Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2015 May;51(7):817-24.
doi: 10.1016/j.ejca.2015.03.003. Epub 2015 Mar 17.

Immediate versus deferred initiation of androgen deprivation therapy in prostate cancer patients with PSA-only relapse. An observational follow-up study

X Garcia-Albeniz  1 , J M Chan  2 , A Paciorek  3 , R W Logan  4 , S A Kenfield  5 , M R Cooperberg  2 , P R Carroll  5 , M A Hernán  6
Affiliations
Observational Study

Immediate versus deferred initiation of androgen deprivation therapy in prostate cancer patients with PSA-only relapse. An observational follow-up study

X Garcia-Albeniz et al. Eur J Cancer. 2015 May.

Abstract

Background: The optimal timing to start androgen deprivation therapy (ADT) in prostate cancer patients with rising prostate-specific antigen (PSA) as the only sign of relapse is unknown.

Methods: We identified men with prostate cancer in the Cancer of the Prostate Strategic Urologic Research Endeavour (CaPSURE) study who would have been eligible (⩽ cT3aN0M0, primary radical prostatectomy or radiotherapy, PSA relapse as the only evidence of recurrence) for a randomised trial comparing 'immediate' versus 'deferred' ADT initiation. We emulated such trial by assigning patients to the 'immediate' strategy if they initiated ADT within 3 months of PSA relapse and to the 'deferred' strategy if they initiated ADT when they presented with metastasis, symptoms or a short PSA doubling time. We censored patients when they deviated from the assigned strategy and adjusted for this censoring via inverse probability weighting.

Results: Of 2096 eligible patients (median age 69, interquartile range 63-75 years), 88% were white, 35% had a Gleason score ⩾ 7, 69% were treated with radical prostatectomy and 31% received radiotherapy only as primary treatment. The mean time from primary treatment to PSA relapse was 37.4 (standard deviation [SD] 34.2) months. Mean follow-up from primary treatment was 91.4 (SD 48.4) months. The adjusted mortality hazard ratio for immediate versus deferred ADT was 0.91 (95% confidence interval (CI), 0.52-1.60), which would be translated into a similar 5-year survival (difference between groups: -2.0% (95% CI: -10.0 to 5.9%).

Conclusion: Our analysis suggests that prostate cancer patients undergoing immediate ADT initiation within three months after PSA-only relapse had similar survival to those who deferred ADT initiation within 3 months after clinical progression.

Keywords: Androgen deprivation therapy; PSA relapse; Prostate cancer.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flowchart of patient selection into the study, CaPSURE.
Figure 2
Figure 2
Overall (A) and prostate cancer-specific (B) survival, standardized for baseline and time-varying variables, for immediate vs. deferred ADT, CaPSURE 1974-2013
See this image and copyright information in PMC

References

    1. Sharifi N, Gulley JL, Dahut WL. Androgen deprivation therapy for prostate cancer. JAMA. 2005;294:238–44. - PubMed
    1. Walsh PC, DeWeese TL, Eisenberger MA. A structured debate: immediate versus deferred androgen suppression in prostate cancer-evidence for deferred treatment. J Urol. 2001;166:508–15. - PubMed
    1. Scher HI, Heller G. Clinical states in prostate cancer: toward a dynamic model of disease progression. Urology. 2000;55:323–7. - PubMed
    1. Loblaw DA, Virgo KS, Nam R, Somerfield MR, Ben-Josef E, Mendelson DS, et al. Initial hormonal management of androgen-sensitive metastatic, recurrent, or progressive prostate cancer: 2006 update of an American Society of Clinical Oncology practice guideline. J Clin Oncol. 2007;25:1596–605. - PubMed
    1. Studer UE, Hauri D, Hanselmann S, Chollet D, Leisinger H-J, Gasser T, et al. Immediate versus deferred hormonal treatment for patients with prostate cancer who are not suitable for curative local treatment: results of the randomized trial SAKK 08/88. J Clin Oncol. 2004;22:4109–18. - PubMed

Publication types

MeSH terms

Substances