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Intermittent Androgen Suppression 'Noninferior' to Continuous in Prostate Cancer

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Which Men Actually Benefited?

In an accompanying editorial, Dr Oliver Sartor called the study by Dr. Crook and her colleagues "the most definitive study to date comparing intermittent versus continuous androgen-deprivation therapy in patients with nonmetastatic cancer."

He noted, however, that an important question remains unanswered: "It is still unclear which men with rising PSA levels needed treatment. This is a heterogeneous patient group, and only a minority of men might be expected to have clinical consequences from their rise in PSA level."

Considering the slow progression of prostate cancer in men, "which of these asymptomatic patients actually benefited from androgen-deprivation therapy?" he asked (N. Engl. J. Med. 2012;367:945-6).

Dr. Sartor is medical director of the Tulane Cancer Center and the C.E. and Bernadine Laborde Professor of Cancer Research at Tulane University, New Orleans He disclosed a financial relationship with Tolmar.


 

FROM THE NEW ENGLAND JOURNAL OF MEDICINE

A secondary analysis of the SWOG 9346 data suggested that intermittent therapy was noninferior to continuous in patients with extensive disease but not minimal disease.

"The two studies targeted different populations," Dr. Crook said in an interview. "There are also some important differences in the way the results were handled in the statistical analysis. The results of the SWOG study are equivocal regarding survival."

"Our study has shown that men with only PSA evidence of recurrent prostate cancer and no evidence of metastatic disease can safely be treated with this intermittent program of androgen suppression to gain quality of life benefits without sacrificing length of life," she added.

"Our study did not address the optimal time to begin androgen ablation, or specifically how long intervention can be safely postponed."

The NCIC trial was supported by grants from the Canadian Cancer Society, the U.S. National Cancer Institute, and Hoeschst Marion Roussel Canada Research. Dr. Crook disclosed no relevant financial conflicts. Study coinvestigators disclosed financial relationships with numerous companies.

*This story was updated 9/6/2012.

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