J Clin Oncol 31: © 2013 by American Society of Clinical Oncology GASTROENTEROLOGY 2012;143:897–912. Journal conference

 Androgen-deprivation therapy (ADT) : Mainstay of initial management for Prostate cancer (locally advanced, recurrent, metastatic)  By either surgical or medical castration !!  Medical ADT : (consist of GnRH agonist with peripheral antiandrogen)  Main goal of treatment is to prolong survival, delay progression, and control symptoms : in more than 80% of patients

 Adverse effect of ‘use of ADT’ : Decreased BMD, Loss of muscle mass, Increased body fat, hot flashes, Gynecomastia, Impotense, Anemia, Coronary artery disease, even Sudden death  Optimal timing of ADT is debatable!!  Concepts of IAD  (Intermittent androgen deprivation) : (ADT is interrupted, guided by serum PSA) : (preclinical model showing longer time to hormone resistance)

 In this journal…. : Researchers reviewd the results of RTCs to adress the following questions  What is the evidence for use of IAD compared with CAD in terms of OS and Time to progression  Difference in adverse effects and quality of life (QoL)  Cost savings from adopting IAD as opposed to CAD CAD* (Continuous Androgen Deprivation)

 Electronic search : MEDLINE (1948 ~ 2012), EMBASE (1980 ~ 2012), Cochrane Library ( ~ 2012) “Hormone therapy” “Hormone blockade” “Intermittent androgen suppression” “Continous androgen suppression” “Antiandrogen” “LHRH” “Leuprolide” “Goserelin” “Flutamide” “ Bicalutamide” “Cyproterone” “Nilutamide” : Proceedings of major oncology/genitoruriary conferences were also searched

 Data collection : Methodology, Quality, Validity and Results (Time to event outcomes, QoL, adverse effects)  Risk of Bias : Studies were rated by their quality : Grades of recommendation (US Preventive Services Task Force) : Level of evidence  Cost savings

 There were no significances in OS and TTP : do not support preclinical data suggestion  support IAD use because of similar survive using less therapy  Studies report improvement in some domains of QoL, buth no significant overall diference : only one study reported significant superiority for IAD  More treatment-related adverse effects were observed with CAD compared with IAD

 1. No notable compromise in health outcomes in eligible men treated with IAD compared with those treated with CAD  2. No difference for IAD compared with CAD in terms of major adverse effects and QoL  there is fair evidence to recommend the substitution of CAD by IAD to treat relapsing, locally advanced, or metastatic prostate cancer