Does Early Initiation of ADT Improve Outcomes in Biochemically Recurrent Prostate Cancer?
Posted: Thursday, September 9, 2021
According to Catherine Handy Marshall, MD, MPH, of the Johns Hopkins School of Medicine, Baltimore, and colleagues, men with biochemically recurrent prostate cancer who deferred hormone therapy seemed to experience long durations of metastasis-free survival and overall survival. This retrospective review, which was published in The Journal of Urology, highlights the need to reevaluate when to initiate primary androgen-deprivation therapy (ADT) in these patients.
“The early initiation of continuous ADT for biochemical relapse may not meaningfully improve overall survival,” the investigators commented. “Adequately designed prospectively randomized studies in patients with biochemical recurrent prostate cancer testing the role of early versus deferred ADT remain critical to inform treatment decisions in this population and enhance patients’ and physicians’ understanding of the clinical significance of the nonmetastatic castration-resistant prostate cancer pivotal studies.”
The investigators reviewed data from 806 men with clinically localized prostate cancer who underwent radical prostatectomy at Johns Hopkins University or the Walter Reed National Military Medical Center. All eligible patients developed biochemical recurrence with a prostate-specific antigen (PSA) doubling time of no more than 10 months.
Men with a PSA doubling time of fewer than 10 months who delayed ADT until metastasis experienced a median duration of metastasis-free survival of 192 months; the median duration of overall survival was 204 months in this population. The median duration of metastasis-free survival and overall survival were 144 and 168 months, respectively, in patients with a PSA doubling time of no more than 6 months.
“These results are in line with the estimated survival times of men treated in contemporary trials of antiandrogens for nonmetastatic castration-resistant prostate cancer,” the investigators explained.
Disclosure: For full disclosures of the study authors, visit auajournals.org.