941 INTERMITTENT VS. CONTINUOUS ANDROGEN DEPRIVATION THERAPY AMONG ELDERLY PATIENTS WITH ADVANCED PROSTATE CANCER

941 INTERMITTENT VS. CONTINUOUS ANDROGEN DEPRIVATION THERAPY AMONG ELDERLY PATIENTS WITH ADVANCED PROSTATE CANCER

Vol. 187, No. 4S, Supplement, Monday, May 21, 2012 however, has been the potential for increased non-prostate cancer related morbidity. Here, then, w...

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Vol. 187, No. 4S, Supplement, Monday, May 21, 2012

however, has been the potential for increased non-prostate cancer related morbidity. Here, then, we evaluated the impact of AHT after RP on overall survival (OS) in men with high risk prostate disease, stratifying patients by Charlson Comorbidity Index (CCI) and the presence of cardiovascular disease (CVD). METHODS: We identified 1,247 patients who underwent RP at our institution from 1988-2004 for high risk prostate cancer, defined according to the D’Amico risk group classification. Patient comorbidity status was stratified by CCI as 0, 1, or ⬎ 2. CVD was defined as pre-operative cerebrovascular disease, congestive heart failure, peripheral vascular disease, and/or prior myocardial infarction. OS was estimated using the Kaplan Meier method, and was compared for patients within each CCI and CVD category according to receipt of AHT with the log rank test. RESULTS: Median patient age at RP was 65.0 years (range 42-82). A total of 419/1247 patients (34%) received AHT. The majority of patients (861, 69%) had a CCI⫽0, while 244 (20%) had a CCI ⫽1, and 142 (11%) had a CCI⫽2. No significant difference in OS was seen between patients who did versus did not receive AHT across CCI stratification. Specifically, the 10-year OS for patients who received AHT compared to those who did not was 75% vs 82% (p⫽0.54) in the cohorts with CCI⫽0, 72% vs 76% (p⫽0.83) in patients with CCI⫽1, and 70% vs 68% (p⫽0.33) in patients with CCI ⬎ 2. Meanwhile, 155/1247 (12%) patients were identified with CVD. Again, no significant adverse impact of AHT on OS was noted when patients were grouped by the presence or absence of CVD. That is, 10-year OS for patients with CVD who received AHT was 72%, compared to 76% in those that did not (p⫽0.97). Likewise, 10-year OS did not significantly differ in patients without CVD according to receipt of AHT (74% vs 79%; p⫽ 0.91). CONCLUSIONS: AHT following RP for men with high risk prostate cancer does not adversely impact OS, even when accounting for comorbidity status. Additional studies, ideally in the prospective clinical trial setting, are warranted as novel therapies emerge that manipulate the hormone axis in order to determine the optimal multimodal treatment approach for these patients. Source of Funding: None

941 INTERMITTENT VS. CONTINUOUS ANDROGEN DEPRIVATION THERAPY AMONG ELDERLY PATIENTS WITH ADVANCED PROSTATE CANCER Benjamin Spencer*, Alfred Neugut, Dawn Hershman, Beverly Insel, Mitchell Benson, New York, NY INTRODUCTION AND OBJECTIVES: Intermittent androgen deprivation (IAD) has been investigated as an alternative to continuous androgen deprivation (CAD) therapy for advanced prostate cancer. IAD has favorable side effect and quality-of-life profiles, lower healthcare costs, and possibly equivalent survival. We investigated predictors of IAD receipt and its association with survival in older patients with advanced prostate cancer. METHODS: We identified individuals diagnosed with stage IV prostate cancer registered in the Surveillance, Epidemiology, and End Results-Medicare database, 1991-2007. We operationally defined IAD as the discontinuation of androgen deprivation therapy for a period of at least six months and within two years of starting it. We used logistic regression to compare those treated with IAD vs. CAD, adjusting for demographic and clinical factors. Cox proportional-hazards modeling was used to analyze the association between IAD and all-cause mortality (ACM) and prostate cancer-specific mortality (PCSM). RESULTS: Among stage IV prostate cancer patients, 3,073 were treated with ADT. Twenty-five percent received IAD, while 75% received CAD. Predictors of IAD receipt were younger age (75-79 years: OR⫽0.64, 95% CI 0.50, 0.82; 80-84 years: OR⫽0.69, 95% CI 0.51, 0.93; and 85⫹ years: OR⫽0.46, 95% CI 0.31, 0.68 vs. 65-69

