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From the Summer/Fall 2016 Quest
A new randomized, controlled trial found that giving androgen-deprivation therapy (ADT) immediately is more effective than delaying treatment for patients with PSA relapse after treatment or if they have prostate cancer that is considered incurable.

ADT, also known as hormone therapy, is typically offered to patients who either have rising PSAs after being treated for prostate cancer or to patients who are not eligible for treatment to due age, life expectancy, or locally advanced disease. Treatment decisions regarding the timing of ADT have been largely based on what the physician or patient prefers.

The trial, led by Gilliam M. Duchesne, MD, a radiation oncologist at Melbourne University, Australia, aimed to assess whether immediate or delayed ADT would improve overall survival compared to delaying treatment.

The study included 293 men randomly assigned to either the immediate therapy group (142 patients) or the delayed therapy group (151 patients). The study participants either had PSA relapse after treatment (261 patients) or they were not considered suitable for curative treatment (32 patients).

Immediate ADT significantly improved overall survival compared to delayed treatment. After a median follow-up of 5 years, 16 men (11%) died in the immediate therapy group compared to 30 men (20%) in the delayed therapy group.

Patients in the immediate therapy group had a small but clinically notable reduction in quality of life during the first 2 years.

The authors concluded that their results provide "benchmark evidence" of survival rates and morbidity for physicians and patients to discuss when considering treatment options.

The study was published online in the Lancet Oncology on May 4, 2016.

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