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Intermittent versus continuous androgen deprivation therapy for advanced prostate cancer

Nature Reviews Urology volume 17, pages 469–481 (2020)Cite this article

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Abstract

Androgen deprivation therapy (ADT) is still a mainstay of treatment for advanced prostate cancer. Continuous ADT causes considerable patient morbidity including sexual dysfunction, poor mood and physical capacity, changes in body composition and health-care-related costs. Intermittent ADT has been used as an approach to ADT monotherapy to limit morbidity by enabling cyclical recovery of serum testosterone levels. To date, a number of well-performed randomized controlled trials and meta-analyses have demonstrated statistically insignificant differences in oncological outcomes between intermittent and continuous ADT monotherapy. Sexual outcomes, morbidity profiles and cost-savings favour intermittent therapy in most randomized trials, but the benefit for clinical practice is unclear. Despite the growing body of evidence, the optimal administration regime for ADT has not been clearly established and incorporation of adjunctive upfront treatments such as chemotherapy and novel anti-androgen agents has further hampered progress. Recommendations by authoritative urological and oncological societies regarding the use of intermittent ADT are limited. The potential benefits of reduced morbidity for a particular patient must be considered in light of the possible oncological outcomes. Although the oncological changes associated with intermittent ADT are controversial, intermittent ADT does seem to provide symptomatic benefit in patients compared with continuous ADT. However, careful selection of suitable patients is crucial.

Key points

  • Intermittent androgen deprivation therapy (ADT) has been proposed to reduce the adverse events and poor quality of life associated with continuous ADT.

  • Current data do not show that intermittent ADT is inferior to continuous ADT with statistical certainty.

  • Quality-of-life measures (including mental health, physical capacity and sexual health) favour intermittent ADT compared with continuous ADT.

  • In the current era of early systemic therapy for hormone-sensitive disease, intermittent ADT is likely to be best suited to patients with M0 or low-volume M1 disease.

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Fig. 1: Administration regimes for intermittent ADT.
Fig. 2: Suggested algorithm for identifying patients with advanced prostate cancer who are suitable for either intermittent or continuous ADT.

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References

  1. Siegel, R. L., Miller, K. D. & Jemal, A. Cancer statistics, 2016. CA Cancer J. Clin. 66, 7–30 (2016).

    PubMed  Google Scholar 

  2. Bartsch, G. et al. Prostate cancer mortality after introduction of prostate-specific antigen mass screening in the Federal State of Tyrol, Austria. Urology 58, 417–424 (2001).

    CAS  PubMed  Google Scholar 

  3. Stamey, T. A. et al. The prostate specific antigen era in the United States is over for prostate cancer: what happened in the last 20 years? J. Urol. 172, 1297–1301 (2004).

    PubMed  Google Scholar 

  4. Sweeney, C. J. et al. Chemohormonal therapy in metastatic hormone-sensitive prostate cancer. N. Engl. J. Med. 373, 737–746 (2015).

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Huggins, C. & Hodges, C. V. Studies on prostatic cancer. I. The effect of castration, of estrogen and of androgen injection on serum phosphatases in metastatic carcinoma of the prostate. 1941. J. Urol. 168, 9–12 (2002).

    PubMed  Google Scholar 

  6. Recine, F. & Sternberg, C. N. Hormonal therapy and chemotherapy in hormone-naive and castration resistant prostate cancer. Transl Androl. Urol. 4, 355–364 (2015).

    PubMed  PubMed Central  Google Scholar 

  7. Cornford, P. et al. EAU-ESTRO-SIOG guidelines on prostate cancer. II. Treatment of relapsing, metastatic, and castration-resistant prostate cancer. Eur. Urol. 71, 630–642 (2017).

    PubMed  Google Scholar 

  8. Wong, Y. N. et al. Evolution of androgen receptor targeted therapy for advanced prostate cancer. Nat. Rev. Clin. Oncol. 11, 365–376 (2014).

