e) Androgen Deprivation Therapy

Fortunately, prostate cancer utilises testosterone as a growth signal in the majority of cases. Targeting this pathway often causes significant reduction in the number of tumour cells, a fall in the PSA, and control of symptoms. Unfortunately, most cases will relapse after an average of 2 years and further treatment with cytotoxic agents may be the only possible remedy.

Evidence

Primary Androgen Deprivation

Androgen deprivation alone is not a suitable treatment for patients with localised disease who are asymptomatic. While it may prevent disease progression, it is also associated with toxicity. It should only be used if the PSA is above 20 and the patient is not suitable or refuses radical therapy.

Adjuvant Androgen Deprivation

With Radiotherapy

Three large studies have demonstrated improved outcomes with androgen deprivation prior to, during and following radiotherapy. The most quoted (Bolla study) showed that biochemical failure was halved with the use of 3 years of androgen deprivation (48% -> 23%) for high risk patients.
The evidence for use in intermediate risk patients is less clear. Some would advocate for a shorter period of androgen deprivation.
There is no benefit in patients with low risk disease.

With Surgery

Techniques

Toxicities


Links