Comparing quality of life in prostate cancer patients: Continuous vs. intermittent androgen deprivation therapy—A systematic review and meta-analysis.
Authors: Shahzad Moazzam , Basharat Ahmad , Mujtaba Ghulam , Khalid Muhammad Fareed , Dave Prashil , Naeem Ammad , Warraich Sarmad Zaman , Jaglal Michael Vishal 
Published: February 2025

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Background:
Intermittent (i) and continuous (c) androgen deprivation therapy (ADT) not only play a critical role in managing prostate cancer (PC) but also impact patient’s quality of life (QoL). This meta-analysis aims to explore the effect of iADT vs. cADT on QoL in PC patients.
Methods:
PubMed, Cochrane, and Clinicaltrials.gov were searched as per PRISMA guidelines and 13 studies reporting iADT and cADT effect on QoL in PC patients were included. Pooled analysis was performed using the ‘meta’ package by Schwarzer et al. in the R programming language (version 4.16-2).
Results:
A total of 5364 (iADT 2685, cADT 2679) patients with median age of 69.9 (59.8-78.6) years and 69.4 (59.6-77.8) years, respectively, were included for analysis. The median PSA to initiate, stop, and restart treatment was ≥ 12.5, ≤ 4, and ≥ 10 ng/ml, respectively. Goserelin (31%) and Flutamide (23%) were the most used treatment modalities. At a median follow-up of 60.8 (52-69.6) months pooled overall survival and progression free survival for cADT was58.3% (95% CI 0.33-0.81, I2=99%, p<0.01), 22.4% (95% CI 0.12-0.34, I2=95%, p<0.01) while it was 54.2% (95% CI 0.29-0.78, I2=99%, p<0.01, n=1183) and27.8% (95% CI 0.15-0.42, I2=96%, p<0.01, n=1156), for iADT at the median follow-up of 51.7 (42.2-61.2) months, respectively. The pooled incidence of weakness, vasomotor side effects, erectile dysfunction, and gynecomastia in cADT arm were 3.8% (95% CI 0.02-0.06, I2=28%, p=0.24), 40.8% (95% CI 0.22-0.61, I2=98%, p<0.01), 25.6% (95% CI 0.03-0.60, I2=97%, p<0.01), and 7.6% (95% CI 0.6-0.1, I2=0%, p=0.93) while in iADT arm were 2.8% (95% CI 0.01-0.06, I2=78%, p=0.03), 32.7% (95% CI 0.15-0.53, I2=99%, p<0.01), 21.3% (95% CI 0.08-0.39, I2=91%, p<0.01), and 5.8% (95% CI 0.02-0.123, I2=88%,p<0.01), respectively. The rate of death in cADT and iADT arms were 35% and 37%, respectively, with prostate cancer (35 % vs 38%) and cardiovascular disease (39% vs 36%) being the most common causes of death.
Conclusions:
This analysis shows potential equal efficacy of iADT with better QoL as compared to cADT. However, further randomized studies are needed to consolidate these findings and to establish guidelines.

Quality of life outcomes.

Variable
iADT (n=2685)
cADT (n=2679)

Side Effects (%)

- Weakness
2.8% (95% CI 0.01-0.06, I2=78%, p=0.03)
3.8% (95% CI 0.02-0.06, I2=28%, p=0.24)

- Vasomotor Side Effects
32.7% (95% CI 0.15-0.53, I2=99%, p<0.01)
40.8% (95% CI 0.22-0.61, I2=98%, p<0.01)

- Erectile Dysfunction
21.3% (95% CI 0.08-0.39, I2=91%, p<0.01)
25.6% (95% CI 0.03-0.60, I2=97%, p<0.01)

- Gynecomastia
5.8% (95% CI 0.02-0.123, I2=88%, p<0.01)
7.6% (95% CI 0.6-0.1, I2=0%, p=0.93)

Common Causes of Death (%)

- Prostate Cancer
38%
35%

- Cardiovascular Disease
36%
39%

iADT: Intermittent androgen deprivation therapy, cADT: continuous androgen deprivation therapy (ADT).