    CAS  PubMed  Google Scholar 

  9. Lilja, H., Ulmert, D. & Vickers, H. J. Prostate-specific antigen and prostate cancer: prediction, detection and monitoring. Nat. Rev. Cancer 8, 268–278 (2008).

    CAS  PubMed  Google Scholar 

  10. James, N. D., Spears, M. R. & Sydes, M. R. Abiraterone in metastatic prostate cancer. N. Engl. J. Med. 377, 1696–1697 (2017).

    PubMed  Google Scholar 

  11. Thomsen, F. B. et al. Survival benefit of early androgen receptor inhibitor therapy in locally advanced prostate cancer: long-term follow-up of the SPCG-6 study. Eur. J. Cancer 51, 1283–1292 (2015).

    CAS  PubMed  Google Scholar 

  12. Studer, U. E. et al. Immediate or deferred androgen deprivation for patients with prostate cancer not suitable for local treatment with curative intent: European Organisation for Research and Treatment of Cancer (EORTC) Trial 30891. J. Clin. Oncol. 24, 1868–1876 (2006).

    PubMed  Google Scholar 

  13. Graff, J. N. & Beer, T. M. Pharmacotherapeutic management of metastatic, castration-resistant prostate cancer in the elderly: focus on non-chemotherapy agents. Drugs Aging 31, 873–882 (2014).

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Dragomir, A. et al. Treatment patterns and trends in patients dying of prostate cancer in Quebec: a population-based study. Curr. Oncol. 24, 240–248 (2017).

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Muralidhar, V. et al. Duration of androgen deprivation therapy for high-risk prostate cancer: application of randomized trial data in a tertiary referral cancer center. Clin. Genitourin. Cancer 14, e299–e305 (2015).

    PubMed  Google Scholar 

  16. Sammon, J. D. et al. Patterns of declining use and the adverse effect of primary androgen deprivation on all-cause mortality in elderly men with prostate cancer. Eur. Urol. 68, 32–39 (2015).

    PubMed  Google Scholar 

  17. Ziehr, D. R. et al. Association of androgen-deprivation therapy with excess cardiac-specific mortality in men with prostate cancer. BJU Int. 116, 358–365 (2015).

    CAS  PubMed  Google Scholar 

  18. Higano, C. S. Side effects of androgen deprivation therapy: monitoring and minimizing toxicity. Urology 61, 32–38 (2003).

    PubMed  Google Scholar 

  19. Gleave, M. et al. Intermittent androgen suppression for prostate cancer: rationale and clinical experience. Prostate Cancer Prostatic Dis. 1, 289–296 (1998).

    CAS  PubMed  Google Scholar 

  20. Klotz, L. H. et al. Intermittent endocrine therapy for advanced prostate cancer. Cancer 58, 2546–2550 (1986).

    CAS  PubMed  Google Scholar 

  21. Bruchovsky, N. et al. Effects of androgen withdrawal on the stem cell composition of the Shionogi carcinoma. Cancer Res. 50, 2275–2282 (1990).

    CAS  PubMed  Google Scholar 

  22. Goldenberg, S. L. et al. Intermittent androgen suppression in the treatment of prostate cancer: a preliminary report. Urology 45, 839–844 (1995).

    CAS  PubMed  Google Scholar 

  23. Shaw, G. L. et al. International study into the use of intermittent hormone therapy in the treatment of carcinoma of the prostate: a meta-analysis of 1446 patients. BJU Int. 99, 1056–1065 (2007).

    CAS  PubMed  Google Scholar 

  24. Magnan, S. et al. Intermittent vs continuous androgen deprivation therapy for prostate cancer: a systematic review and meta-analysis. JAMA Oncol. 1, 1261–1269 (2015).

    PubMed  Google Scholar 

  25. Niraula, S., Le, L. W. & Tannock, I. F. Treatment of prostate cancer with intermittent versus continuous androgen deprivation: a systematic review of randomized trials. J. Clin. Oncol. 31, 2029–2036 (2013).

