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Early versus delayed hormonal treatment in locally advanced or asymptomatic metastatic prostatic cancer patient dilemma

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Abstract

Introduction

The objective of this work is to compare the effectiveness of hormonal treatment (luteinizing hormone-releasing hormone agonists and/or antiandrogens) as an early or as a deferred intervention for patients with locally advanced prostate cancer (LAPC) and/or asymptomatic metastasis.

Materials and methods

Systematic review of trials published in 1950–2007. Sources included MEDLINE and bibliographies of retrieved articles. Eligible trials included adults with a history of LAPC who are not suitable for curative local treatment of prostate cancer. We retrieved 22 articles for detailed review, of which 8 met inclusion criteria. The Veterans Administration Cooperative Urological Research Group suggested that delaying hormonal therapy did not compromise overall survival and that many of the patients died of causes other than prostate cancer. In European Organisation for Research and Treatment of Cancer (EORTC) 30846 trial, the median survival for delayed endocrine treatment was 6.1 year, and for immediate treatment 7.6 year, the HR for survival on delayed versus immediate treatment was 1.23 (95 % CI 0.88–1.71), indicating a 23 % nonsignificant trend in favour of early treatment. In EORTC 30891, the immediate androgen deprivation resulted in a modest but statistically significant increase in overall survival. The protocol SAKK 08/88 showed the lack of any major advantage of immediate compared with deferred hormonal treatment regarding quality of life or overall survival.

Conclusions

The early intervention with hormonal treatment for patients with LAPC provides important reductions in all-cause mortality, prostate cancer-specific mortality, overall progression, and distant progression compared with deferring their use until standard care has failed to halt the disease.

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Abbreviations

APC:

Advanced prostate cancer

CAB:

Combined androgen blockade

CI:

Confidence interval

CPA:

Cyproterone acetate

DES:

Diethylstilbestrol

DET:

Delayed estrogenic treatment

EET:

Early estrogenic treatment

EORTC:

European Organisation for Research and Treatment of Cancer

EPC:

Early prostate cancer

HR:

Hazard ratio

LAPC:

Locally advanced prostate cancer

LHRH:

Luteinizing hormone-releasing hormone

MRC:

Medical Research Council

NSAA:

Nonsteroidal antiandrogen

OS:

Overall survival

PC:

Prostate cancer

PFS:

Progression-free survival benefit

PSA:

Prostate-specific antigen

RR:

Relative risk

RTC:

Randomized controlled clinical trial

SEER:

Surveillance epidemiology and end results

VACURG:

Veterans Administration Cooperative Urological Research Group

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Correspondence to Ester Illiano.

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Prezioso, D., Iacono, F., Romeo, G. et al. Early versus delayed hormonal treatment in locally advanced or asymptomatic metastatic prostatic cancer patient dilemma. World J Urol 32, 661–667 (2014). https://doi.org/10.1007/s00345-013-1144-x

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  • DOI: https://doi.org/10.1007/s00345-013-1144-x

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