An introduction to the concept of intermittent ADT


Initially, androgen deprivation therapy (ADT) was conceived of and developed as long-term, palliative therapy for men with evident and commonly painful forms of metastatic prostate cancer. The primary goal was the alleviation of pain associated with metastasis, and had little or nothing to do with the patient’s long-term survival.

With the introduction of the PSA test into widespread clinical practice in the late 1980s and early 1990s, men started to be diagnosed regularly long before the onset of metastatic disease. Thus hormone therapy for men with progressive forms of prostate cancer also started to be used to manage the PSA levels of men with progressive rather than metastatic disease, and the side effects of long-term ADT became a serious issue for men who otherwise appeared to be in good health with a relatively high quality of life.

The concept behind intermittent ADT grew from a desire to see if men who needed hormone therapy to control their PSA levels could be managed with regular “off-therapy” drug “holidays,” with little to no impact on the long-term survival of the patient.

Gomella has now published a sound and practical introduction to and overview of the applicability of intermittent ADT in a recent issue of Renal & Urology News. The entire article (“Intermittent ADT in prostate cancer: a step-by-step approach“) is available on line for patients, support group leaders, and other interested readers.

The article is restricted to what might be considered the traditional forms of intermittent ADT — with either an LHRH agonist alone or an LHRH agonist + and antiandrogen. It does not touch on the pros or the cons of intermittent triple drug ADT or ADT3 using an LHRH agonist (like leuprolide acetate), an antiandrogen (like bicalutamide), and a 5α-reductase inhibitor (like dutasteride). Why? Because there are almost no meaningful data to support the use of such a combination. Could intermittent ADT3 be more effective than standard forms of intermittent ADT in a significant number of men with progressive forms of metastatic and non-metastatic prostate cancer? We certainly believe it could … but we have no data from randomized clinical trials to support such an opinion as yet … just case data from carefully selected patients.

Is intermittent ADT a therapy of choice for all men with advanced forms of prostate cancer? Probably not. It is least likely to be successful in men with a high Gleason score (8 or higher) and a low PSA doubling time (less than 9 months) after first-line or second-line therapy. However, we do know that men who respond well to hormone therapy can maintain an excellent response for many years and multiple cycles of ADT. Finding the individual men who are really good candidates for intermittent ADT can still be very much a matter of trial and error, however.

4 Responses

  1. The link to the document is not working: Page not found

    Jean

  2. Sorry about that. Link is now fixed.

  3. Diagnosed with Na stage cancer 12 months ago, on Lucrin 4-monthly PSA has gone from 5.9 to 0.2 after radiation. Urologist plans to continue with intermittent hormone treatment after 24 months; my oncologist disagrees and wants to retain continuous treatment as he expected PSA to drop to zero. I am confused about my options here.

  4. Dear Ken:

    I strongly suggest you join our social network, where we can discuss these options in more detail.

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