Androgen deprivation therapy as backbone therapy in the management of prostate cancer

Abstract

Androgen deprivation therapy (ADT) is well established as a backbone therapy for metastatic prostate cancer (mPCa), and both European and American guidelines emphasize the importance of maintaining ADT after progression to metastatic castration-resistant prostate cancer (CRPC). However, the use of ADT varies widely in clinical practice despite these recommendations. Both research and development of increasingly precise assay technologies have improved our understanding of androgen production and signaling, and the recent data have suggested that a new serum testosterone cutoff value of <0.7 nmol/L should be employed. Most clinical trials to date have used the historical 1.7 nmol/L cutoff, but the <0.7 nmol/L cutoff has been associated with improved patient outcomes. Combining agents with different mechanisms of action to achieve intense androgen blockade may improve survival both before and after progression to CRPC. Data suggest that this intensive approach to androgen deprivation could delay the transition to CPRC and hence improve survival dramatically. Various combinations of backbone ADT with chemotherapy or radiotherapy are under investigation. Administration of ADT is established in patients with intermediate or high-risk localized prostate cancer (PCa) receiving radiotherapy with curative intent. This article reviews the current and potential role of ADT as backbone therapy in both hormone-sensitive PCa and CRPC with a focus on mPCa.

Lipid quantification by Raman microspectroscopy as a potential biomarker in prostate cancer

“…In general, many types of tumor cells require lipids to meet their energy and growth demands, but this requirement of lipids in the case of PCa is unique because the use of lipids is required A) as an energy source, B) as building blocks for cellular and subcellular membranes and C) as precursor reagents for de novo steroidogenesis. PCa is primarily a hormone-driven cancer and need androgens to grow, which is why androgen deprivation therapy (castration and administration of anti-androgens) or ADT is mostly employed by clinicians to manage this cancer [41]. Unfortunately, PCa re-emerges with time (termed as CRPC), which is more aggressive and resistant against current therapeutics, and reactivation of AR signaling promotes the return of PCa [42–45].…”

Cancer-associated fibroblasts promote prostate tumor growth and progression through upregulation of cholesterol and steroid biosynthesis

“…Prostate cancer (PCa) is one of the four most common types of cancer in Europe in 2018 [1]. Treatment options mainly depend on whether the tumor is localized or metastatic.…”

Pharmacological inhibition of the Notch pathway enhances the efficacy of androgen deprivation therapy for prostate cancer

“…Prostate cancer (PCa) remains the most prevalent cancer in adult males, with the highest cancer incidence rates and as the third cause of cancer‐related deaths in the developed world . Androgen deprivation therapy (ADT) that profoundly reduces the levels of androgen hormones or blocks the action of androgen on tumor cell growth has been the gold standard treatment for metastatic prostate cancer since the 1940s . ADT can delay PCa progression for 2–3 years on average .…”