Early Development of Castrate Resistance Varies with Different Dosing Regimens of Luteinizing Hormone Releasing Hormone Agonist in Primary Hormonal Therapy for Prostate Cancer

Early Development of Castrate Resistance Varies with Different Dosing Regimens of Luteinizing Hormone Releasing Hormone Agonist in Primary Hormonal Therapy for Prostate Cancer

Objectives Luteinizing hormone releasing hormone (LHRH) agonist therapy is one of the mainstays of prostate cancer treatment. Three dosing regimens currently exist: calendar-based, intermittent, and a testosterone (T)-based (T-based) regimen. We investigated the differences in development of early c...

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Bibliographic Details
Published in:Urology (Ridgewood, N.J.) Vol. 77; no. 2; pp. 412 - 416
Main Authors: Blumberg, Jeremy M, Kwon, Eric O, Cheetham, T. Craig, Niu, Fang, Shapiro, Charles E, Pacificar, Judith, Loo, Ronald K, Williams, Stephen G, Chien, Gary W
Format: Journal Article
Language:English
Published: New York, NY Elsevier Inc 01-02-2011
Elsevier
Subjects:
Aged
Antineoplastic Agents, Hormonal - administration & dosage
Biological and medical sciences
Drug Resistance, Neoplasm
Gonadotropin-Releasing Hormone - agonists
Gynecology. Andrology. Obstetrics
Humans
Leuprolide - administration & dosage
Male
Male genital diseases
Medical sciences
Nephrology. Urinary tract diseases
Prostatic Neoplasms - drug therapy
Retrospective Studies
Time Factors
Tumors
Tumors of the urinary system
Urinary tract. Prostate gland
Urology
Agonist
Nephrology
Urinary system disease
Prostate disease
Hormone therapy
Gonadotropin
Malignant tumor
Posology
Urology
Resistance
Adenohypophyseal hormone
Development
Luteinizing hormone
Early
Therapeutic protocol
Male genital diseases
Prostate cancer
Cancer
Primary cancer
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Summary:Objectives Luteinizing hormone releasing hormone (LHRH) agonist therapy is one of the mainstays of prostate cancer treatment. Three dosing regimens currently exist: calendar-based, intermittent, and a testosterone (T)-based (T-based) regimen. We investigated the differences in development of early castrate resistance rates between these different regimens. Methods We evaluated 1617 patients with prostate cancer who received LHRH-agonist monotherapy in the Kaiser Permanente Southern California Cancer Registry between January 2003 and December 2006. Patients who had undergone surgery and/or radiation were excluded. Patients were grouped according to their dosing regimen: calendar-based, intermittent dosing, and T-based. Cox proportional hazard-regression analysis was used to estimate the hazards ratio (HR) for treatment failure. Results A total of 692 patients who received an LHRH agonist as primary monotherapy for prostate cancer fit our criteria. Calendar-based dosing was used in 325 patients; 252 received T-based dosing and 115 received intermittent dosing. On multivariate analysis controlling for demographic and prostate cancer–related variables, the T-based dosing group showed a significantly lower relative risk of treatment failure (HR = 0.65, P = .02). The intermittent-dosing group trended toward a lower risk treatment failure (HR = 0.80, P = .3). Among the variables analyzed, only a Gleason score >8 (HR = 2.05, P = .01) and a pretreatment prostate-specific antigen >20 (HR = 2.00, P <.01) were associated with a higher risk of treatment failure. Conclusions During the time period studied, T-based and intermittent dosing regimen of LHRH agonist had lower rates of early castrate resistance compared with standard calendar dosing, based on measurements for early androgen resistance.
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ISSN:0090-4295
1527-9995
DOI:10.1016/j.urology.2010.08.037