News from ASCO GU

Some potentially good news for men dealing with prostate cancer has come out of the ASCO GU conference. In this study of over 1,200 men with a PSA recurrence of prostate cancer (defined as a PSA over 3) after definitive radiotherapy, androgen deprivation therapy was given in 8-month blocks after PSA rose above 10 and was compared with continuous androgen deprivation. Giving androgen blockade continuously is currently the standard of care. Patients in both arms were followed for just over 6 years. OS was equal in both arms, as was time to castrate resistant disease. Somewhat surprisingly, the only side effect that was less in the intermittent arm was hot flashes, but not MIs or osteoporosis.

The perspective below the story brings up an interesting point about compliance: if you are going to treat based on PSA, you had better make sure the patients come in for their PSA checks. I don't see that compliance was reported in this study, but given that it was a large clinical trial, it is likely that compliance was good. Whether this is doable in real life — outside of a trial — is an open question. This study is important because continuous androgen deprivation therapy leads to long-term problems, including fatigue, impotence, and as a patient of mine once said, "feeling like half a man." It's great to see that some breaks can be taken to allow for some recovery while not compromising the cancer treatment.