ADT May Be Safely Deferred After PSA Relapse

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Immediate ADT found to offer little or no survival advantage.
Immediate ADT found to offer little or no survival advantage.

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.

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