Ultra-early versus early salvage androgen deprivation therapy for post-prostatectomy biochemical recurrence in pT2-4N0M0 prostate cancer. By Taguchi et al. 2014
Key sentence from the paper: “…patients who started salvage ADT before meeting a currently accepted definition of biochemical recurrence were less likely to develop subsequent biochemical recurrence after salvage ADT than those who started salvage ADT when they meet the definition.”
For the full abstract, see: http://www.ncbi.nlm.nih.gov/pubmed/25323845
Commentary: About one quarter to a third of all patients who are treated with a radical prostatectomy (with the intention to cure), nevertheless experience a subsequent rise in their PSA. This is called “biochemical failure”. It is standard practice for patients experiencing biochemical failure—particularly if they are relatively young with no major comorbidities (i.e., have relatively long life expectancy)—to start on ADT as “salvage therapy”. But how high should one let the PSA climb before starting ADT?
The majority of papers that we have reviewed on this blog over the last year have focused on the deleterious side effects of ADT. This has led to the suggestion that one should be cautious about using this treatment. The current paper, however, looks at the other side of the issue. The authors here explore the optimal timing for starting ADT. In this study, they started patients with biochemical failure, as soon as any rise in PSA was detected; i.e., what they call “ultra-early ADT”. The authors report a modest statistical benefit to ultra-early over early “salvage ADT”.
It is papers like this one that keep the debate alive about when patients should start on ADT. It should be noted though that this is a relatively small study; there were only 51 patients in the ultra-early group and 70 patients in the control group. Furthermore, the study ran only for medium length of 65.5 months, which was too short to look at cancer-specific survival or survival overall. Hopefully the authors will publish a follow-up paper in future years when they have more long-term data.
Taguchi, S., Fukuhara, H., Azuma, T., Suzuki, M., Fujimura, T., Nakagawa, T., Ishikawa, A., Kume, H., Igawa, Y., Homma, Y., 2014. Ultra-early versus early salvage androgen deprivation therapy for post-prostatectomy biochemical recurrence in pT2-4N0M0 prostate cancer. BMC Urol. 14, 81.