primary ADT in this patient population.
Additional Info
Disclosure statements are available on the authors' profiles:
Timing of Androgen Deprivation Treatment for Men With Biochemical Recurrent Prostate Cancer in the Context of Novel Therapies
J Urol 2021 Sep 01;206(3)623-629, CH Marshall, Y Chen, C Kuo, J Cullen, J Jiang, I Rosner, M Markowski, DG McLeod, BJ Trock, MA EisenbergerFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
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For the last 3 decades, clinicians have debated the management of PSA rise after failed local therapy. Numerous attempts to provide an answer with randomized phase III trials failed. Therefore, we rely on institutional experiences as reported here. Administering ADT to many men with biochemical failure resulted in the creation of the iatrogenic disease state nmCRPC. Although we have not been able to answer the initial question regarding ADT, we have data from three randomized clinical trials showing a significant improvement in delaying progression and death among men with nmCRPC with third-generation anti-androgens.
I applaud the authors for again highlighting this clinical challenge, and hopefully a trial will someday deliver the truth. And, finally, we lost an outstanding clinician and friend among the authors, Dr. David McLeod. David died late last year. Maybe he knew the answer! Implementing next-generation imaging?