Current Approach to Androgen Deprivation Therapy in Patients With Advanced Prostate Cancer

ContextGuidelines for the management of prostate cancer are based on specific levels of clinical evidence.ObjectiveThis review examines the clinical evidence for the use of androgen-deprivation therapy (ADT) in prostate cancer (PCa). This is placed in the context of individual patient management and how guidelines should be adapted to optimise individual patient care.Evidence acquisitionDuring the 2010 Annual Congress of the European Association of Urology (EAU) in Barcelona, Spain, a satellite symposium was held on the individualised management of patients with PCa. This paper is based on one of the presentations at the symposium. Data were retrieved from recent review articles, original articles, and abstracts on adjuvant ADT in PCa.Evidence synthesisADT is one of the main treatment options for locally advanced and metastatic PCa. The EAU Guidelines recommend a risk adapted approach to the use of ADT in patients with locally advanced disease and in those with prostate-specific antigen (PSA) relapse following radical prostatectomy. ADT provides specific benefits in patients with a PSA rise following radical prostatectomy, such as poorly differentiated PCa (Gleason score 8–10) and a very short PSA doubling time (<12 mo). The use of immediate versus deferred ADT in locally advanced disease remains controversial, while intermittent ADT can be considered for patients with both PSA rise following local treatment or metastatic disease. Individualised patient care management is required in the modern day use of ADT in men with PCa and a balance has to be reached between the risks and benefits so that appropriate patient populations can be targeted. Patients should be actively involved in such treatment-making decisions.ConclusionsADT is still the standard of care for non-localised PCa, but treatment strategies should be adapted to individual patient profiles.