Intermittent androgen deprivation: clinical experience and practical applications.

Prostate cancer is more frequently being diagnosed at an earlier age, men are dying of prostate cancer at an older age, and men are now treated with androgen deprivation for biochemical relapse. As a result, the amount of time that patients are potentially subjected to androgen deprivation is increasing. Intermittent androgen deprivation (IAD) has been investigated as a potential alternative to continuous androgen deprivation (CAD) in order to improve quality of life and potentially delay the progression to androgen independence. Along with the increased use of primary hormonal therapy in clinically localized prostate cancer, IAD may supplant the traditional surgical or radiotherapy options, specifically in men who have underlying co-morbidities and decreased life expectancy. There are ongoing multi-institutional, randomized trials that will lend insight into the utility, efficacy, and feasibility of IAD versus CAD. This article discusses the theoretical benefits and rationale of IAD and reviews the completed and on-going IAD trials. Finally, the controversies, practical applications, and future directions of IAD are addressed.