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Evidence summaries

Early Versus Deferred Androgen Suppression in the Treatment of Advanced Prostatic Cancer

Early androgen suppression may provide a small improvement in overall survival. This outcome needs to be evaluated with the evidence suggesting higher costs and more frequent adverse effects with early therapy. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 4 studies with a total of 2167 subjects. All of the trials were conducted before to use of prostate specific antigen testing. The percent overall survival at 1, 2, 5, and 10 years for the early treatment group was 88%, 73%, 44% and 18%. For the deferred therapy group the percent overall survival was 86%, 71%, 37%, and 12%. The pooled estimate of the difference in overall survival favoured early therapy but was significant only at 10 years (OR 1.50, 95% CI 1.04 to 2.16).

Comment: The quality of evidence is downgraded by sparse data (wide confidence interval) and study limitations (variability in study design, stage of cancer and subjects enrolled, interventions utilized, definitions and reporting of outcomes and the lack of PSA testing for diagnostic and monitoring purposes).

    References

    • Wilt T, Nair B, MacDonald R, Rutks I. Early versus deferred androgen suppression in the treatment of advanced prostatic cancer. Cochrane Database Syst Rev. 2001;(4):CD003506.

Primary/Secondary Keywords