Testosterone recovery in the off-treatment time in prostate cancer patients undergoing intermittent androgen deprivation therapy

Tunn, U.; Canepa, G; Kochanowsky, A; Kienle, E.

doi:10.1038/pcan.2012.12

Cited by 37 publications

(57 citation statements)

References 18 publications

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“…In addition, when androgen blockade is used intermittently, a minority of patients can have recovery of testosterone and have no progression [10,41]. These findings mirror similar observations in postmenopausal breast cancer treated with oestrogen therapy, as the response rate was higher in those over the age of 60 [42].…”

Section: Discussionsupporting

confidence: 78%

A Prospective Audit of Intermittent Anti-Androgen verses Pituitary Blockade Suggests a Bipolar Androgen Type Strategy May Be Safe in Untreated Prostate Cancer

et al. 2017

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Objective: A locally advanced Gleason 4 + 4 prostate cancer patient who was on self-medication with intermittent anti-androgen monotherapy (iAAm) over 14 years suggested that raised testosterone was not dangerous and this suggestion needed investigating. Patients: Others who were on AA continuously were recruited to ongoing audit of intermittent hormone therapy (IHT) and iAAm outcomes were compared with intermittent LHRH therapy (iLHRH or iMAB). Results: Between 1994 and 2007, 111 patients sought IHT because of side effects of treatment. Forty-two M0 patients received IHT with iLHRHm or iMAB and 33 received iAAm (31 of these were M0). PSA nadir below 4 was necessary for entry. Overall survival was 87, 72 and 67% with iAAm and 73, 56 and 43% with iLHRH/MAB at 5, 8 and 10 years respectively. Overall survival was 61, 55 and 33% continued on iAAm and 56, 41, and 32% on iLHRH/MAB at 5, 8, and 10 years respectively. Multivariable analysis and matched case control analysis confirm that the maintenance of advantage for iAAm Testosterone levels in patients on iAAm compared to iLHRH therapy was more intense throughout treatment. Conclusion: These results complement recent progress in using bipolar androgen therapy to reverse castration resistance and add to the increasing acceptance that controlled testosterone exposure might be relevant in hormone-naïve patients.

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Section: Discussionsupporting

confidence: 78%

A Prospective Audit of Intermittent Anti-Androgen verses Pituitary Blockade Suggests a Bipolar Androgen Type Strategy May Be Safe in Untreated Prostate Cancer

et al. 2017

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“…Evaluation of OS was the primary endpoint in 4 studies [8-10,50,55,58] and TTP or time to androgen-independent was the primary endpoint in 7 studies [1,11,12,44-47,50-54,56,57] (Table 2). Five studies [1,8-10,44-47,55,58] were designed to evaluate the non-inferiority of IAD compared to CAD (Table 4).…”

Section: Resultsmentioning

confidence: 99%

Intermittent versus continuous androgen deprivation for locally advanced, recurrent or metastatic prostate cancer: a systematic review and meta-analysis

Engel¹,

Clark²,

Reis³

et al. 2014

BMC Urol

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BackgroundProstate cancer is the most common cancer in older men in the United States (USA) and Western Europe. Androgen deprivation (AD) constitutes, in most cases, the first-line of treatment for these cases. The negative impact of CAD in quality of life, secondary to the adverse events of sustained hormone deprivation, plus the costs of this therapy, motivated the intermittent treatment approach. The objective of this study is to to perform a systematic review and meta-analysis of all randomized controlled trials that compared the efficacy and adverse events profile of intermittent versus continuous androgen deprivation for locally advanced, recurrent or metastatic hormone-sensitive prostate cancer.MethodsSeveral databases were searched, including MEDLINE, EMBASE, LILACS, and CENTRAL. The endpoints were overall survival (OS), cancer-specific survival (CSS), time to progression (TTP) and adverse events. We performed a meta-analysis (MA) of the published data. The results were expressed as Hazard Ratio (HR) or Risk Ratio (RR), with their corresponding 95% Confidence Intervals (CI 95%).ResultsThe final analysis included 13 trials comprising 6,419 patients with hormone-sensitive prostate cancer. TTP was similar in patients who received intermittent androgen deprivation (IAD) or continuous androgen deprivation (CAD) (fixed effect: HR = 1.04; CI 95% = 0.96 to 1.14; p = 0.3). OS and CSS were also similar in patients treated with IAD or CAD (OS: fixed effect: HR = 1.02; CI 95% = 0.95 to 1.09; p = 0.56 and CSS: fixed effect: HR = 1.06; CI 95% = 0.96 to 1.18; p = 0.26).ConclusionOverall survival was similar between IAD and CAD in patients with locally advanced, recurrent or metastatic hormone-sensitive prostate cancer. Data on CSS are weak and the benefits of IAD on this outcome remain uncertain. Impact in QoL was similar for both groups, however, sexual activity scores were higher and the incidence of hot flushes was lower in patients treated with IAD.

