Quality of life is not compromised with intensification of androgen therapy in recurrent prostate cancer

[...]in these three separate trials (SPARTAN, LATITUDE, and STAMPEDE), intensification of androgen deprivation therapy yielded substantial improvement in clinical outcomes. [...]follow-up is needed to assess overall survival, but as Saad and colleagues show, the improvement in biochemical and metastatic progression was not associated with a decrease in patient-reported HRQoL, as shown with several general and prostate-specific metrics.1,3,4 Results from the PROSPER trial5 offer an interesting comparison with SPARTAN, because the study population was similar (ie, participants had non-metastatic, castrate-resistant prostate cancer with a high risk of developing distant metastases) but enzalutamide was used as the androgen receptor inhibitor. Put into context, the findings from both PROSPER and SPARTAN show that the greatest decrease in quality of life among men receiving treatment for prostate cancer probably occurs from initial therapies (androgen deprivation therapy, radical prostatectomy, and radiotherapy), and that the addition of second-generation androgen deprivation therapy does not seem to add substantially to the decrease in quality of life observed with conventional first-line androgen deprivation therapy. [...]given the significant improvement in distant metastasis-free survival shown in both PROSPER and SPARTAN and the minimal effect on quality of life, the threshold for use of second-generation androgen deprivation therapy should be low.