Benefits of intermittent/continuous androgen deprivation in patients with advanced prostate cancer

Abstract

Background and aimsIn 1941 Huggins described the effect of castration on prostate cancer. gonadotropin-releasing hormone (GNRH) analogues were introduced in 1985. Complete androgen blockade (association of GNRH analogue with antiandrogen) was introduced by Fernand Labrie to achieve suppression of suprarenal testosterone. Long time androgen deprivation lead to androgen independence of the prostate cancer cell.Our principal aim was to demonstrate longer survival rates on prostate cancer patients with intermittent androgen deprivation.Methods82 patients in the Urology Department of Vasile Goldis West University Arad were included into two groups, with continuous and intermittent androgen deprivation.Treatment efficiency was assessed by the level of testosterone and PSA.Adverse events (AE) and serious adverse events were reported according to Common Terminology Criteria of Adverse Events (CTCAE) of the National Cancer Institute (NCI).ResultsEvolution towards castrate resistant prostate cancer: 12.5% from the intermittent androgen deprivation group and 23.8% from the continuous androgen deprivation groupMortality rate: 15% of patients from the intermittent androgen deprivation group; 19% of patients from the continuous androgen deprivation groupConclusionsBetter quality of life (Qol) in periods without treatment due to testosteron recovery;Less AE’s and metabolic syndrome (MS) related complications;Better survival and longer time of disease control andCost reduction.

Development of depression in patients using androgen deprivation therapy: A systemic review and meta‐analysis

“…In contrast, Hervouet et al 22 concluded no difference in incidence rates of depression between the two groups, however, several patients were already diagnosed with a mood depressive order at baseline which could have produced discrepancy in the results. The inconsistent findings amongst studies may be attributed to the fact that many studies were underpowered with small sample sizes, 6,22,46,49 and few studies have considered only primary ADT usage instead of also considering neoadjuvant ADT. 20,27,28,[30][31][32][33]37,[40][41][42][43][44][46][47][48][49] The dual therapy nature of neoadjuvant ADT may have pre-disposed patients to developing depression.…”

“…The inconsistent findings amongst studies may be attributed to the fact that many studies were underpowered with small sample sizes, 6,22,46,49 and few studies have considered only primary ADT usage instead of also considering neoadjuvant ADT. 20,27,28,[30][31][32][33]37,[40][41][42][43][44][46][47][48][49] The dual therapy nature of neoadjuvant ADT may have pre-disposed patients to developing depression.…”

“…The search and study selection procedure are summarized in the PRISMA flow chart (Figure 1). We identified 38 studies out of which 17 were retrospective studies, 4,7,9,10,[20][21][22][23][24][25][26][27][28][29][30][31][32] 16 prospective studies, 6,11,13,[33][34][35][36][37][38][39][40][41][42][43][44][45] 2 cross-sectional 46,47 and two randomized trials. 48,49 A total of 360,650 patients were included in the study.…”

“…The Hospital Anxiety and Depression Scales (HADS) was utilized by seven studies. 6,9,12,20,34,43,46 The Geriatric Depression Scale was employed by two studies. 21,31 The Beck Depression Inventory (BDI) scale was used in four studies.…”

“…Scale (CES-D), 16,24 Langenhuijsen et al 23 utilized the EORTC core quality of life questionnaire (EORTC QLQ-C30). 22 Muresanu et al 46 used the Common Terminology Criteria for Adverse Events (CTCAE) scale while Gay et al 35 used the Expanded Prostate Cancer Index-26 | 529…”