Is Intermittent Hormonal Therapy as Effective as Continuous Therapy in Advanced Prostate Cancer?

A study in the respected New England Journal of Medicine reported that intermittent hormonal treatment for advanced prostate cancer is less effective than continuous therapy and shortens survival.

Hormonal therapy (androgen deprivation) has long been the most used metastatic prostate cancer treatment, but ideal dose, intervals and duration remain unclear.

Male hormones, androgens, have long been known as major contributors to development and progression. Treatments therefore aim to reduce them through orchiectomy (surgical removal of the testes, the largest source) or androgen suppression (hormonal medication).

Surgical castration, once common, is no longer preferred because of surgical risks, psychological effects and no substantial advantage over hormonal therapy. Medication is therefore favored. Despite excellent initial responses and several years of delayed progression, resistance eventually develops. At this stage patients die within an average 5 years. Research continues into procedures delaying resistance, reducing effects and improving quality of life, including intermittent versus continuous treatment.

Intermittent therapy aims to reduce hormone suppression-related psychological changes, sexual difficulties and hot flashes, delay resistance, improve quality of life and lower costs. Earlier studies suggested equal effectiveness and safety plus advantages in effects, resistance timing and cost. The issue remains debated because others disagree, including this study.

Researchers expected intermittent treatment to be superior, but results did not support this. Among metastatic hormone-sensitive patients, 1535 men were assigned: 765 continuous and 770 intermittent, in 2 groups followed approximately 10 years. Intermittent therapy was less effective, with no significant side-effect or quality-of-life difference. Only during the first 3 months was there a small sexual and mental health advantage.

In conclusion, hormonal treatment remains the main approach, but dose, intervals and duration are disputed. Some studies favor intermittent treatment; others find it less effective. More research is needed to clarify ideal procedures. Until a clear advantage is demonstrated, continuing continuous therapy appears more appropriate.