• How well does androgen deprivation treatment work?

    A randomised controlled trial of 934 patients receiving immediate or deferred androgen deprivation treatment found a significant reduction in extraskeletal metastases (number needed to treat 25), spinal cord compression (33), and ureteric obstruction (20) in those receiving the immediate treatment. [3] Overall, survival was significantly improved in patients with non-metastatic disease but not with metastatic disease.

    Similar overall survival results were seen in the landmark Veterans Administration Co-operative Research Group studies, which randomised 2052 men to receive either androgen deprivation treatment or a placebo (with this group later being allowed androgen deprivation treatment on clinical progression). [4] The researchers found no significant difference in five year overall survival (54% v 56% respectively for locally advanced disease and 32% v 20% for metastatic disease).

    A meta-analysis of 10 randomised controlled trials of 1908 patients with advanced prostate cancer found no significant difference in overall survival between LHRH [luteinising hormone releasing hormone] and surgical castration (hazard ratio 1.12, 95% confidence interval 0.915 to 1.386). [5]

    More by Thomas and Neal in BMJ. The review also covers NICE guidelines, complications, cost effectiveness, how the newer and older drugs are administered, and more. Here’s a JAMA clinical review of androgen deprivation therapy.

    References

    [3] Immediate versus deferred treatment for advanced prostatic cancer: initial results of the Medical Research Council Trial. The Medical Research Council Prostate Cancer Working Party Investigators Group. Br J Urol 1997;79:235-46.

    [4] Treatment and survival of patients with cancer of the prostate. The Veterans Administration Co-operative Urological Research Group. Surg Gynecol Obstet 1967;124:1011-7.

    [5] Seidenfeld J, Samson DJ, Hasselblad V, Aronson N, Albertsen PC, Bennett CL, et al. Single-therapy androgen suppression in men with advanced prostate cancer: a systematic review and meta-analysis. Ann Intern Med 2000;132:566-77.

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