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Where the unexpected results are concerned, we have the following: firstly that the effects on overall survival are not just from a reduction in prostate cancer deaths but also from deaths from other causes. Other trials have also shown this, which suggests a real finding, the causes of which remain unclear. Secondly, the effects on global health-related quality of life, at least over the first two years, showed no major difference between immediate and delayed therapy, meaning that men may choose to start relatively early with major detriment. This may relate to the use of intermittent schedules for two thirds of both arms, which did not appear to have an impact on disease control (data not shown in the publication), despite the lack of firm evidence supporting its use. An exploratory unplanned analysis in fact suggested that the highest survival rate was seen in men treated with immediate intermittent therapy.
One of the most thought-provoking findings was that the development of the castration-resistant phase occurred significantly earlier in the men who started treatment after a delay, a counter-intuitive finding. This may again be linked to treating low volume disease before it grows resistant clones.
We are undertaking two further major analyses, the long-term detailed quality of life, and the combined analysis with the Canadian ELAAT trial, to add further evidence in this arena.
Read the Abstract
Author: Prof Gillian Duchesne Radiation Oncologist
Professor, Radiation Oncology Research