Aims: To compare the efficacy of intermittent androgen deprivation (IAD) versus continuous androgen deprivation (CAD) in the management of prostate cancer.

Methods: Twelve studies of 5405 patients were analysed, with median follow-ups ranging from 29 to 118 months. Pooled hazard ratios (HRs) were calculated for overall survival, cancer-specific survival, time to cancer progression, and mortality unrelated to prostate cancer. Planned subgroup analyses of survival in patients with and without metastatic disease were also performed. Data were weighted by generic inverse variance, and pooled with fixed effect modelling.

Results: No difference in overall survival separated IAD and CAD (HR 1.01; 95% CI 0.93 – 1.10). Similarly, there was no difference in cancer-specific survival (HR 1.03; 95% CI 0.88 – 1.21). A nonsignificant trend towards longer time to progression in IAD (HR 0.93; 95% CI 0.84 - 1.04) was noted. There was no difference in overall survival with IAD in the subgroups of patients with metastatic disease (HR 1.04; 95% CI 0.91 - 1.19) and without metastatic disease (HR 1.06; 95% CI 0.91 - 1.23).

Conclusion: IAD is non-inferior to CAD in terms of overall survival, cancer-specific survival, and time to progression. This corroborative evidence of non-inferior efficacy now confirms IAD as the most rational standard of care for managing prostate cancer patients in whom considerations of QOL and/or cost are deemed clinically pertinent