A 16-year clinical experience with intermittent androgen deprivation for prostate cancer: oncological results

• Published in: World journal of urology 2009-10, Vol.27 (5), p.627-635
• Main Authors: Prapotnich, Dominique, Cathelineau, Xavier, Rozet, François, Barret, Eric, Mombet, Annick, Cathala, Nathalie, Sanchez-Salas, Rafael E., Vallancien, Guy
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Androgen Antagonists - therapeutic use; Androgen Receptor Antagonists; Anilides - therapeutic use; Antineoplastic Agents, Hormonal - therapeutic use; Drug Administration Schedule; Follow-Up Studies; Gonadotropin-Releasing Hormone - agonists; Goserelin - therapeutic use; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Nephrology; Nitriles - therapeutic use; Oncology; Original Article; Prostatic Neoplasms - drug therapy; Time Factors; Tosyl Compounds - therapeutic use; Treatment Outcome; Urology
• ISSN: 0724-4983; 1433-8726
• DOI: 10.1007/s00345-009-0393-1

Objective To present oncological results with intermittent androgen deprivation (IAD) in a single center. Methods Between 1992 and 2008, 566 patients with prostate cancer (PC) were selected for a non-randomized study of IAD. Two hundred and eighteen patients had biochemical recurrence (BCR) after local treatment for PC and 348 patients had micro- or macro-metastatic disease. On-treatment period (ONTP) consisted of three-monthly injections of gonadatropin-releasing hormone (GnRH) agonist combined with daily oral androgen receptor antagonist. Off-treatment period (OFTP) was indicated when prostate-specific antigen (PSA) was 20 ng/ml or clinical symptoms. Cancer specific survival curves were computed according to the Kaplan–Meier method. Results Median follow-up was 81 months (12–230). Median age was 74.7 years (52–92). Median Gleason score at diagnosis was 7 (3–9). Median initial PSA was 17 ng/ml (0.4–433). Cycle duration decreased progressively from 23 months for the 1st cycle to 10 months at 12th cycle. The number of patients who became hormone resistant was 182 (32%). Median cancer specific survival probability for the series is 12 (10.8–infinity) years. No previous treatment group showed a higher cancer specific survival probability (log rank test, CI 95%, P  = 0.003) versus BCR group. Multivariate analysis of cancer specific survival demonstrates age, initial Gleason score and initial PSA level as significant factors affecting mortality ( P