|
Definition |
The optimal thresholds at which ADT must be stopped or resumed are empirical. Nevertheless, several points are clear.
• IAD is based on intermittent castration. Therefore, only drugs leading to castration are suitable for use in IAD.
• Most published experiences are based on CAB, which is considered as standard treatment. An LHRH antagonist might be a valid alternative, without any significant benefits.
• The induction cycle must last 9 months at the most, otherwise testosterone recovery is unlikely.
• The treatment is stopped only if patients have fulfilled all the following criteria:
- well-informed and compliant patient;
- no clinical progression;
- clear PSA response, empirically defined as a PSA < 4 ng/mL in metastatic disease.
• Strict follow-up is mandatory, with clinical examination every 3-6 months. The more advanced the disease, the closer the follow-up. The same laboratory should be used to measure the PSA level.
• Treatment is resumed when the patient reaches either a clinical progression, or a PSA above a predetermined, empirically fixed, threshold: usually 10-20 ng/mL in metastatic cases.
• The same treatment is used for at least 3-6 months.
• Subsequent cycles of treatment are based on the same rules until the first sign is seen of a castrateresistant
status.
• The best population for IAD has still to be fully characterised. However, the most important factor seems to be the patient’s response to the first cycle of IAD, e.g. the PSA level response.IAD might be an option in metastatic situations after a standardised induction period, even if the benefits are fewer compared to those with less advanced situations.
|