    CAS  PubMed  Google Scholar 

  26. Botrel, T. E. et al. Intermittent versus continuous androgen deprivation for locally advanced, recurrent or metastatic prostate cancer: a systematic review and meta-analysis. BMC Urol. 14, 9 (2014).

    PubMed  PubMed Central  Google Scholar 

  27. Sciarra, A. & Salciccia, S. A novel therapeutic option for castration-resistant prostate cancer: after or before chemotherapy? Eur. Urol. 65, 905–906 (2014).

    PubMed  Google Scholar 

  28. Tsai, H. T. et al. Adoption of intermittent androgen deprivation therapy for advanced prostate cancer: a population based study in American urology practice. Urol. Pract. 2, 190–198 (2015).

    PubMed  PubMed Central  Google Scholar 

  29. Liede, A. et al. International survey of androgen deprivation therapy (ADT) for non-metastatic prostate cancer in 19 countries. ESMO Open 1, e000040 (2016).

    PubMed  PubMed Central  Google Scholar 

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

    PubMed  Google Scholar 

  31. Irani, J. et al. Continuous versus six months a year maximal androgen blockade in the management of prostate cancer: a randomised study. Eur. Urol. 54, 382–391 (2008).

    PubMed  Google Scholar 

  32. Salonen, A. J. et al. Advanced prostate cancer treated with intermittent or continuous androgen deprivation in the randomised FinnProstate Study VII: quality of life and adverse effects. Eur. Urol. 63, 111–120 (2013).

    CAS  PubMed  Google Scholar 

  33. Salonen, A. J. et al. The FinnProstate Study VII: intermittent versus continuous androgen deprivation in patients with advanced prostate cancer. J. Urol. 187, 2074–2081 (2012).

    CAS  PubMed  Google Scholar 

  34. Hussain, M. et al. Intermittent versus continuous androgen deprivation in prostate cancer. N. Engl. J. Med. 368, 1314–1325 (2013).

    CAS  PubMed  PubMed Central  Google Scholar 

  35. Yamanaka, H. et al. Effectiveness of adjuvant intermittent endocrine therapy following neoadjuvant endocrine therapy and external beam radiation therapy in men with locally advanced prostate cancer. Prostate 63, 56–64 (2005).

    PubMed  Google Scholar 

  36. Calais da Silva, F. et al. Locally advanced and metastatic prostate cancer treated with intermittent androgen monotherapy or maximal androgen blockade: results from a randomised phase 3 study by the South European Uroncological Group. Eur. Urol. 66, 232–239 (2014).

    PubMed  Google Scholar 

  37. Schasfoort, E., et al. Intermittent androgen suppression with buserelin and nilutamide for the treatment of prostate cancer patients. Eur. Urol. Suppl. 2, 187 (2003).

  38. Mottet, N. et al. Intermittent hormonal therapy in the treatment of metastatic prostate cancer: a randomized trial. BJU Int. 110, 1262–1269 (2012).

    CAS  PubMed  Google Scholar 

  39. Tunn, U. et al. 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. J. Urol. 177, 201 (2007).

    Google Scholar 

  40. Hering, F. et al. Metastatic adenocarcinoma of the prostate: comparison between continuous and intermittent hormonal treatment. Braz. J. Urol. 26, 276–282 (2000).

    Google Scholar 

  41. Verhagen, P. C. et al. Intermittent versus continuous cyproterone acetate in bone metastatic prostate cancer: results of a randomized trial. World J. Urol. 32, 1287–1294 (2014).

    CAS  PubMed  Google Scholar 

  42. Shim, M. et al. Effectiveness of three different luteinizing hormone-releasing hormone agonists in the chemical castration of patients with prostate cancer: goserelin versus triptorelin versus leuprolide. Investig. Clin. Urol. 60, 244–250 (2019).

