How is metastatic and advanced prostate cancer treated after local therapy has failed?

Updated: Dec 29, 2020
  • Author: Martha K Terris, MD, FACS; Chief Editor: Edward David Kim, MD, FACS  more...
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No guidelines have been set for treating patients with advanced prostate cancer in whom local therapy has failed. A balance between disease control and minimization of the toxicity and intolerance of the treatment is difficult to maintain. Androgen-deprivation therapy (ADT), although able to limit disease progression and to reduce urinary outlet obstruction, produces adverse effects and increases the risk of anemia, hot flashes, gastrointestinal tract disturbances, loss of libido, impotence, osteoporosis, muscle wasting, gynecomastiadeep vein thrombosiscongestive heart failure, myocardial infarction, pulmonary edema, and psychological changes.

Therapeutic options include the following:

  • Luteinizing hormone–releasing hormone (LHRH) agonists – Offered in 1-month, 3-month, and once-yearly depots
  • Combined androgen blockade (CAB) – LHRH agonist with an oral antiandrogen
  • Monotherapy with nonsteroidal antiandrogens - Eg,  bicalutamide
  • Gonadotropin-releasing hormone (GnRH) agonist

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