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Publications

Intermittent versus continuous androgen deprivation in prostate cancer.

By:
Contributors: Bryan Donnelly, MD, MSc, FRCSC, Peter Venner, MD, FRCPC
Urol Oncol. 2014 Aug;32(6):936-7. doi: 10.1016/j.urolonc.2014.01.009.

Abstract

BACKGROUND:

Castration resistance occurs in most patients with metastatic hormone-sensitive prostate cancer who are receiving androgendeprivation therapy. Replacing androgens before progression of the disease is hypothesized to prolong androgen dependence.

METHODS:

Men with newly diagnosed, metastatic, hormone-sensitive prostate cancer, a performance status of 0 to 2, and a prostate-specific antigen (PSA) level of 5 ng per milliliter or higher received a luteinizing hormone-releasing hormone analogue and an antiandrogen agent for 7 months. We then randomly assigned patients in whom the PSA level fell to 4 ng per milliliter or lower to continuous or intermittent androgen deprivation, with patients stratified according to prior or no prior hormonal therapy, performance status, and extent of disease (minimal or extensive). The coprimary objectives were to assess whether intermittent therapy was noninferior to continuous therapy with respect to survival, with a one-sided test with an upper boundary of the hazard ratio of 1.20, and whether quality of life differed between the groups 3 months after randomization.

RESULTS:

A total of 3040 patients were enrolled, of whom 1535 were included in the analysis: 765 randomly assigned to continuous androgen deprivation and 770 assigned to intermittent androgen deprivation. The median follow-up period was 9.8 years. Median survival was 5.8 years in the continuous-therapy group and 5.1 years in the intermittent-therapy group (hazard ratio for death with intermittent therapy, 1.10; 90% confidence interval, 0.99 to 1.23). Intermittent therapy was associated with better erectile function and mental health (P<0.001 and P=0.003, respectively) at month 3 but not thereafter. There were no significant differences between the groups in the number of treatment-related high-grade adverse events.

CONCLUSIONS:

Our findings were statistically inconclusive. In patients with metastatic hormone-sensitive prostate cancer, the confidence interval for survival exceeded the upper boundary for noninferiority, suggesting that we cannot rule out a 20% greater risk of death with intermittent therapy than with continuous therapy, but too few events occurred to rule out significant inferiority of intermittent therapy. Intermittent therapy resulted in small improvements in quality of life. (Funded by the National Cancer Institute and others; ClinicalTrials.gov number, NCT00002651.).

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2018 APCaRI Fall Symposium

Our fall APCaRI 2018 symposium wrapped up on Saturday afternoon after two days of excellent seminars, great food, lots of coffee, bowling, hikes around Banff, get-togethers at the local pub, and beautiful fall weather with minimal snowfall!

The APCaRI meeting was attended by people from across Canada and the USA representing the Alberta Cancer Foundation, Bird Dogs for Prostate Cancer Research, Cross Cancer Institute, DynaLIFE Medical Labs, Edmonton Health City, Entos Pharmaceuticals, Institute of Health Economics, Nanostics Inc, Northern Alberta Urology Centre, Oisin Biotechnologies, PandiaDX, PROSTAID Calgary, Prostate Cancer Centre, Prostate Cancer Support Group, University of Alberta, University of Calgary, Western University, and the Yukon Hospital Corporation.
The invited speakers gave excellent keynote talks that kick-started interesting conversations during the meeting.

Dr. Alison Allan from Western University gave the Friday keynote seminar on developing circulating tumour cells as liquid biospies for early detection of cancers.

Dr. Melina Cimler, CEO of PandiaDX, and Saturday’s keynote speaker, outlined the potentially complex regulatory pathways that molecular diagnostic companies need to navigate when pursuing regulation in the USA.


Thank you to Rume Djebah for organizing the 2018 APCaRI Fall Symposium!

- Perrin Beatty