    PubMed  PubMed Central  Google Scholar 

  43. Calais da Silva, F. E. et al. Intermittent androgen deprivation for locally advanced and metastatic prostate cancer: results from a randomised phase 3 study of the South European Uroncological Group. Eur. Urol. 55, 1269–1277 (2009).

    CAS  PubMed  Google Scholar 

  44. Crook, J. M. et al. Intermittent androgen suppression for rising PSA level after radiotherapy. N. Engl. J. Med. 367, 895–903 (2012).

    CAS  PubMed  PubMed Central  Google Scholar 

  45. Miller, K., Steiner, U. & Lingnau, A. Intermittent vs continuous androgen suppression in advanced prostate cancer: a randomised prospective study. J. Urol. 177, 573 (2007).

    Google Scholar 

  46. Hussain, M. et al. Absolute prostate-specific antigen value after androgen deprivation is a strong independent predictor of survival in new metastatic prostate cancer: data from Southwest Oncology Group Trial 9346 (INT-0162). J. Clin. Oncol. 24, 3984–3990 (2006).

    PubMed  Google Scholar 

  47. Arai, Y., Yoshiki, T. & O. Yoshida, O. Prognostic significance of prostate specific antigen in endocrine treatment for prostatic cancer. J. Urol. 144, 1415–1419 (1990).

    CAS  PubMed  Google Scholar 

  48. Tombal, B. et al. Enzalutamide monotherapy in hormone-naive prostate cancer: primary analysis of an open-label, single-arm, phase 2 study. Lancet Oncol. 15, 592–600 (2014).

    CAS  PubMed  Google Scholar 

  49. Klotz, L. et al. The efficacy and safety of degarelix: a 12-month, comparative, randomized, open-label, parallel-group phase III study in patients with prostate cancer. BJU Int. 102, 1531–1538 (2008).

    CAS  PubMed  Google Scholar 

  50. Scher, H. I. et al. Eligibility and outcomes reporting guidelines for clinical trials for patients in the state of a rising prostate-specific antigen: recommendations from the Prostate-Specific Antigen Working Group. J. Clin. Oncol. 22, 537–556 (2004).

    PubMed  Google Scholar 

  51. Duchesne, G. M. et al. Timing of androgen-deprivation therapy in patients with prostate cancer with a rising PSA (TROG 03.06 and VCOG PR 01-03 [TOAD]): a randomised, multicentre, non-blinded, phase 3 trial. Lancet Oncol. 17, 727–737 (2016).

    CAS  PubMed  Google Scholar 

  52. Evens, A. M., Lestingi, T. M. & Bitran, J. D. Intermittent androgen suppression as a treatment for prostate cancer: a review. Oncologist 3, 419–423 (1998).

    CAS  PubMed  Google Scholar 

  53. Abrahamsson, P. A. Intermittent androgen deprivation therapy in patients with prostate cancer: Connecting the dots. Asian J. Urol. 4, 208–222 (2017).

    PubMed  PubMed Central  Google Scholar 

  54. Schulman, C. et al. Intermittent versus continuous androgen deprivation therapy in patients with relapsing or locally advanced prostate cancer: a phase 3b randomised study (ICELAND). Eur. Urol. 69, 720–727 (2016).

    CAS  PubMed  Google Scholar 

  55. Brungs, D. et al. Intermittent androgen deprivation is a rational standard-of-care treatment for all stages of progressive prostate cancer: results from a systematic review and meta-analysis. Prostate Cancer Prostatic Dis. 17, 105–111 (2014).

    CAS  PubMed  Google Scholar 

  56. Hussain, M. et al. Evaluating intermittent androgen-deprivation therapy phase III clinical trials: the devil is in the details. J. Clin. Oncol. 34, 280–285 (2016).

    CAS  PubMed  Google Scholar 

  57. Hershman, D. L. et al. Adverse Health events following intermittent and continuous androgen deprivation in patients with metastatic prostate cancer. JAMA Oncol. 2, 453–461 (2016).

