Optimizing the role of androgen deprivation therapy in advanced prostate cancer: Challenges beyond the guidelines

Abstract

Background For specific clinical indications, androgen deprivation therapy (ADT) will induce disease prostate cancer (PC) regression, relieve symptoms and prolong survival; however, ADT has a well‐described range of side effects, which may have a detrimental effect on the patient's quality of life, necessitating additional interventions or changes in PC treatment. The risk‐benefit analysis for initiating ADT in PC patients throughout the PC disease continuum warrants review. Methods A 14‐member panel comprised of urologic and medical oncologists were chosen for an expert review panel, to provide guidance on a more judicious use of ADT in advanced PC patients. Panel members were chosen based upon their academic and community experience and expertise in the management of PC patients. Four academic members of the panel served as group leaders; the remaining eight panel members were from Large Urology Group Practice Association practices with proven experience in leading their advanced PC clinics. The panel members were assigned to four separate working groups, and were tasked with addressing the role of ADT in specific PC settings. Results This article describes the practical recommendations of an expert panel for the use of ADT throughout the PC disease continuum, as well as an algorithm summarizing the key recommendations. The target for this publication is all providers (urologists, medical oncologists, radiation oncologists, or advanced practice providers) who evaluate and manage advanced PC patients, regardless of their practice setting. Conclusion The panel has provided recommendations for monitoring PC patients while on ADT, recognizing that PC patients will progress despite testosterone suppression and, therefore, early identification of conversion from castrate‐sensitive to castration resistance is critical. Also, the requirement to both identify and mitigate side effects of ADT as well as the importance of quality of life maintenance are essential to the optimization of patient care, especially as more combinatorial therapeutic strategies with ADT continue to emerge.

Androgen Deprivation Induces Reprogramming of Prostate Cancer Cells to Stem-Like Cells

“…Patients that are not cured with surgery or radiation undergo androgen deprivation by chirurgical or endocrine therapy. Although this androgen deprivation therapy (ADT) is initially effective in suppressing tumor growth, most patients inevitably develop resistance to androgen deprivation therapy and experience cancer recurrence in an aggressive form named Castration Resistant Prostate Cancer (CRPC) of a very poor prognosis [2]. Currently, development of chemoresistance represents one of the greatest challenges in cancer treatment.…”

Effect of androgen deprivation therapy on cardiovascular function in Chinese patients with advanced prostate cancer: a prospective cohort study

“…Since the ground-breaking work of Charles Huggins on the role of androgen deprivation therapy (ADT) in prostate cancer, it has become one of the key players in the management of prostate cancer (PCa), particularly in metastatic disease 1 . Even in castration resistant stage, ADT is still considered the backbone therapy for most patients 1 .…”

“…Since the ground-breaking work of Charles Huggins on the role of androgen deprivation therapy (ADT) in prostate cancer, it has become one of the key players in the management of prostate cancer (PCa), particularly in metastatic disease 1 . Even in castration resistant stage, ADT is still considered the backbone therapy for most patients 1 . Currently, beside the traditional bilateral orchidectomy (surgical castration), there were also luterizing hormone releasing hormone agonist (LHRH agonist) and antagonist (LHRH antagonist) available as options for medical castration 1 .…”

“…Even in castration resistant stage, ADT is still considered the backbone therapy for most patients 1 . Currently, beside the traditional bilateral orchidectomy (surgical castration), there were also luterizing hormone releasing hormone agonist (LHRH agonist) and antagonist (LHRH antagonist) available as options for medical castration 1 . The choice of treatment would be depend on the clinical conditions (need of rapid testosterone suppression), financial implications, patient preference etc.…”

PSA nadir and time to PSA nadir during initial androgen deprivation therapy as prognostic factors in metastatic castration‐resistance prostate cancer patients treated with docetaxel

“…In China, more than 68% of patients with PCa have already metastasised by the time of diagnosis due to its insidious nature of onset(B. H. Chung et al., 2019; Halabi et al., 2019; He et al., 2019). So far, androgen deprivation therapy (ADT) is the first line of treatment against disease progression (Shore et al., 2020). However, the majority of patients inevitably developed castration resistance (Matsubara et al., 2020), and these were diagnosed with metastatic castration‐resistant PCa (mCRPC) after a median of 1 year of ADT.…”