Is Intermittent Androgen Deprivation Therapy a Better Treatment Than Continuous Androgen Deprivation Therapy in the Treatment of Patients with Hormone-Sensitive Prostate Cancer?

Abstract

Accumulated experience indicates that intermittent androgen deprivation (IADT) is an acceptable treatment option for patients with prostate cancer that need ADT. Compared to continuous ADT (CADT), IADT has the advantages of being more economic and less detrimental to the quality of life, and shows similar efficacy in terms of overall survival and disease progression. For this reason, European Association of Urology Guideline and National Comprehensive Cancer Network Guideline recommend its use for the treatment of prostate cancer. Recently, several randomized phase 3 trials comparing IADT with CADT have been published (SEUG9401, TAP22, FinnProstate VII, NCT3653, SEUG9901 and SWOG9346). These heterogeneous studies have shown that IADT is at least non-inferior to CADT in terms of overall survival and disease progression, except for the SWOG9346 trial which was unable to rule out that IADT may decrease overall survival by 20% compared to CADT. The effect of IADT on quality of life was positive with many studies demonstrating significantly better quality of life score compared to CADT. However, these studies should be criticized for not being able to show any prolongation of time to progression as has been shown in the experimental settings. New studies with different designs should elicit undiscovered effectiveness of IADT in the future. For the time being, IADT should be considered in every patient who could potentially benefit from recovery of testosterone, but the method of IADT should be individualized rather than strictly abide by the arbitrarily set criteria in the randomized trial settings.