    PubMed  PubMed Central  Google Scholar 

  58. Bruchovsky, N. et al. Quality of life, morbidity, and mortality results of a prospective phase II study of intermittent androgen suppression for men with evidence of prostate-specific antigen relapse after radiation therapy for locally advanced prostate cancer. Clin. Genitourin. Cancer 6, 46–52 (2008).

    CAS  PubMed  Google Scholar 

  59. Jin, C. et al. A meta-analysis of cardiovascular events in intermittent androgen-deprivation therapy versus continuous androgen-deprivation therapy for prostate cancer patients. Prostate Cancer Prostatic Dis. 19, 429 (2016).

    CAS  PubMed  Google Scholar 

  60. McDuff, S. G. R. et al. Impact of time to testosterone rebound and comorbidity on the risk of cause-specific mortality in men with unfavorable-risk prostate cancer. Cancer 124, 1391–1399 (2018).

    PubMed  PubMed Central  Google Scholar 

  61. Cano, A. & Baal, W. M. Van The mechanisms of thrombotic risk induced by hormone replacement therapy. Maturitas 40, 17–38 (2001).

    CAS  PubMed  Google Scholar 

  62. Li, S. et al. Experimental arterial thrombosis regulated by androgen and its receptor via modulation of platelet activation. Thromb. Res. 121, 127–134 (2007).

    CAS  PubMed  Google Scholar 

  63. O’Farrell, S. et al. Risk and timing of cardiovascular disease after androgen-deprivation therapy in men with prostate cancer. J. Clin. Oncol. 33, 1243–1251 (2015).

    PubMed  Google Scholar 

  64. Damber, J. E. et al. The effect of baseline testosterone on the efficacy of degarelix and leuprolide: further insights from a 12-month, comparative, phase III study in prostate cancer patients. Urology 80, 174–180 (2012).

    PubMed  Google Scholar 

  65. Corona, G. et al. Age-related changes in general and sexual health in middle-aged and older men: results from the European Male Ageing Study (EMAS). J. Sex. Med. 7, 1362–1380 (2010).

    PubMed  Google Scholar 

  66. Nguyen, P. L. et al. Adverse effects of androgen deprivation therapy and strategies to mitigate them. Eur. Urol. 67, 825–836 (2015).

    CAS  PubMed  Google Scholar 

  67. Corona, G. et al. Androgen deprivation therapy in prostate cancer: focusing on sexual side effects. J. Sex. Med. 9, 887–902 (2012).

    CAS  PubMed  Google Scholar 

  68. Potosky, A. L. et al. Quality-of-life outcomes after primary androgen deprivation therapy: results from the Prostate Cancer Outcomes Study. J. Clin. Oncol. 19, 3750–3757 (2001).

    CAS  PubMed  Google Scholar 

  69. Fowler, F. J. Jr. et al. The impact of androgen deprivation on quality of life after radical prostatectomy for prostate carcinoma. Cancer 95, 287–295 (2002).

    PubMed  Google Scholar 

  70. Watkins Bruner, D. et al. Randomized, double-blinded, placebo-controlled crossover trial of treating erectile dysfunction with sildenafil after radiotherapy and short-term androgen deprivation therapy: results of RTOG 0215. J. Sex. Med. 8, 1228–1238 (2011).

    PubMed  Google Scholar 

  71. Salonen, A. J. et al. Comparison of intermittent and continuous androgen deprivation and quality of life between patients with locally advanced and patients with metastatic prostate cancer: a post hoc analysis of the randomized FinnProstate Study VII. Scand. J. Urol. 48, 513–522 (2014).

    CAS  PubMed  Google Scholar 

  72. Boccon-Gibod, L. et al. Degarelix as an intermittent androgen deprivation therapy for one or more treatment cycles in patients with prostate cancer. Eur. Urol. 66, 655–663 (2014).

