High Risk Biochemical Relapse and the Timing of Androgen Deprivation Therapy

Purpose: Although the timing of androgen deprivation therapy in patients with prostate specific antigen-only relapse remains controversial, a large amount of data exists supporting the use of androgen deprivation early in the clinical course in patients with high risk localized prostate cancer as well as in those with metastatic disease. We offer guidance on its use in patients with prostate specific antigen recurrence only. Materials and Methods: We reviewed recent data on androgen deprivation for nonmetastatic prostate cancer, including updates from phase III, randomized studies of androgen deprivation in conjunction with radiation therapy or surgery in patients with high risk features. Results: We commented on the extent to which these data on androgen deprivation for nonmetastatic prostate cancer could be extrapolated to the setting of recurrent disease. In addition, we reviewed retrospective analyses of androgen deprivation in patients with prostate specific antigen-only relapse and prognostic data regarding prostate specific antigen doubling time in recurrent disease. Furthermore, consideration was given to rapid prostate specific antigen doubling time as an indication for androgen deprivation. Conclusions: In patients with nonmetastatic prostate cancer with high risk features as well as in those with serological (prostate specific antigen-only) relapse androgen deprivation before the development of metastatic disease is indirectly supported by long-term outcomes in a series of clinical trials and retrospective data sets. Furthermore, prognostic data suggest that early androgen deprivation may be most beneficial in patients with serological relapse with prostate specific antigen doubling times less than 12 months.