• Oncology Clinical Trials
• Reproductive Cancers

• Oncology Clinical Trials
• Oncology
• Reproductive Cancers

Mortality rates were similar among patients with prostate antigen (PSA)–only relapsed prostate cancer who received immediate or deferred androgen deprivation therapy (ADT). Xabier Garcia-Albeniz, Harvard School of Public Health, Boston, Massachusetts, USA, presented data from a study of the immediate versus deferred initiation of ADT in patients with PSA-only relapsed prostate cancer [Garcia-Albeniz X et al. J Clin Oncol 2014].

PSA is used to assess disease course in patients with prostate cancer; however, its accurate assessment is confounded by time and previous treatment. In addition, the most beneficial timing of the initiation of ADT in asymptomatic patients with PSA-relapsed prostate cancer is not known. The purpose of this analysis was to determine if the timing of ADT initiation would affect mortality in this patient population.

In this longitudinal, observational trial, 2012 patients with PSA-only relapsed prostate cancer received immediate or deferred treatment with ADT. Data were from patients who had participated in the CaPSURE study, in which over 14,000 men with biopsy-proven prostate cancer received treatment and were followed in a typical practice setting. ADT was initiated immediately at study entry (Intermediate ADT), or after disease progression or at 2 or more years after enrollment (Deferred ADT). PSA relapse was defined as PSA levels of 0.2 ng/mL or above in patients who were treated with primary prostatectomy, or 3 rising levels of PSA 1 month apart if patients received radiation-based primary treatment. Progression was characterized as the development of metastasis, severe cancer-related symptoms, or a PSA doubling time of less than 12 months. Outcomes included all-cause mortality and prostate cancer-specific mortality.

At baseline, the median age at the time of PSA relapse was 69 years, and 40% and 58% of patients were stage cT1 or cT2, respectively. The Gleason scores were 2 to 5 (19%), 6 (40%), and 7 to 10 (34%), and the median time since primary treatment was 27 months.

There was no significant difference in all-cause mortality adjusted for time-varying confounders in patients who received immediate or deferred ADT therapy (HR, 0.94; 95% CI, 0.51 to 1.73). The 5- and 10-year survival rates were similar, ranging from 85.1 to 87.2 months and 71.6 months, respectively. In addition, the rates of prostate cancer–specific mortality were similar between the study groups (HR, 1.15; 95% CI, 0.33–3.97).

In conclusion, Dr. Albeniz stated that survival rates are similar among patients who receive immediate or deferred ADT therapy for PSA-only relapsed prostate cancer. Dr. Albeniz noted that the observational design of this study is a limitation in drawing conclusion from the data. However, a randomized Phase 3 trial is ongoing to evaluate the effect of the timing of ADT in patients with prostate cancer and increasing PSA levels, and Dr. Albeniz expects that the results of this trial will set the standard for the timing of ADT therapy in this population [NCT00110162].

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