    CAS  PubMed  Google Scholar 

  73. Cleary, P. D., G. Morrissey, G. & Oster, G. Health-related quality of life in patients with advanced prostate cancer: a multinational perspective. Qual. Life Res. 4, 207–220 (1995).

    CAS  PubMed  Google Scholar 

  74. Mondaini, N. et al. Finasteride 5 mg and sexual side effects: how many of these are related to a nocebo phenomenon? J. Sex. Med. 4, 1708–1712 (2007).

    PubMed  Google Scholar 

  75. Wittmann, D. et al. The psychosocial aspects of sexual recovery after prostate cancer treatment. Int. J. Impot. Res. 21, 99–106 (2009).

    CAS  PubMed  Google Scholar 

  76. Nelson, C. J. et al. Determinants of sexual satisfaction in men with prostate cancer. J. Sex. Med. 4, 1422–1427 (2007).

    PubMed  Google Scholar 

  77. Organ, M. et al. Intermittent LHRH therapy in the management of castrate-resistant prostate cancer (CRPCa): results of a multi-institutional randomized prospective clinical trial. Am. J. Clin. Oncol. 36, 601–605 (2013).

    PubMed  Google Scholar 

  78. Fayers, P. et al. Quality of life research within the EORTC — the EORTC QLQ-C30. European Organisation for Research and Treatment of Cancer. Eur. J. Cancer 38 (Suppl. 4), 125–133 (2002).

    Google Scholar 

  79. Koga, H., Naito, S. & Ito, K. Quality of life in locally advanced prostate cancer patients who underwent hormonal treatment combined with radiotherapy. Nishi Nihon Hinyokika 66, 255–262 (2004).

    Google Scholar 

  80. Nead, K. T. et al. Association of androgen deprivation therapy and depression in the treatment of prostate cancer: a systematic review and meta-analysis. Urol. Oncol. 35, 664 e1–664 e9 (2017).

    Google Scholar 

  81. Nead, K. T., Sinha, S. & Nguyen, P. L. Androgen deprivation therapy for prostate cancer and dementia risk: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis. 20, 259–264 (2017).

    CAS  PubMed  Google Scholar 

  82. Bonfill, X. et al. Intermittent androgen deprivation therapy: recommendations to improve the management of patients with prostate cancer following the GRADE approach. Cancer Manag. Res. 10, 2357–2367 (2018).

    PubMed  PubMed Central  Google Scholar 

  83. Eknoyan, D., Hurley, R. A. & Taber, K. H. The neurobiology of placebo and nocebo: how expectations influence treatment outcomes. J. Neuropsychiatry Clin. Neurosci. 25, vi–254 (2013).

    PubMed  Google Scholar 

  84. Fizazi, K. et al. Abiraterone plus prednisone in metastatic, castration-sensitive prostate cancer. N. Engl. J. Med. 377, 352–360 (2017).

    CAS  PubMed  Google Scholar 

  85. Kyriakopoulos, C. E. et al. Chemohormonal therapy in metastatic hormone-sensitive prostate cancer: long-term survival analysis of the randomized phase III E3805 chaarted trial. J. Clin. Oncol. 36, 1080–1087 (2018).

    CAS  PubMed  PubMed Central  Google Scholar 

  86. Cattrini, C. et al. Current treatment options for metastatic hormone-sensitive prostate cancer. Cancers 11, 1355 (2019).

    CAS  PubMed Central  Google Scholar 

  87. Boeve, L. M. S. et al. Effect on survival of androgen deprivation therapy alone compared to androgen deprivation therapy combined with concurrent radiation therapy to the prostate in patients with primary bone metastatic prostate cancer in a prospective randomised clinical trial: data from the HORRAD trial. Eur. Urol. 75, 410–418 (2019).

    PubMed  Google Scholar 

  88. Parker, C. C. et al. Radiotherapy to the primary tumour for newly diagnosed, metastatic prostate cancer (STAMPEDE): a randomised controlled phase 3 trial. Lancet 392, 2353–2366 (2018).

