Reply from Authors re: Nicolas Mottet. Intermittent Androgen Deprivation in Prostate Cancer: Is Everything So Clear? Eur Urol 2013;63:121–2: Intermittent Androgen Deprivation in Advanced Prostate Cancer: An Optional Treatment Regimen

Abstract

Because of the limited duration of response to androgen deprivation therapy (ADT) in treatment of prostate cancer (PCa) and because of the adverse effects (AEs) of castration with deterioration in health-related quality of life (QoL), the FinnProstate Study VII (FPVII) was planned in the 1990s to compare intermittent androgen deprivation (IAD) and continuous ADT (CAD) in treatment of advanced PCa in terms of time to progression, overall survival, PCa-specific survival, time to treatment failure, and changes in QoL. Our interim analysis showed that patients with advanced PCa, having high tumour burden, high prostate-specific antigen (PSA) levels, high alkaline phosphatase levels, or metastatic disease with numerous skeletal hot spots did not show adequate biochemical PSA response to ADT, were not candidates for IAD, and were excluded from randomisation and further trial [1]. The results of the FPVII showed IAD to be as efficient as CAD in treatment of advanced PCa, with risk analysis showing a mild, but not statistically significant, advantage to IAD [2]. These results are in accordance with other trials despite our higher PSA cut-off values for withdrawal and resumption of ADT. We admit and agree with the editorial that the lack of postponing the castration-resistant status and the lack of extended survival with IAD were disappointing [3]. The evaluation of QoL was based on the formulated and self-administered Cleary 30-itemquestionnaire. The benefit in sexual functioning (SF) was apparent during the first treatment cycles (Fig. 1c and 1g) when the duration of treatment-off phase (TOFF) was longer than in later cycles (Table 2) [4]. This meant longer time for testosterone recovery and higher testosterone recovery rates during early, rather than later, TOFFs [2]. The differences between the IAD and CAD arms were demonstrated more evidently in Figure 2 (repeatedmeasures analysis of variance) [4]. The benefit of IAD in SF was also evident when we analysed the respondents in domain 9, who had any kind of sexual