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Cent European J Urol. 2016;69(2):131-8. doi: 10.5173/ceju.2016.812. Epub 2016 Jun 20.

Evidence-based recommendations on androgen deprivation therapy for localized and advanced prostate cancer.

Author information

1
Department of Urology, Jagiellonian University, Medical College, Cracow, Poland; Mediqus Medical Centre, Wieluń, Poland.
2
JB Medical Ltd, Sudbury, United Kingdom.
3
Department of Urology, Ludwik Rydygier Medical College in Bydgoszcz, Nicolaus Copernicus University in Toruń, Poland; Department of Urology Nicolaus Copernicus Hospital in Toruń, Poland.
4
Department of Urology and Oncological Urology, Wrocław Medical University in Wrocław, Poland.
5
Department of Oncology Saint Elizabeth's Hospital, Mokotów Medical Center, Warsaw, Poland; Department of Urology, Warsaw Medical University, Warsaw, Poland.
6
Department of Electroradiology, Poznań University of Medical Sciences in Poznań, Poland; Department of Radiotherapy, Greater Poland Cancer Centre in Poznań, Poland.
7
Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland.
8
Department of Urology and Urological Oncology, Pomeranian Medical University in Szczecin, Poland.
9
Department of Urology, Jagiellonian University, Medical College, Cracow, Poland.

Abstract

INTRODUCTION:

The management of prostate cancer (PC) is still evolving. Although, androgen deprivation therapy (ADT) is an established treatment option, particularly in patients with disseminated disease, important data regarding hormonal manipulation have recently emerged. The aim of this paper is to review the evidence on ADT, make recommendations and address areas of controversy associated with its use in men with PC.

MATERIAL AND METHODS:

An expert panel was convened. Areas related to the hormonal management of patients with PC requiring evidence review were identified and questions to be addressed by the panel were determined. Appropriate literature review was performed and included a search of online databases, bibliographic reviews and consultation with experts.

RESULTS:

The panel was able to provide recommendations on: 1) which patients with localised PC should receive androgen deprivation in conjunction with radiotherapy (RT); 2) what standard initial treatment should be used in metastatic hormone-naïve PC (MHNPC); 3) efficacy of androgen deprivation agents; 4) whether ADT should be continued in patients with castration resistant PC (CRPC). However, no recommendations could be made for combined ADT and very high-dose RT in patients with an intermediate-risk disease.

CONCLUSIONS:

ADT remains the cornerstone of treatment for both metastatic hormone-naïve and castration-resistant PC. According to the expert panel's opinion, based on the ERG report, luteinizing hormone-releasing hormone agonists might not be equivalent but this needs to be confirmed in long-term data. The combined use of ADT and RT improves outcome and survival in men with high-risk localised disease. The benefits in patients with intermediate-risk disease, particularly those subject to escalated dose RT are controversial.

KEYWORDS:

androgen deprivation therapy; prostate cancer; recommendations

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