There were three recent FDA approvals for drugs to be used in non-metastatic castration resistant prostate cancer, a state that arises from the unproven start of continuous androgen deprivation therapy (ADT) for biochemical recurrent prostate cancer (BCR), before metastatic disease is evidence. This report examines the outcome of men with BCR who defer ADT until time of metastasis.
Patients and Methods
Retrospective review of men diagnosed with clinically localized prostate cancer who underwent radical prostatectomy at Johns Hopkins Hospital and Walter Reed National Military Medical Center and developed BCR with a PSA doubling time of not more than 10 months (n=806). The primary endpoints were metastasis free (MFS) and overall survival (OS)– from time of local treatment, among men who delayed ADT until time of metastasis.
The median MFS of men with BCRP and a PSADT <6 months and 10 months who delay ADT until metastasis is 144 months (95% CI 48-not reached) and 192 months (95% CI 72 – not reached) respectively, with a median overall survival of 168 months (95% CI 96-276 months) and 204 months (95% CI 120-276), respectively.
MFS and OS of men with BCRP who delay hormone therapy is long. This underscores the need to reevaluate when to start primary ADT in this patient population.