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years), more recent diagnosis (1997-1999: OR⫽2.14, 95% CI 1.68, 2.73 and 2000-2002: OR⫽1.44, 95% CI 1.14, 1.81 vs. 1991-1993), urban residence (OR⫽1.53, 95% CI 1.11, 2.12 vs. rural), and two physician characteristics: practice type (private: OR⫽0.72, 95% CI 0.57, 0.91 vs. non-private), and female gender (OR⫽1.65, 95% CI 1.15, 2.39 vs. male). In multivariate analysis, subjects who received IAD demonstrated improved ACM (HR⫽0.84, 95% CI 0.75, 0.93), and PCSM (HR⫽0.82, 95% CI 0.71, 0.95) compared to those receiving CAD. CONCLUSIONS: With neither evidence-based data nor guidelines supporting its use, IAD is still used in 25% of eligible patients. IAD was associated with improved ACM and PCSM among older patients with advanced prostate cancer. Randomized clinical trials are needed to confirm these findings. Source of Funding: Department of Defense (Grants PC094372 and PC040167)

942 BICALUTAMIDE MONOTHERAPY IN OSTEOPOROTIC MEN REQUIRING HORMONE MANIPULATION FOR ADVANCED PROSTATE CANCER: 12 YEAR OUTCOMES FROM A ‘STEP UP’ REGIME. Kingsley Ekwueme*, Nigel Parr, Wirral, United Kingdom INTRODUCTION AND OBJECTIVES: Androgen deprivation (ADT) using bicalutamide monotherapy (BiM) maintains bone mineral density. It provides a similar survival outcome in locally advanced, non-metastatic prostate cancer (PCa) and is an option in those patients with metastatic disease who find castration by surgery or LHRHa unacceptable. In patients initially commenced on LHRHa, but who subsequently relapse, response to addition of Bi has been reported. However, the response to addition of LHRHa in those relapsing on BiM is less well characterised. We report our experience with BiM in osteoporotic men diagnosed with locally advanced or metastatic PCa and evaluate their response rate at relapse to addition of LHRHa. METHODS: 1198 men initiating ADT for PCa from January 1999 - 2011 underwent immediate DEXA scanning and were followed up in a dedicated clinic. Of these, 260 with osteoporosis (T score ⬍ -2.5) and initial PSA ⬍400 ng/ml were commenced on Bi 150mg daily. LHRHa was added to Bi at relapse to achieve complete androgen ablation. RESULTS: Median age at presentation was 78yrs (range 53 – 94) with median PSA of 29ng/ml (range 1.5 – 378). Mean follow up of 41 months. All patients responded to BiM with median nadir PSA of 1.0ng/ml (range 0.1 – 23) at a median of 13 months (range 1 – 100). 66 (26%) required addition of LHRHa for consecutive rises in PSA, at a median of 30 months (range 5 – 114). Their PSA changed from a median of 26ng/ml (4 – 635) to 11ng/ml(0.1 – 721) at 2– 4 months, with 49 (74%) responding. Median initial PSA and PSA nadir differed significantly between the group relapsing on BiM compared to the no relapse group (58 vs 24ng/ml and 2.9 vs 0.7ng/ml respectively, P ⫽ 0.001). Of the 190 patients commenced on BiM but not requiring LHRHa, 69 (36%) died, 48 (69%) from non PCa causes at a median of 38 months (range 1 – 117). BiM was discontinued in 4 patients due to diarrhoea or painful gynaecomastia. CONCLUSIONS: BiM demonstrates a high initial response in this group of patients, where LHRHa would have aggravated osteoporosis and potentially resulted in increased fractures, as most were alive at 3yrs. When LHRHa is required for relapse, the majority respond to ‘step up’. Furthermore, more patients die from non PCa causes than require LHRHa for relapse. BiM is well tolerated in this group, is considerably cheaper than LHRHa and avoids bone prophylaxis with bisphosphonates. We suspect it is underutilised in this setting. Source of Funding: None