At least since 2008 IAD has been considered an option that may be offered to men with metastatic prostate cancer but I have no idea about actual application of this strategy. Any feedback or publications would be welcomed.
Sciarra et al has provided a good critical review based on 7 RCTs on this subject. The team found that iADT is as good as continous ADT in terms of oncological outcomes. We do this here in Adelaide, Australia, but I suspect it is not as widely accepted as it should elsewhere.
Thank you Ivan. Very good paper.
Curiously, I have the same perception that IAD was not widely accepted as it should. Then, taking into account that:
1) "The evidence indicates that IAD is not inferior to continuous ADT" in terms of overall survival.
2) "Data are insufficient to determine whether IAD is able to prevent the long-term complications of ADT" but it seems logical to imagine that QoL would be improved with IAD at least in off periods.
3) Prostate Cancer has one of the highest incidences in men of occidental countries (constantly increasing for more than 20 years)
4) Hormonal therapy for PC is a quite expensive prescription.
My naive question is Why IAD is not more widely accepted? Maybe it is but is not published? Other...
As to why IAD is not widely accepted is not naive at all. I think there are 2 reasons ( you may be able to find more) for it being controversial are as follows:
a) Not all the RCTs are sufficiantly powered and followed up long enough
b) The study populations are mixed: metastatic vs. non-metastatic ; minimal mets vs. extensive mets
The comment given by Bachir Bassel on Brook's paper is a good and pragmatic one: " IAD is an option when recurrent disease is local, a state that can be treated with IAD, CAD, salvage local therapy, or even surveillance, depending on the context. However, when disease displays an aggressive biologic phenotype with early BCR, high PSA levels, short PSA doubling time, or metastasis, CAD remains the standard of care."
You may find this article interesting.
www.researchgate.net/publication/258824139_Intermittent_versus_continuous_cyproterone_acetate_in_bone_metastatic_prostate_cancer_results_of_a_randomized_trial
Article 680 Intermittent versus continuous cyproterone acetate in bo...
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