Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Viewpoint
  • Published:

Intermittent androgen blockade should be regarded as standard therapy in prostate cancer

Nature Clinical Practice Oncology volume 5, pages 574–576 (2008)Cite this article

Androgen deprivation (AD) therapy for prostate cancer is being used in an increasingly wide range of settings, such as advanced disease, loco-regional disease, as an adjunct to surgery or radiotherapy, and in patients with rising prostate-specific antigen (PSA) levels after local therapy. More than 80% of men with advanced prostate cancer will respond to AD therapy, experiencing improvement in disease-related symptoms and a marked reduction in level of serum PSA. The standard of care for advanced prostate cancer has been continuous AD therapy, usually combined with an agonist of gonadotropin releasing hormone (GnRH) such as goserelin acetate or leuprolide. A peripheral anti-androgen is given briefly before and during initiation of such treatment to prevent disease flare. AD therapy is associated with several side-effects that impair the patient's quality of life, including sexual dysfunction, osteoporosis, hot flashes, fatigue, gynecomastia, anemia and, in some patients, depression and cognitive dysfunction.1 The metabolic syndrome—a known risk factor for cardiovascular disease that is characterized by reduced glucose tolerance, increased body fat and altered lipid profile—is also associated with AD therapy.2 An observational study of a population-based cohort of 73,196 men with loco-regional prostate cancer showed that patients treated with continuous AD therapy had a significantly increased risk for cardiovascular morbidity and mortality.3

In contrast to normal prostatic epithelial cells, which are not able to regenerate and grow in an androgen-deprived state, prostate cancer cells almost always manage to acquire an androgen-independent phenotype. Most patients receiving continuous AD therapy for advanced disease develop androgen resistance and disease progression within 2–3 years of starting treatment.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Thompson CA et al. (2003) Andropause: symptom management for prostate cancer patients treated with hormonal ablation. Oncologist 8: 474–487

    Article  Google Scholar 

  2. Braga-Basaria M et al. (2006) Metabolic syndrome in men with prostate cancer undergoing long-term androgen-deprivation therapy. J Clin Oncol 24: 3979–3983

    Article  Google Scholar 

  3. Keating NL et al. (2006) Diabetes and cardiovascular disease during androgen deprivation therapy for prostate cancer. J Clin Oncol 24: 4448–4456

    Article  CAS  Google Scholar 

  4. Sato N et al. (1996) Intermittent androgen suppression delays progression to androgen-independent regulation of prostate-specific antigen gene in the LNCaP prostate tumor model. J Steroid Biochem Mol Biol 58: 139–146

    Article  CAS  Google Scholar 

  5. Akakura E et al. (1993) Effects of intermittent androgen suppression on androgen-dependent tumors: apoptosis and prostate-specific antigen. Cancer 71: 2782–2790

    Article  CAS  Google Scholar 

  6. de Leval J et al. (2002) Intermittent versus continuous total androgen blockade in the treatment of patients with advanced hormone-naïve prostate cancer: results of a prospective randomized multicenter trial. Clin Prostate Cancer 1: 163–171

    Article  CAS  Google Scholar 

  7. Tunn UW (online 2007) Intermittent androgen deprivation in patients with PSA-relapse after radical prostatectomy-final results of a European randomized prospective phase-III clinical trial AUO study AP 06/95, EC 507 [http://www.abstracts2view.com/aua_archive/view.php?nu=200791183] (accessed 17 June 2008)

  8. Miller K et al. (2007) Randomized prospective study of intermittent versus continuous androgen suppression in advanced prostate cancer [abstract]. J Clin Oncol 25 (Suppl 18S): 5015

    Google Scholar 

  9. Calais da Silva FM et al. (2006) Phase III study of intermittent MAB versus continuous MAB [abstract]. J Clin Oncol 24 (Suppl 18S): 4513

    Google Scholar 

  10. Prostate Cancer Trialists' Collaborative Group (2000) Maximum androgen blockade in advanced prostate cancer: an overview of the randomized trials. Lancet 335: 1491–1498

Download references

Author information

Authors and Affiliations

  1. B Seruga is a Clinical Research Fellow, and IF Tannock is the DE Bergsagel Professor of Medical Oncology, at the Princess Margaret Hospital, Toronto, ON, Canada.,

    Bostjan Seruga & Ian F Tannock

Authors
  1. Bostjan Seruga
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ian F Tannock
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ian F Tannock.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Supplementary information

Supplementary Table 1

Randomized clinical trials comparing intermittent and continuous androgen deprivation therapy in prostate cancer. (DOC 30 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Seruga, B., Tannock, I. Intermittent androgen blockade should be regarded as standard therapy in prostate cancer. Nat Rev Clin Oncol 5, 574–576 (2008). https://doi.org/10.1038/ncponc1180

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncponc1180

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing