COMPARATIVE ANALYSIS OF THE RESULTS OF CONTINUOUS AND INTERMITTENT HORMONE THERAPY FOR DISSEMINATED PROSTATE CANCER

Objective: to compare the results of continuous and intermittent hormone therapy (HT) in unselected patients with disseminated prostate cancer (PC).

Subjects and methods. The study enrolled 113 patients with verified stage cT2b–4N0–1M0–1 PC. The median age of the patients was 70 ± 7.3 years. The median pretreatment concentration of prostate-specific antigen (PSA) was 309.8 ng/ml. The cT2 category was diagnosed in 12 (10.6 %) patients, сТ3 in 85 (75.2 %), сТ4 in 16 (14.2 %), сN+ in 32 (28.3 %), and М+ in 74 (65.5 %). At baseline, the median Gleason grade was (3.0 ± 0.8) + (4.0 ± 0.9) = 7.0 ± 1.7. All the patients received immediate HT: castration therapy was performed in 2 (1.8 %) patients, maximal androgen blockade in 96 (85 %), and antiandrogen monotherapy in 15 (13.3 %). Continuous and intermittent treatment regimens were used in 100 (70.8 %) and 33 (29.2 %) cases, respectively. The median follow-up was 31.9 ± 17.7 months.

Results. The intermittent HT regimen was associated with a significant increase in overall survival versus that during continuous treatment (medians 57.8 ± 11.6 and 25.2 ± 2.8 months, respectively; p = 0.031). Overall survival benefit remained in the poor prognosis (bone pain and/or a PSA of  100 ng/ml and/or сТ4 and/or М+) group. The HT regimen failed to affect survival in the good prognosis (no bone pain, a PSA of < 100 ng/ml, сТ < T4, М0) group. Impotence was less common during intermittent treatment than during continuous ablation (68.2 and 96.2 %, respectively; p = 0.002). No relationship was found between the incidence of other complications and the HT regimen. There was no significant difference between the groups in quality-of-life indicators before and during treatment. The average cost of an intermittent course of therapy per year was significantly lower than that of a continuous course (50586.7 and 72996.0 rubles, respectively; p < 0.0001).

Conclusions. Intermittent HT fails to result in a clinically relevant worsening of the quality of life, promotes better sexual function, and is economically expedient. In the poor prognosis group, intermittent treatment causes a significant increase in the time to hormone refractoriness and in overall survival rates as compared with these indicators when the continuous regimen is used. Intermittent therapy is as good as continuous ablation for overall survival among the good prognosis patients.

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