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A Journal on Nephrology and Urology

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Minerva Urologica e Nefrologica 2003 December;55(4):219-38

language: English

The evolving role of androgen deprivation therapy in the management of prostate cancer

Cooperberg M. R. 1, Small E. J. 1,2, D’Amico A. 3, Carroll P. R. 1

1 Department of Urology, UCSF/Mt Zion Comprehensive Cancer Center, University of California, San Francisco, CA, USA
2 Department of Medicine, UCSF/Mt Zion Comprehensive Cancer Center, University of California, San Francisco, CA, USA
3 Department of Radiation Oncology, Brigham and Women’s Hospital and Dana Farber Cancer Institute, Boston, MA, USA


Andro­gen dep­ri­va­tion ther­a­py (ADT) ­plays a cen­tral ­role in the man­age­ment of pros­tate can­cer. ADT is the main­stay of treat­ment for me-
t­a­stat­ic dis­ease; the ­most com­mon meth­od is gon­a­dal sup­pres­sion via lutein­iz­ing hor­mone ­release hor­mone (LH) ago­nists, ­with or with­out anti­an­dro­gens. Anti­an­dro­gen mono­ther­a­py ­remains inves­ti­ga­tion­al, as is the appro­pri­ate ­role of 5αreduc­tase inhi­bi­tion for pros­tate can­cer. Inter­mit­tent ADT ­offers the prom­ise of ­improved qual­ity of ­life and ­reduced ­cost with­out a ­decrease ­found to ­date in onco­log­ic effi­ca­cy. A grow­ing ­menu of ­options ­exists for sec­on­dary andro­gen dep­ri­va­tion ­after dis­ease pro­gres­sion on pri­mary ther­a­py: ­these ­include ­high-­dose anti­an­dro­gens, estro­gens, and adren­al andro­gen sup­press­ants. ADT is ­being ­used ­with increas­ing fre­quen­cy as pri­mary mono­ther­a­py in ­patients ­with local­ized dis­ease, but ­only ­small, non­ran­dom­ized stud­ies of high­ly select­ed ­patients ­have ­been report­ed to ­date. Neo­ad­ju­vant ADT (­NADT) has ­been dem­on­strat­ed in pros­pec­tive, mul­ti-insti­tu­tion­al ­trials to ­improve out­comes for ­patients ­with ­high-­risk or local­ly ­advanced dis­ease under­go­ing exter­nal-­beam radio­ther­a­py. ­Trials for ­patients ­with low­er-­risk, local­ized dis­ease are ­still ongo­ing. Neo­ad­ju­vant ther­a­py ­does not ­improve out­comes for ­patients ­with local­ized dis­ease opt­ing for rad­i­cal pros­ta­tec­to­my (RP) and has not ­been ­well stud­ied in asso­ci­a­tion ­with bra­chy­ther­a­py. The ­side ­effects of ADT can be man­aged increas­ing­ly suc­cess­ful­ly; in par­tic­u­lar, the intro­duc­tion of zoled­ro­nate may ­reduce the ­impact of ADT-asso­ciat­ed oste­o­por­o­sis. Final­ly, con­tem­po­rary prac­tice pat­tern ­data sug­gest ­that use of ADT is increas­ing ­across ­patient ­risk ­groups, ­both in con­texts ­where ­such ther­a­py is ­well sup­port­ed by cur­rent evi­dence and in oth­ers ­where it is not.

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