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Comparison of maximal and more maximal intermittent androgen blockade during 5-year treatment of advanced prostate cancer T3NxMx-1

  • Urology – Original Paper
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Abstract

Purpose

Patients with advanced prostate cancer (PCa) benefit from intermittent maximal androgen blockade (IMAB) therapy when time-off period (TOP) is extended. A comparative study included patients who received uninterrupted finasteride (mMAB) treatment and those who did not MAB.

Methods

A randomized group of 63 patients with PCa (T3NxM1; Gl. 6-7) was prospectively examined for 5 years: group A (GrA)—31 patients receiving MAB and group B (GrB)—32—mMAB. Testosterone inactivating pharmaceuticals period (TIP) lasted until PSA was 0.2 ng/ml (group A) and 0.1 ng/ml (group B), followed by MAB (TOP) discontinuation. CR, PR, BP, and TP evaluation criteria were adopted. Tests were carried out every 3 months.

Results

After 5 years, five patients in GrA did not reach PSA concentration nadir value and were eliminated from final evaluation. TIP1 for both groups was comparable; TIP2-4 were shorter in GrB. TOP1-3 for GrB were longer than in GrA, and TOP4 was comparable in both groups. Treatment effects were, respectively, CR, 1(3.2%) and 17(53%); PR, 9(29%) and 3(9%); BP 11(35.5%) and 5(15.6%); TP, 10(32.2%) and 7(22%). Before the therapy, QoL of 63 patients was between 4 and 5 points; after 5 years for patients with CR and PR, between 1 and 2 points, but for BP, between 3 and 4 points.

Conclusions

Better therapy effects were observed in patients treated with mMAB, receiving additional finasteride. Response to the treatment improved by nearly double, and progression was two times lower. TOP after TIP was extending in time.

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Abbreviations

ADT:

Androgen deprivation therapy

5AR:

5-Alfa-reductase

5ARI:

5-Alfa-reductase inhibitor

BPH:

Benign prostatic hyperplasia

CAB:

Combined androgen blockade

CRPCa:

Castration-resistant prostate cancer

DHT:

Dihydrotestosterone

GrA:

Group of patients A

GrB:

Group of patients B

HT:

Hormone therapy

IAB:

Intermittent androgen blockade

IHT:

Intermittent hormone therapy

IPSS:

International Prostate Score System

LHRH:

Luteinizing-hormone-releasing hormone

MAB:

Maximal androgen blockade

mMAB:

More maximal androgen blockade

PCa:

Prostate cancer

PCPT:

Prostate Cancer Prevention Trial

TIP:

Testosterone inactivating pharmaceuticals

TOP:

Time-off period

PSA:

Prostate-specific antigen

QoL:

Quality of life

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Authors and Affiliations

  1. Department of Urology, Center of Clinical and Industrial Medicine “ATTIS”, Warsaw, Poland

    Slawomir A. Dutkiewicz

  2. Division of Prophylaxis and Oncological Epidemiology, Faculty of Medical Sciences, Institute of Public Health, Institute of Public Health Natural and Humanistic, Kielce, Poland

    Slawomir A. Dutkiewicz

  3. 2 Lachmana St. Apt. 56, 02-786, Warsaw, Poland

    Slawomir A. Dutkiewicz

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Correspondence to Slawomir A. Dutkiewicz.

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Dutkiewicz, S.A. Comparison of maximal and more maximal intermittent androgen blockade during 5-year treatment of advanced prostate cancer T3NxMx-1. Int Urol Nephrol 44, 487–492 (2012). https://doi.org/10.1007/s11255-011-0051-6

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  • DOI: https://doi.org/10.1007/s11255-011-0051-6

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