The selection of hormonal therapy in prostate cancer: Who, when, and for how long?

Charles J. Ryan, Eric J. Small

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Androgen deprivation is the foundation for the systemic therapy of advanced prostate cancer. Multiple trials have tested combined androgen blockade versus androgen deprivation alone in patients with advanced disease. These studies suggest a slight advantage to the combined approaches that contain flutamide and bicalutamide, but the lack of dramatic differences in outcome makes monotherapy reasonable, especially in patients with more indolent disease. Intermittent androgen deprivation is an alternative that may allow patients to reduce the total time on androgen suppression as well as possibly delay the onset of androgen independence. A number of secondary hormonal therapies, including deferred and secondary antiandrogens, ketoconazole, and estrogens have shown modest response proportions. Patients with less advanced disease such as a rising prostate-specific antigen have varied outcomes, and no standard approach exists. In this group, noncastrating forms of hormonal therapy are being evaluated. Patients undergoing definitive local therapy who have high-risk features may benefit from early, as opposed to deferred, androgen deprivation. This review examines the evidence for the current state of the art in hormonal therapy in patients with prostate cancer and focuses, in particular, on treatment composition and timing as well as the rationale for the use of hormonal therapy in early stage disease.

Original languageEnglish (US)
Pages (from-to)261-268
Number of pages8
JournalJNCCN Journal of the National Comprehensive Cancer Network
Volume2
Issue number3
DOIs
StatePublished - May 1 2004
Externally publishedYes

Keywords

  • Androgen deprivation
  • Combined androgen blockade
  • Hormone therapy
  • Ketoconazole
  • Prostate cancer
  • Secondary hormonal therapy

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