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Intermittent Androgen Suppression for Rising PSA Level after Radiotherapy
Open accessAbstract
BACKGROUND: Intermittent androgen deprivation for prostate-specific antigen (PSA) elevation after radiotherapy may improve quality of life and delay hormone resistance. We assessed overall survival with intermittent versus continuous androgen deprivation in a noninferiority randomized trial. METHODS: We enrolled patients with a PSA level greater than 3 ng per milliliter more than 1 year after primary or salvage radiotherapy for localized prostate cancer. Intermittent treatment was provided in 8-month cycles, with nontreatment periods determined according to the PSA level. The primary end point was overall survival. Secondary end points included quality of life, time to castration-resistant disease, and duration of nontreatment intervals. RESULTS: Of 1386 enrolled patients, 690 were randomly assigned to intermittent therapy and 696 to continuous therapy. Median follow-up was 6.9 years. There were no significant between-group differences in adverse events. In the intermittent-therapy group, full testosterone recovery occurred in 35% of patients, and testosterone recovery to the trial-entry threshold occurred in 79%. Intermittent therapy provided potential benefits with respect to physical function, fatigue, urinary problems, hot flashes, libido, and erectile function. There were 268 deaths in the intermittent-therapy group and 256 in the continuous-therapy group. Median overall survival was 8.8 years in the intermittent-therapy group versus 9.1 years in the continuous-therapy group (hazard ratio for death, 1.02; 95% confidence interval, 0.86 to 1.21). The estimated 7-year cumulative rates of disease-related death were 18% and 15% in the two groups, respectively (P=0.24). CONCLUSIONS: Intermittent androgen deprivation was noninferior to continuous therapy with respect to overall survival. Some quality-of-life factors improved with intermittent therapy. (Funded by the Canadian Cancer Society Research Institute and others; ClinicalTrials.gov number, NCT00003653.).
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D'Amico, A. V., Denham, J. W., Crook, J., Chen, M.-H., Goldhaber, S. Z., Lamb, D. S., Joseph, D., Tai, K.-H., Malone, S., Ludgate, C., et al. (2007) · Journal of Clinical Oncology · doi:10.1200/jco.2006.09.3369 · Cited by 501
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Metadata
- Authors
- Crook, J. M., O'Callaghan, C. J., Duncan, G., Dearnaley, D. P., Higano, C. S., Horwitz, E. M., Frymire, E., Malone, S., Chin, J., Nabid, A., Warde, P., Corbett, T., Angyalfi, S., Goldenberg, S. L., Gospodarowicz, M. K., Saad, F., Logue, J. P., Hall, E., Schellhammer, P. F., Ding, K., & Klotz, L.
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2012-09-06
- Volume
- 367
- Issue
- 10
- Pages
- 895-903
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2107270081
- Cited by
- 499
- References
- 1
- FWCI
- 40.08
- Type
- journal article
- Language
- en
- Open access
- bronze
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- Crook, J. M., O'Callaghan, C. J., Duncan, G., Dearnaley, D. P., Higano, C. S., Horwitz, E. M., Frymire, E., Malone, S., Chin, J., Nabid, A., Warde, P., Corbett, T., Angyalfi, S., Goldenberg, S. L., Gospodarowicz, M. K., Saad, F., Logue, J. P., Hall, E., Schellhammer, P. F., . . . Klotz, L. (2012). Intermittent Androgen Suppression for Rising PSA Level after Radiotherapy. New England Journal of Medicine. https://doi.org/10.1056/nejmoa1201546
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Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).
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