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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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Enbridge Ride to Conquer Cancer 2018

APCaRI members participated in the Enbridge Ride to Conquer Cancer, benefiting the Alberta Cancer Foundation, again this year! The ride is a 2-day cycling adventure that covers 200 km along the majestic Rockies. Unfortunately,  the air was so smoky from fires that the air quality health index reached 10+.  The 1800 riders rode approximately 75 km, but had to stop due to potential negative health risks from the smoke.
Although the ride was shortened it was still an amazing experience for the APCaRI member-riders and the Cross Cancer riding team. Thank you again to the amazing team of volunteers that helped to organize, set-up and transport riders to Calgary!
Most importantly, over $8 M dollars was raised to support cutting-edge cancer research in Alberta! We are very thankful for the support we received, which will help us to beat prostate cancer.
If you didn’t get a chance to support one of our riders, please consider contributing to the team’s efforts at our DONATE page

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