title: A 10-year clinical experience with intermittent hormonal therapy for prostate cancer.
abstract: OBJECTIVE
  To evaluate, over a 10-year period, the feasibility, efficacy, duration of action and adverse effects of intermittent hormonal therapy (IHT) in patients with advanced prostate cancer or biochemical recurrence after radical treatment.
  
  
  METHODS
  Two hundred and thirty-three patients with prostate cancer have been included in an IHT protocol since 1992. Fifty-five patients had already been treated by radical prostatectomy (group A), 35 patients had received radiotherapy or a treatment with high-intensity focused ultrasound (HIFU) (group B) and 143 patients had not received any previous treatment (group C). Three-monthly injection of LHRH analogue combined with a non-steroidal antiandrogen was administered during the treatment phase ("on" phase). Treatment was stopped ("off" phase) when the PSA level fell below 4 ng/ml, regardless of the duration of the "on" phase. Criteria for resumption of hormonal therapy were PSA >20 ng/ml, PSA progression slope over the previous three months >5 ng/ml per month or recurrence of pain or urinary symptoms.
  
  
  RESULTS
  The median follow-up was 34.9 months (range: 13-151) and the median initial PSA was 28 ng/ml (range: 1-433). Five cycles were performed in the patients with the longest follow-up. The mean duration of cycles was gradually decreased from 19.6 months to 11.8 months. The "on/off" ratio was close to 30% regardless of the cycle or patient group. Ten patients (4%) died from their cancer during the study, with a median survival of 42.2 months. Six patients (2.5%) developed painful symptoms during IHT.
  
  
  CONCLUSIONS
  IHT ensures medium-term (three years) control of the disease, using a treatment resumption criteria of PSA >20 ng/ml and was not associated with major complications.
authors.affiliation: Department of Urology, Institut Mutualiste Montsouris, Université Pierre et Marie Curie, Paris VI, 42 Boulevard Jourdan, 75674 Paris Cedex, France. dominique.prapotnich@imm.fr
authors.forename: Dominique
authors.initials: D
authors.lastname: Prapotnich
authors.forename: Karim
authors.initials: K
authors.lastname: Fizazi
authors.forename: Bernard
authors.initials: B
authors.lastname: Escudier
authors.forename: Annick
authors.initials: A
authors.lastname: Mombet
authors.forename: Nathalie
authors.initials: N
authors.lastname: Cathala
authors.forename: Guy
authors.initials: G
authors.lastname: Vallancien
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D009376:Neoplasms, Hormone-Dependent / Q000097:blood / Q000188:drug therapy / Q000378:metabolism / Q000628:therapy*; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000188:drug therapy / Q000378:metabolism / Q000628:therapy*; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D018931:Antineoplastic Agents, Hormonal; D007987:Gonadotropin-Releasing Hormone; D017430:Prostate-Specific Antigen