ABSTRACT
Defining the future of androgen deprivation therapy (ADT) for prostate cancer can be best addressed by briefly reviewing the multitude of established uses, and then by evaluating the emerging utilities of hormonal therapy, which are not yet standard of practice. Box 93.1 presents an overview, with references, of existing and emerging uses of hormonal therapies in prostate cancer. Examples of the former include the use of ADT in patients with metastatic disease (N+, M+); use as a neoadjuvant and adjuvant therapy prior to, during, or after definitive radiation therapy; to downsize prostate gland volume prior to either external-beam radiation therapy (XRT) or brachytherapy. Emerging uses include ADT as an adjunct in the adjuvant setting for patients who have undergone radical prostatectomy and are found to harbor unfavorable pathologic characteristics (e.g., pT2 and pT3 with unfavorable histologies); use of hormonal therapies for those with a biochemical relapse following definitive therapy (so called rising prostatespecific antigen [PSA] following definitive therapy); use of ADT for intermittent hormonal therapy; use of ADT for primary therapy of clinically localized prostate cancer; use of sequences of hormonal therapies, either alone or in combination, in a sequential fashion such as “step-up” therapy; the use of therapies that induce androgen deprivation, either alone or in combination with cytotoxic chemotherapy for those with androgen independent prostate cancer; use of ADT, alone or in combination with cytotoxic chemotherapy for regionally advanced prostate cancer (e.g., cT3 or pT3 or greater) or those with intermediate or high risk characteristics (e.g., those with a ≤50% biochemical 5-
year disease-free survival following definitive localized treatment).
