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The role of intermittent androgen suppression in biochemically recurrent or newly diagnosed metastatic prostate cancer

Purpose of reviewTo review the current status of intermittent androgen suppression in the management of biochemically recurrent or newly diagnosed metastatic prostate cancer with respect to two recently reported multicenter phase III randomized trials. Recent findingsThe Canadian lead trial for men with biochemically recurrent prostate cancer after definitive radiotherapy (National Cancer Institute of Canada Clinical Trials Group PR7) randomized 1386 men and found a hazard ratio for death of 1.03 at a median follow-up of 6.9 years, declaring intermittent therapy noninferior to continuous for the trial algorithm. Over the same time frame, the South West Oncology Group (SWOG) compared continuous to intermittent therapy in metastatic prostate cancer. Although results were very similar in absolute terms, at 9.8 years follow-up, the hazard ratio for death was 1.1 in favor of the continuous approach. Intermittent therapy could not be declared noninferior. Both trials reported improved quality of life in the intermittent arms. SummaryThere is a small increased risk for death from prostate cancer with the use of intermittent androgen suppression in both these patient populations. This situation may be especially true for higher Gleason score tumors (8–10) and in men with symptomatic bone metastases. Quality-of-life benefits may make this approach worthwhile for some individuals.