Controversies Surrounding Androgen Deprivation for Prostate Cancer

Stephen G. Patterson, MD, Lodovico Balducci, MD, Julio M. Pow-Sang, MD

Disclosures

Cancer Control. 2002;9(4) 

In This Article

Abstract and Introduction

Background: Management of metastatic prostate cancer continues to evolve. The widespread use of the prostate-specific antigen (PSA) assay has led to earlier diagnosis and earlier detection of recurrent disease. Debates continue regarding the proper use and timing of endocrine therapy with orchiectomy, estrogen agonists, luteinizing hormone-releasing hormone (LHRH) analogs, LHRH antagonists, and androgen antagonists.
Methods: The authors reviewed the significant published materials of the last 20 years that have shaped hormonal management of metastatic and progressive prostate cancer. Major areas of controversy were also identified.
Results: The present approach to hormonal management is summarized. Five potential pathways to the development of androgen-independent prostate cancer are described. Controversial topics of hormonal management, including immediate vs delayed hormonal therapy, monotherapy vs maximal androgen blockade (MAB), and intermittent hormonal therapy, are discussed.
Conclusions: Orchiectomy, estrogen agonists, and LHRH analogs have therapeutic equivalence. Patients who have a rising PSA after definitive treatment for prostate cancer and high risk of recurrent disease may warrant early androgen deprivation. MAB does not appear to be significantly better than single-agent LHRH analog therapy. Intermittent therapy may delay emergence of androgen independence and maintain or improve quality of life.

Conventional management of non-organ-confined, recurrent or metastatic prostate cancer continues to evolve due to earlier diagnosis of recurrent disease with prostate-specific antigen (PSA) monitoring, new medications such as luteinizing hormone-releasing hormone (LHRH) analogs, LHRH antagonists, and androgen antagonists. This article reviews the evidence supporting current treatment strategies and major controversies related to hormonal manipulations such as immediate vs delayed androgen blockade, monotherapy vs maximal androgen blockade (MAB), and intermittent vs continuous androgen blockade. The thrust of the article is to address which treatment will delay emergence of androgen independence and improve quality of life without sacrificing efficacy.

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