    PubMed  PubMed Central  Google Scholar 

  89. Sooriakumaran, P. Testing radical prostatectomy in men with prostate cancer and oligometastases to the bone: a randomized controlled feasibility trial. BJU Int. 120, E8–E20 (2017).

    PubMed  Google Scholar 

  90. Clarke, N. W. et al. Addition of docetaxel to hormonal therapy in low- and high-burden metastatic hormone sensitive prostate cancer: long-term survival results from the STAMPEDE trial. Ann. Oncol. 30, 1992–2003 (2019).

    CAS  PubMed  PubMed Central  Google Scholar 

  91. Bitting, R. L., et al. Phase II trial of enzalutamide and androgen deprivation therapy with salvage radiation in men with high-risk prostate-specific antigen recurrent prostate cancer: the STREAM trial. Eur. Urol. Oncol. https://doi.org/10.1016/j.euo.2020.01.005 (2020).

  92. Klotz, L. & Higano, C. S. Intermittent androgen deprivation therapy-an important treatment option for prostate cancer. JAMA Oncol. 2, 1531–1532 (2016).

    PubMed  Google Scholar 

  93. Mohler, J. L. et al. Prostate cancer, version 2.2019, NCCN clinical practice guidelines in oncology. J. Natl Compr. Canc. Netw. 17, 479–505 (2019).

    PubMed  Google Scholar 

  94. National Institute for Health and Care Excellence. Prostate cancer: diagnosis and management. NICE https://www.nice.org.uk/guidance/ng131/resources/prostate-cancer-diagnosis-and-management-pdf-66141714312133 (2019).

  95. US National Library of Medicine. ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT03630666 (2020).

  96. US National Library of Medicine. ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT03689699 (2019).

  97. US National Library of Medicine. ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT03511196 (2020).

  98. Langenhuijsen, J. F. et al. Continuous vs. intermittent androgen deprivation therapy for metastatic prostate cancer. Urol. Oncol. 31, 549–556 (2013).

    CAS  PubMed  Google Scholar 

  99. US National Library of Medicine. ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT03007732 (2020).

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Authors and Affiliations

  1. University of Melbourne, Department of Surgery, Austin Health, Melbourne, Victoria, Australia

    Marlon Perera, Nathan Papa, Shomik Sengupta & Damien Bolton

  2. The University of Queensland Centre for Clinical Research, Faculty of Medicine, Brisbane, Queensland, Australia

    Marlon Perera & Matthew J. Roberts

  3. Department of Urology, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia

    Matthew J. Roberts

  4. Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada

    Laurence Klotz

  5. Division of Oncology, University of Washington, Washington, WA, USA

    Celestia S. Higano

  6. School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia

    Nathan Papa

  7. EHCS, Monash University, Box Hill, Melbourne, Victoria, Australia

    Shomik Sengupta

  8. Urology Department, Eastern Health, Box Hill, Melbourne, Victoria, Australia

    Shomik Sengupta

  9. Olivia Newton-John Cancer Research Institute, Melbourne, Victoria, Australia

    Damien Bolton

  10. Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

    Nathan Lawrentschuk

  11. Department of Urology, Royal Melbourne Hospital, Melbourne, Victoria, Australia

    Nathan Lawrentschuk

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M.P., N.P. and S.S. researched data for the article, M.P., L.K. and C.S.H. made substantial contributions to discussions of content, M.P., M.J.R., D.B., and N.L. wrote the article and L.K., C.S.H., N.P., S.S., D.B. and N.L. reviewed and edited the manuscript before submission.

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Perera, M., Roberts, M.J., Klotz, L. et al. Intermittent versus continuous androgen deprivation therapy for advanced prostate cancer. Nat Rev Urol 17, 469–481 (2020). https://doi.org/10.1038/s41585-020-0335-7

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