The role of intermittent androgen deprivation therapy in the management of biochemically recurrent or metastatic prostate cancer.

Androgen deprivation therapy (ADT) is a well-established treatment for locally advanced, biochemically recurrent and metastatic prostate cancer. However, it is associated with significant side effects including hot flashes, loss of libido and erectile function, muscular atrophy, metabolic abnormalities, and osteoporosis. In attempt to mitigate the side effects of ADT while retaining the oncological benefits, an approach of intermittent ADT (IAD) has been investigated. IAD involves alternating periods of treatment with intervals off treatment to allow hormone recovery. PSA thresholds are triggers for withdrawing and reinitiating therapy. Potential advantages of IAD include improved quality of life with fewer side effects and reduced cost. Delays in the development of hormone resistance have not been demonstrated clinically. The appropriate use of IAD requires patient selection and close monitoring of quality of life and disease status. This review presents the most recent evidence on the role of IAD in the management of prostate cancer.