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Definition |
There is no discussion regarding the introduction of IAD in symptomatic patients. However, there is still controversy concerning the best time to introduce hormonal therapy in asymptomatic metastatic patients due to the lack of properly conducted RCTs. These are underpowered trials with heterogeneous patient enrolment(i.e. locally advanced, M1a, M1b status) and variations in ADT modalities and follow-up schedules.ADT was shown to be the most cost-effective therapy if started at the time the patient developed symptomatic metastases. The Cochrane Library review extracted four good-quality RCTs: VACURG I and II trials, the MRC trial, and the ECOG 7887 study. These studies were all conducted in the pre-PSA era and included patientswith advanced PCa, who had received early vs. deferred ADT, either as primary therapy or adjuvant to radical prostatectomy. The Cochrane review found that the M1a/b population showed no improvement in OS,although early ADT significantly reduced disease progression and complication rates due to progression. Based on a systematic review of the literature, the ASCO guidelines on initial hormonal treatment for androgen-sensitive, metastatic, recurrent or progressive PCa concluded it was not possible to makea recommendation on when to start hormonal therapy in advanced asymptomatic PCa. The ESMOguidelines do not make any statement .
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