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In Reply

University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA

We appreciate the interest by Duchesne et al in our recent article regarding the timing of androgen deprivation therapy.¹ They correctly point out that certain aspects of the trials cited in our review were flawed methodologically and that trials within certain patient populations have yet to be conducted.

In addition, Duchesne et al cite a study of early deprivation versus deferred androgen deprivation that yielded negative results. The study cited by Studer et al² failed to show a survival benefit for early androgen deprivation. It is worth noting that this study enrolled patients who were deemed incurable with local therapy and that 24% of the patients in the study had metastases at the time of enrollment. Treatment was either immediate orchiectomy or deferred orchiectomy on progression of disease associated with symptoms. In the final analysis, this study demonstrated a trend towards significance in terms of prostate cancer specific survival for those receiving immediate androgen deprivation (P = .09) but found no difference in terms of overall survival—perhaps reflecting the advanced age in this patient population (median age at enrollment, 76 years).

We acknowledge that the issue of the timing of androgen deprivation has not been entirely resolved for all situations. Despite this, when viewed in aggregate, we feel the evidence in support of early androgen deprivation justifies consideration of its use, particularly in intermediate-risk and high-risk patient populations.

Finally, Duchesne et al cite their ongoing work in Australia and New Zealand, which addresses the dilemma of the timing of androgen deprivation in the setting of prostate-specific antigen only relapse. We applaud these efforts as well as the design of the trial, which appropriately stratifies patients at enrollment based on prostate-specific antigen doubling time and time elapsed since definitive local therapy. Enrollment in trials such as this should be a high priority and we look forward to seeing the results.

Author's Disclosures of Potential Conflicts of Interest

The author indicated no potential conflicts of interest.

REFERENCES

1. Ryan CJ, Small, EJ: Early versus delayed androgen deprivation for prostate cancer: New fuel for an old debate. J Clin Oncol 23:8225-8231, 2005[Abstract/Free Full Text]

2. Studer UE, Hauri D, Hanselmann S, et al: Immediate versus deferred hormonal treatment for patients with prostate cancer who are not suitable for curative local treatment: Results of the randomized trial SAKK 08/88. J Clin Oncol 22:4109-4118, 2004[Abstract/Free Full Text]

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This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Ryan, C. J. Search for Related Content PubMed Articles by Ryan, C. J. Social Bookmarking                            What's this?