Jerry
Junior Member
Posts: 44 
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Post by Jerry on Jan 25, 2014 19:16:23 GMT -8
I believe this to be recent information about the effectiveness of intermittant hormone therapy compared to continued. Previous studies awhile back concluded that there were significant overall survival differences in certain groups of men, but there was a lot of controversy....as I guess with many studies.
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Post by Tony Crispino on Jan 26, 2014 0:03:18 GMT -8
Jerry, The first thing I see that is different than the Hussain et al paper is that locally advanced is included and that can really skew the SWOG/Hussain findings if they included that subgroup. Hussain et al established a 20% incase in mortality for IHT versus CAD with hormonally sensitive metastatic cases. They did also draw a limit to their findings that they can see that IHT may in fact may not be the only contributing factor to their data. But it is compelling to look at this one: Hussain et alHere are some differences: 1> The SWOG findings were from a randomized clinical trial. Botrel et al is a meta-annalysis compiled from 13 various trials.
2> The inclusion criteria appears to differ by a lot. The Hussain trial is specific that these were metastatic men whose PSA 4 ng/dl or below after starting HT. The Botrel paper makes no distinction on PSA and includes locally advanced cases possibly without mets?
3> SWOG determined it was inconclusive whether IHT was non-inferior that they cannot rule out a 20% increase in mortality in the IHT arm after 9.8 years median versus the CAD arm.
It's possible for both of these studies to be correct. But there is a couple major differences in the groups of men in the inclusion criteria of the two papers I believe.
The Hussain et al. paper is looking at sicker men I believe.
Tony
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Jerry
Junior Member
Posts: 44
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Post by Jerry on Jan 26, 2014 6:00:41 GMT -8
I find it interesting that both studies suggest that "Intermittent therapy resulted in small improvements in quality of life." I've lived on both sides of hormone therapy. I do ok while on HT, but I would say quality of life is way improved when not on it....one feels more like themselves. They must be talking qol issues as it relates to overall survival.
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Post by Tony Crispino on Jan 26, 2014 11:57:34 GMT -8
Jerry I would bet that you and I are in the category that would benefit most with IHT in terms of QoL related matters. We were both diagnosed with advanced prostate cancer before age 45. There are far more 60-75yo men in this study than under 45's. Men tend to have drops in testosterone as they age. In addition, other morbidities in treatments for other ailments as we age contribute to ED and loss of libido.
While there are clearly some good data from a Lupron/Casodex trial like this one, I wonder the value of the trial today because the metastatic patients may better benefit, and will typically get, abiraterone + prednisone or enzalutimide in addition to standard HT, for example, out of the gate. And depending how advanced they are they may even benefit from early docetaxel chemotherapy (Sweeney et al, 2013).
In any case I would bet the younger guys have better ability to recover after stints on any of these drugs. I also bet the ability to efficiently do so decreases as we arrive at the median age of a metastatic patient (70+). Thus the QoL improvements are less, possibly negligible.
Tony
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