NEXT GENERATION

Androgen Deprivation Therapy

Section Editor: Celestia S. Higano, MD

One of the major treatments for prostate cancer is androgen-deprivation therapy (ADT), and about 50% of prostate cancer patients are treated with ADT at some point in their disease. ADT is used most frequently for patients with local but advanced prostate cancer or metastatic prostate cancer. The rate of ADT use in the USA increased in the 1990s and continues to be high today. ADT treatments work to decrease the amount of androgens in the prostate microenvironment to prevent this tumor progression from initiating via testosterone. This can be done with medical or surgical castration (orchiectomy). Many different types of drugs are available and approved for use as ADT for prostate cancer patients, but use different mechanisms of action (eg, LHRH agonists, LHRH antagonists, CYP17 inhibitors, and older and newer anti-androgens). There are many issues around hormone therapy that not all doctors agree on, such as the best time to start and stop it and the best way to give it. Studies are now looking at these issues, and we hope that this Next Generation Learning Center will provide additional information for the practicing physician.

PLATINUM LECTURES

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ADDITIONAL LECTURES

Dr. Morgan - Side Effects of ADT

Recognizing and Managing the Side Effects of Androgen Deprivation Therapy

Alicia K. Morgans, MD, MPH, Associate Professor of Medicine in Hematology and Oncology at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, discusses the side effects of androgen deprivation therapy (ADT) and how urologists can mitigate them. She observes that up to 40% of non-metastatic prostate cancer patients are treated with ADT, and those patients tend to be older and have more comorbidities.
Disease Flare with LHRH Agonists is a Myth

Disease Flare with LHRH Agonists is a Myth

Abraham Morgentaler, MD, FACS, describes the phenomenon of testosterone flare following prostate cancer treatment with luteinizing hormone-releasing hormone (LHRH) agonists and argues that this flare does not necessarily cause disease progression. He also discusses the effects of testosterone therapy in patients with untreated prostate cancer.

Long-term Morbidity of ADT and Radiation Therapy

Nelson N. Stone, MD, discusses long-term data about extended neoadjuvant hormone therapy following radiation therapy for high-risk prostate cancer patients. He observes the morbidity, mortality, and testosterone recovery rates of extended hormone therapy, especially in patients treated with hormone therapy for over 6 months.
The Optimal Nadir T Level on ADT Is

Point Counterpoint: The Optimal Nadir T Level on ADT Is <20mg/mL

John W. Davis, MD, debates the pros of using <20mg/mL as a threshold for the optimal nadir level of serum testosterone in prostate cancer patients treated with ADT.
Androgen Annihilation

Androgen Annihilation as a New Therapeutic Paradigm in Advanced Prostate Cancer

R. Jonathan Henderson, MD, argues that the goal of ADT should be to achieve and maintain the lowest levels of T possible in prostate cancer patients. The FDA-recommended target low of 50 ng/dL originates from constraints of outdated technology, and multiple studies indicate that there is a benefit to patients when T-levels fall below 20 ng/dL.
Agonists vs Antagonists

Point Counterpoint in ADT—Agonists versus Antagonists

Lawrence Karsh, MD, FACS, argues that agonists are effective, sustainable androgen deprivation therapy (ADT) options, and the belief that agonists present a high cardiovascular (CV) risk could be due to selection bias in trials. Conversely, Thomas Keane, MD, argues that patients treated with antagonists have lower CV risk and are more responsive to ADT than those treated with agonists.
The Role of Follicle Stimulating Hormones (FSH) in Prostate Cancer

The Role of FSH in Prostate Cancer

Marc B. Garnick, MD, discusses whether or not follicle stimulating hormone (FSH) affects prostate cancer progression and cause adverse effects when used in combination with androgen deprivation therapy (ADT). He presents evidence for both the pro and con sides of this argument.
Mottet EAU Guidelines Featured Image

EAU Guidelines for Monitoring Prostate Cancer Patients Under Treatment

Dr. Nicolas Mottet presented  “EAU Guidelines for Monitoring Prostate Cancer Patients Under Treatment” at the 6th Symposium on the Treatment of Prostate Cancer (STOP-6), which was held in Lisbon, Portugal between October 14th and 16th 2016.

ADDITIONAL RESOURCES

SECTION EDITOR

Celestia S. Higano, MD
University of Washington School of Medicine
Seattle, Washington
Celestia S. Higano, MD, is a prostate cancer specialist and Professor of Medicine at the University of Washington School of Medicine in Seattle, Washington. She is also Director of the Genitourinary Oncology Clinical Research Group at the University of Washington, and a member of Fred Hutchinson Cancer Research Center. She is board certified in both Internal Medicine and Medical Oncology. Her clinical and research interests included genitourinary oncology including prostate, bladder and testicular cancer.
 
 
Dr. Higano received her medical degree from the University of Massachusetts and went on to complete her residency at the Mayo Graduate School of Medicine, followed by a fellowship at the University of Washington Fred Hutchinson Cancer Research Center in Seattle. Dr. Higano specializes in treating prostate cancer. She believes communication is a key element in the physician-patient relationship. She enjoys the challenge of educating patients about their disease and treatment options, and promotes maintaining or improving quality of life should be the goal of any treatment modality.  In her free time Dr. Higano enjoys hiking, cycling, gardening and family outings.

Supported by Myovant Sciences.