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.





Dr. Sellinger - Management of Advanced Prostate Cancer

Burning Questions and Controversies in the Management of Advanced Prostate Cancer Patients

Scott B. Sellinger, MD, breaks down treatment groups for advanced prostate cancer and details management options for each.

Updates in Treatment Using ADT and Anti-Androgens

E. David Crawford, MD, discusses ADT and anti-androgens and where they currently stand as prostate cancer treatment methods.

Role of ADT with Radiation

Steven E. Finkelstein, MD, and Kevin D. Healey discuss the role of ADT with radiation therapy in definitive and salvage settings.

Real World Utilization of Guideline Based Therapy in mCSPC: Update From the 2021 ASCO Annual Meeting

Neeraj Agarwal, MD, examines efficacy and underutilization of intensified ADT in mCSPC, citing studies from the 2021 ASCO Annual Meeting.

Updates in ADT: Managing Adverse Effects

Laurence Klotz, MD, FRCSC, discusses interventions to ameliorate side effects from ADT for prostate cancer.
Dr. Morgentaler - Androgen Society Meeting

Androgen Society 3rd Annual Meeting Review (Day 1)

Abraham Morgentaler, MD, FACS, reviews lectures from the first day of the 3rd annual meeting of the Androgen Society.
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.




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Celestia S. Higano, MD
University of Washington School of Medicine
Seattle, Washington
Celestia (Tia) S. Higano, MD, FACP, was formerly a Professor in the Departments of Medicine and Urology, Division of Medical Oncology at the University of Washington, and Clinical Division of Fred Hutchison Cancer Research Center. She is an Adjunct Professor in the Department of Urologic Sciences at the University of British Columbia. She has been the Medical Director of the Prostate Cancer Supportive Care Program at the Vancouver Prostate Centre since 2013.
Dr. Higano received her medical degree from the University of Massachusetts Medical School and completed her residency at the Mayo Graduate School of Medicine in Rochester, MN. She was an oncology fellow under E. Donnall Thomas and Robert B. Livingston at the Fred Hutchison Cancer Research Center and the University of Washington.
Dr. Higano is an internationally renowned expert and clinical researcher focusing on prostate cancer. At UW, she led the prostate cancer clinical research group that participated in developing agents such as zoledronic acid, sipuleucel-T, enzalutamide, apalutamide, abiraterone, radium 223. Over these years, her clinical research has impacted the standards of care for patients with prostate cancer. She is a passionate educator and mentor and has guided many fellows and young faculty at the University of Washington and elsewhere who have chosen an academic career in GU Oncology.

Supported in part by Verity Pharmaceuticals.