Androgen Deprivation
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Introduction

Prostate cancer needs testosterone to survive. Blocking testosterone is proven to prolong life in randomized prospective trials. Testosterone Inactivating Pharmaceuticals (TIP), otherwise known as androgen deprivation (ADT) or hormone blockade, are FDA approved medicines used either alone or with radiation to treat various stages of prostate cancer. Despite widespread experience, there are many controversies about the optimal way to use TIP. Probably the biggest issue is side effects. TIP impacts quality of life. So there is an art to picking the right amount of TIP for each individual. The goal is to continue TIP long enough to get the job done, but stop before going too long.

In 2010 review articles, Buchan, et al1 and Shore et al2 summarized Phase II studies of intermittent vs. continuous androgen suppression describing “ample phase II evidence that intermittent ADT is non-inferior to continuous androgen ablation” in terms of time to progression and overall survival, and evidence is accumulating to suggest that intermittent ADT offers significant quality-of-life benefits during the off-treatment phase for selected patients.

A second major controversy is whether combined androgen blockade (LHRH agonist + antiandrogen) is superior to monotherapy with an LHRH agonist. In 2009, Akaza et al3 reported on a random multi-center study which concluded that “CAB with bicalutamide 80 mg offered a significant overall survival benefit compared with LHRH-A monotherapy without reducing tolerability in patients with locally advanced or metastatic prostate cancer.”

It may also be beneficial to add a 5-alpha reductase inhibitor (Proscar® or Avodart®) to block the conversion of testosterone to dihydrotestosterone, which is more potent at promoting the growth of prostate cancer.

 

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References:

  1. Intermittent versus continuous androgen suppression therapy: do we have consensus yet? {Curr Oncol. 2010 September; 17(Supplement 2): S45–S48. Buchan, et al}
  2. Intermittent Androgen Deprivation Therapy: Redefining the Standard of Care? Rev Urol. 2010 Winter; 12(1): 1–11. Shore N, Crawford, ED
  3. Combined androgen blockade with bicalutamide for advanced prostate cancer: long-term follow-up of a phase 3, double-blind, randomized study for survival. Cancer. 2009 Aug 1;115(15):3437-45. Akaza et al