On 2016 Mar 27, Stephen Strum commented:

I have not completed the entire article but I will say that I find the results to be counter-intuitive and not at all in keeping with what I have seen in over 25 years using IAD (intermittent androgen deprivation) plus another 8 years in using CAD (continuous androgen deprivation). Absolutely, unequivocally, there are many signs & symptoms relating to androgen deprivation (AD) that resolve once testosterone recovery occurs in those using an IAD approach. So no apparent QoL benefits seen in this study has me wondering about how careful the internal medical issues were documented in the medical record.

Moreover, we found major differences in mortality that correlated with the ability to achieve an undetectable PSA defined as ≤ 0.05 during ADT. This was published in Urology in 2007: Prostate Cancer-Specific Survival and Clinical Progression-Free Survival in Men with Prostate Cancer Treated Intermittently with Testosterone Inactivating Pharmaceuticals by Scholz, Lam, Strum et al, & the mean follow-up of patients was ten years.

Men in the current study should have been analyzed to assess who achieved an undetectable PSA on either ADT or IAD & how long was that undetectable status maintained while on ADT. We found that finding to be of major value in ascertaining the prognosis of men receiving ADT. If such subset analysis is not done, then those having an excellent response to ADT can be camouflaged by those men not doing well. Issues of testosterone nadir on ADT are also important to control.

On 2016 Mar 27, Stephen Strum commented:

I have not completed the entire article but I will say that I find the results to be counter-intuitive and not at all in keeping with what I have seen in over 25 years using IAD (intermittent androgen deprivation) plus another 8 years in using CAD (continuous androgen deprivation). Absolutely, unequivocally, there are many signs & symptoms relating to androgen deprivation (AD) that resolve once testosterone recovery occurs in those using an IAD approach. So no apparent QoL benefits seen in this study has me wondering about how careful the internal medical issues were documented in the medical record.

Moreover, we found major differences in mortality that correlated with the ability to achieve an undetectable PSA defined as ≤ 0.05 during ADT. This was published in Urology in 2007: Prostate Cancer-Specific Survival and Clinical Progression-Free Survival in Men with Prostate Cancer Treated Intermittently with Testosterone Inactivating Pharmaceuticals by Scholz, Lam, Strum et al, & the mean follow-up of patients was ten years.

Men in the current study should have been analyzed to assess who achieved an undetectable PSA on either ADT or IAD & how long was that undetectable status maintained while on ADT. We found that finding to be of major value in ascertaining the prognosis of men receiving ADT. If such subset analysis is not done, then those having an excellent response to ADT can be camouflaged by those men not doing well. Issues of testosterone nadir on ADT are also important to control.