Early androgen deprivation therapy may not improve PCa survival

The American Society of Clinical Oncology has updated its 2004 clinical practice guidelines for the initial management of androgen-sensitive, metastatic, recurrent, or progressive prostate cancer.

After addressing whether patients with metastatic or progressive prostate cancer benefit from starting early androgen deprivation therapy over deferring therapy, the guideline panel found a 17% decrease in mortality from prostate cancer, but a 15% increase in mortality from causes not associated with prostate cancer. This indicates no overall survival advantage for patients who are treated with early deprivation therapy versus deferred therapy.

"There is debate in the medical community regarding optimal timing for starting androgen deprivation therapy for prostate cancer," said guideline lead author Andrew Loblaw, MD, a radiation oncologist at Toronto-Sunnybrook Regional Cancer Centre. "Doctors should discuss with patients the risks and benefits of early androgen deprivation therapy versus deferred therapy. If the patient prefers to defer therapy, he should have regular visits with his doctor every 3 to 6 months to monitor the disease."

The guideline update recommends either bilateral orchiectomy or luteinizing hormone-releasing hormone as initial deprivation therapy treatments. Additionally, combined androgen blockade should be considered in the treatment of locally advanced or metastatic prostate cancer.

"Overall, survival for men with prostate cancer is greater with the combination of nonsteroidal anti-androgen therapy and surgical or medical castration, over one of these treatments alone, though patients may experience increased side effects due to combined therapies, depending on the nonsteroidal agent used," Dr. Loblaw said.

The guideline update appears in the online edition of the Journal of Clinical Oncology (April 2, 2007).