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“…This includes intermittent treatment. 5,6 Most phase 2 studies have shown that intermittent ADT regimens decrease adverse events and improve QoL during offtherapy periods, with promising tolerability profiles. Also, early phase 3 results show a better tolerability profile and QoL with intermittent ADT than with continuous treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Intermittent androgen suppression may reduce the side effects of therapy during off-treatment periods. 6 The resulting hypogonadism due to ADT may leads to adverse results, such as osteoporosis, unfavourable body composition (increase in body mass index, increased fat mass, reduced lean body mass and muscle strength), sexual dysfunction, and reduced quality of life. Recent studies suggest male hypogonadism is an independent risk factor for the development of metabolic syndrome and diabetes.…”

Section: Introductionmentioning

confidence: 99%

Metabolic syndrome in patients with prostate cancer undergoing intermittent androgen-deprivation therapy

Rezaei¹,

Rezaei²,

Ghoreifi

et al. 2016

CUAJ

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Introduction: The presence of metabolic syndrome in men with prostate cancer (PCa) undergoing androgen-deprivation therapy (ADT), especially intermittent type, has not been completely evaluated. The aim of this study is to evaluate metabolic syndrome in men with PCa undergoing intermittent ADT. Methods: In this longitudinal study, we studied the prevalence of metabolic syndrome and its components in 190 patients who were undergoing intermittent ADT. The metabolic syndrome was defined according to the Adult Treatment Panel III criteria. All metabolic parameters, including lipid profile, blood glucose, blood pressures, and waist circumferences of the patients were measured six and 12 months after treatment. Results: Mean age of the patients was 67.5 ± 6.74 years. The incidence of metabolic syndrome after six and 12 months was 6.8% and 14.7%, respectively. Analysis of various components of the metabolic syndrome revealed that patients had significantly higher overall prevalence of hyperglycemia, abdominal obesity, and hypertriglyceridemia in their six-and 12-month followups, but blood pressure has not been changed in the same period except for diastolic blood pressure after six months. Conclusions: Although there was an increased risk of metabolic syndrome in patients receiving intermittent ADT, it was lower than other studies that treated the same patients with continuous ADT. Also it seems that intermittent ADT has less metabolic complications than continuous ADT and could be used as a safe alternative in patients with advanced and metastatic PCa.

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Testosterone recovery in the off-treatment time in prostate cancer patients undergoing intermittent androgen deprivation therapy

Cited by 37 publications

References 18 publications

A Prospective Audit of Intermittent Anti-Androgen verses Pituitary Blockade Suggests a Bipolar Androgen Type Strategy May Be Safe in Untreated Prostate Cancer

A Prospective Audit of Intermittent Anti-Androgen verses Pituitary Blockade Suggests a Bipolar Androgen Type Strategy May Be Safe in Untreated Prostate Cancer

Intermittent versus continuous androgen deprivation for locally advanced, recurrent or metastatic prostate cancer: a systematic review and meta-analysis

Metabolic syndrome in patients with prostate cancer undergoing intermittent androgen-deprivation therapy

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