Immediate androgen deprivation therapy (ADT) offers little or no survival benefit over deferred ADT to prostate cancer patients who experience PSA-only relapse after radical prostatectomy of radiotherapy, investigators concluded in a presentation at the American Society of Clinical Oncology annual meeting in Chicago.
Xabier Garcia-Albeniz, MD, Harvard School of Public Health, Boston, and colleagues studied 2,022 men in the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE), a national, prospective registry. All patients underwent radical prostatectomy or radiotherapy and experienced PSA-only relapse. Researchers defined PSA relapse as a PSA level greater than 0.2 ng/mL after radical prostatectomy or 3 PSA rises one month apart after radiotherapy. Subjects had a median age of 69 years, and 33.8% had a Gleason score greater than 7. The investigators defined immediate ADT as ADT started within 3 months after PSA relapse and deferred ADT as ADT started 2 or more years after patients had PSA relapse or when they presented with metastasis, symptoms, or a short PSA doubling time. Following relapse, patients had a median follow-up of 53.2 months.
Compared with deferred ADT, immediate ADT was associated with a 6% increased risk of all-cause mortality and a 48% increased risk of prostate cancer-specific mortality, which corresponded to a -5.5% and -5.6% survival difference at 5 years, respectively.