Recent findings presented at the American Society of Clinical Oncology Genitourinary Cancers Symposium highlight the complex balance between treatment efficacy and quality of life for prostate cancer patients receiving androgen deprivation therapy (ADT).
Comparing Continuous vs. Intermittent ADT Approaches
A comprehensive meta-analysis involving over 5,300 patients has revealed comparable survival outcomes between continuous ADT (cADT) and intermittent ADT (iADT) treatments. The study tracked 2,685 patients receiving intermittent therapy and 2,679 on continuous treatment, with median ages of 69.9 and 69.4 years, respectively.
Overall survival rates showed minimal difference between the approaches, with cADT at 58.3% and iADT at 54.2%. Progression-free survival rates were 22.4% for continuous and 27.8% for intermittent therapy. However, both methods demonstrated significant quality of life impacts.
Quality of life metrics revealed notable adverse effects:
- Vasomotor symptoms affected 40.8% of cADT patients versus 32.7% of iADT patients
- Erectile dysfunction occurred in 25.6% of cADT patients compared to 21.3% of iADT patients
- Gynecomastia was reported in 7.7% of cADT patients versus 5.8% of iADT patients
ADT Impact in Post-Operative Radiotherapy
A separate analysis of 1,124 patients receiving post-operative radiotherapy revealed significant quality of life implications when combined with ADT. The study compared 436 patients receiving ADT with 682 who did not receive hormone therapy.
The findings showed a clear deterioration in health-related quality of life (HRQOL) scores:
- Pre-radiotherapy scores were similar (69.6 vs 68.9)
- Immediate post-treatment scores showed significant divergence (65.1 vs 69.9)
- Long-term follow-up at 59 months revealed further deterioration (62.8 vs 68.1)
Clinical Implications and Treatment Considerations
The research underscores ADT as an independent predictor of worse HRQOL outcomes, with an odds ratio of 0.68 (95% CI, 0.47-0.96). Longer duration of ADT treatment consistently correlated with poorer general health outcomes and quality of life measures.
These findings emphasize the critical need for careful patient selection and individualized treatment approaches. Clinicians must weigh the oncological benefits against potential long-term impacts on patient well-being, particularly when considering treatment duration and combination therapies.
Treatment Options and Administration
Current ADT options include:
- Surgical orchiectomy
- Medical castration using LHRH agonists or antagonists
- Androgen receptor blockers
- Androgen synthesis inhibitors
The most commonly used hormone therapies in the studies were goserelin (31%) and flutamide (23%), with treatment protocols typically initiated at PSA levels of 12.5 ng/mL or higher.
The mounting evidence suggests that while ADT remains a cornerstone of prostate cancer treatment, its application requires careful consideration of individual patient factors, treatment goals, and quality of life priorities. Healthcare providers are increasingly encouraged to develop personalized treatment strategies that optimize both cancer control and patient well-being.
