Study: Continuous hormone therapy more effective than interupted therapy (with mets)

www.nytimes.com/2012/06/03/health/research/study-backs-continuous-prostate-cancer-treatment.html

Study presented at ASCO meeting that continuous hormone therapy / androgen deprivation therapy produces longer survival for men with metastasis
All men in the study had metastasis.

Post Edited (robertcool) : 6/3/2012 8:00:49 AM (GMT-6)

Good to get some solid data on that question. I expect to get to the mets stage eventually. I am very much in favor of evidence based medicine -- this adds to the knowledge base when decision time comes.

NewspaperLover

In the real world, would any doctor do HT for only 7 months?

"To test the issue, they enrolled 3,040 patients with newly diagnosed metastatic disease and prostate-specific antigen (PSA) level of at least 5 ng/mL of blood.

They were given androgen deprivation therapy for 7 months, using goserelin (Zoladex) and bicalutamide (Casodex), Hussain said. Those who showed a response, defined as a PSA of no more than 4 ng/mL in months six and seven were assigned randomly to continue the therapy or to have it interrupted."

Would any doctor stop HT at 7 months with a PSA = .4 (or am I getting the decimals confused?  i.e. 4 ng/ml isn't .004 i.e. call it zero?).  Don't doctors usually recommend at least a year (or two, or three) of HT?

I don't think that this proves that intermittent therapy doesn't work.  It proves that 7 months of HT isn't enough, when you don't get the PSA down to "zero".  What am I missing?

This is a shock. I seem to remember reading studies that seemed to indicate IHT was as good as HT.

Given the miserable SE of HT, this is not good news at all.

I guess more questions for Dr. Lam!

Mel

I also would like to know what kind of a doctor would stop HT in 7 months when the PSA was only reduced to 4?????????

That is not the criteria for intermittent therapy.

A nonsense study..................

Jerry L. said...
So much for my vacation off HT.

Same here. Dr.H told me at my last visit that she was waiting for the results from this to see weather i would be able to go inter. I was hoping to go "off cycle" late June. Should be an interesting visit. My question to her will be...what category do i fall into if i had mets but do not have detectable mets now?? And the plot thickins....

To 1370, actually, one oncologist (from a major cancer institution) that we saw for second opinion, did recommend my husband be on HT for only 6 months. We decided to get a third opinion (for different reasons) and he recommended 18 - 24 months. Stay tuned.....

In the article by the InfoLink the following was outlined from the study:

There were, however, distinctions between the survival of the men randomized to IAD as compared to those randomized to CAD based on the extent of their disease at the time of randomization.

> For the men with extensive disease, HR = 0.96, suggesting that IAD is not inferior to CAD in this group of men.
> For the men with minimal disease, HR = 1.23, indicating that IAD is actually inferior to CAD in this group of men.

This is very interesting to me and I think needs clarification. But what this indicates is that men with lower PSA's at the time of inclusion faired worse than men that had higher PSA's. If this is how this was determined I think the take home is that IHT and CAD made little difference in men with higher PSA, and metastatic bone disease that was already racing through their bodies. And men that has the lower PSA's believed that they were more apparently responding to treatment did not fair well with IHT.

It's hard to decipher because the abstract does not clarify what defines these two categories of patients. I have asked for the whole paper and when my oncologist returns from Chicago he said he'll bring it and forward it to me. but he said basically I am correct in my assessment. So the through that a PSA of 4 was the entry criteria, and that is a high number, is also mixed with patients that had full response to remission and patients that definitely should never have entered into IHT to begin with. But that is the point of this abstract. many men simply want a break and their PSA's are not low enough. But this study shows that the may actually ok with that break and under false pretenses men whose PSA's are low or non-detectable should not consider the break if mets were ever detected in the bones.

Tony