Intermittent Versus Continuous Therapy

Intermittent cessation of hormonal therapy may improve long-term outcome by preventing the development of mutations in an environment of androgen deprivation or by impeding the evolution to AR overexpression that is a feature of prostate cancer progression.132 To attenuate the side effects of hormonal suppression, recent investigative strategies have been designed to determine whether intermittent cessation of CAB improves QOL without compromising cancer control. The answer to this question awaits the outcome of a number of prospective randomized studies currently in accrual phase. Experimental and some clinical evidence suggests that tumors that respond initially and then progress when hormonal therapy is stopped will usually respond to further androgen deprivation.133,134 Preliminary evidence suggests that interruption of hormonal therapy can improve QOL.135 However, studies initiated in Canada in 1995 have largely been undertaken in patients with PSA relapse rather than patients with symptomatic advanced dis-ease.132 Recent phase II studies in patients with symptomatic advanced prostate cancer show variable responses to intermittent cessation of therapy;136,137 therefore extrapolation of early data from patients with elevated PSA as the only evidence of disease to symptomatic patients requires randomized studies incorporating QOL assessment with survival analysis.

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