Timing of ADT

While scheduling of androgen deprivation therapy (ADT) is an important factor in ensuring the greatest benefits for patients, doctors’ practices don’t always match up in this respect. Some doctors recommend starting ADT right after surgery, others are in favour of beginning it after biochechemical recurrence (determined by PSA rise), and still others advise waiting until there are signs of the cancer spreading (either symptoms or those seen on radiographic tests). So what’s the best strategy?

Wishing to investigate this issue further, Mayo clinic (Rochester, Minnesota) researchers followed groups of men who went on ADT at varying times after having radical prostatectomies:

• within 90 days (called adjuvant ADT)
• when PSA reached 0.4 ng/mL or higher
• when PSA rose to 1.0 ng/mL or above
• when the PSA level was 2.0 ng/mL or greaterwhen signs of progression were detected

Results for men in the first four groups were compared to those of men who didn’t go on ADT at all.

According to the recently published study report, the men who received adjuvant ADT had significantly higher progression-free survival and cancer-specific survival after 10 years than those who didn’t receive the treatment within 90 days. On the other hand, the benefits weren’t much greater for the men who started ADT once their PSA rose, compared to those who didn’t go on ADT.

The authors concluded that immediate ADT after surgery may be a good choice for high-risk patients, but that further studies should be done to identify which patients would benefit the most (especially because of some possible heart risks associated with long-term ADT).