TY - JOUR
T1 - Optimizing the role of androgen deprivation therapy in advanced prostate cancer
T2 - Challenges beyond the guidelines
AU - Shore, Neal D.
AU - Antonarakis, Emmanuel S.
AU - Cookson, Michael S.
AU - Crawford, E. David
AU - Morgans, Alicia K.
AU - Albala, David M.
AU - Hafron, Jason
AU - Harris, Richard G.
AU - Saltzstein, Daniel
AU - Brown, Gordon A.
AU - Henderson, Jonathan
AU - Lowentritt, Benjamin
AU - Spier, Jeffrey M.
AU - Concepcion, Raoul
N1 - Funding Information:
The authors wish to thank Mary Gabb, MS, who provided medical writing services and Integra Connect (West Palm Beach, FL) for their assistance in the preparation of this manuscript. Figure 1 was created by Neal Shore, Alicia Morgan, and Raoul Concepcion with technical assistance from Brandon Wang, Integra Connect. Funding for the advisory panel and manuscript was provided by an unrestricted grant from Tolmar Pharmaceuticals.
Publisher Copyright:
© 2020 The Authors. The Prostate published by Wiley Periodicals, Inc.
PY - 2020/5/1
Y1 - 2020/5/1
N2 - Background: For specific clinical indications, androgen deprivation therapy (ADT) will induce disease prostate cancer (PC) regression, relieve symptoms and prolong survival; however, ADT has a well-described range of side effects, which may have a detrimental effect on the patient's quality of life, necessitating additional interventions or changes in PC treatment. The risk-benefit analysis for initiating ADT in PC patients throughout the PC disease continuum warrants review. Methods: A 14-member panel comprised of urologic and medical oncologists were chosen for an expert review panel, to provide guidance on a more judicious use of ADT in advanced PC patients. Panel members were chosen based upon their academic and community experience and expertise in the management of PC patients. Four academic members of the panel served as group leaders; the remaining eight panel members were from Large Urology Group Practice Association practices with proven experience in leading their advanced PC clinics. The panel members were assigned to four separate working groups, and were tasked with addressing the role of ADT in specific PC settings. Results: This article describes the practical recommendations of an expert panel for the use of ADT throughout the PC disease continuum, as well as an algorithm summarizing the key recommendations. The target for this publication is all providers (urologists, medical oncologists, radiation oncologists, or advanced practice providers) who evaluate and manage advanced PC patients, regardless of their practice setting. Conclusion: The panel has provided recommendations for monitoring PC patients while on ADT, recognizing that PC patients will progress despite testosterone suppression and, therefore, early identification of conversion from castrate-sensitive to castration resistance is critical. Also, the requirement to both identify and mitigate side effects of ADT as well as the importance of quality of life maintenance are essential to the optimization of patient care, especially as more combinatorial therapeutic strategies with ADT continue to emerge.
AB - Background: For specific clinical indications, androgen deprivation therapy (ADT) will induce disease prostate cancer (PC) regression, relieve symptoms and prolong survival; however, ADT has a well-described range of side effects, which may have a detrimental effect on the patient's quality of life, necessitating additional interventions or changes in PC treatment. The risk-benefit analysis for initiating ADT in PC patients throughout the PC disease continuum warrants review. Methods: A 14-member panel comprised of urologic and medical oncologists were chosen for an expert review panel, to provide guidance on a more judicious use of ADT in advanced PC patients. Panel members were chosen based upon their academic and community experience and expertise in the management of PC patients. Four academic members of the panel served as group leaders; the remaining eight panel members were from Large Urology Group Practice Association practices with proven experience in leading their advanced PC clinics. The panel members were assigned to four separate working groups, and were tasked with addressing the role of ADT in specific PC settings. Results: This article describes the practical recommendations of an expert panel for the use of ADT throughout the PC disease continuum, as well as an algorithm summarizing the key recommendations. The target for this publication is all providers (urologists, medical oncologists, radiation oncologists, or advanced practice providers) who evaluate and manage advanced PC patients, regardless of their practice setting. Conclusion: The panel has provided recommendations for monitoring PC patients while on ADT, recognizing that PC patients will progress despite testosterone suppression and, therefore, early identification of conversion from castrate-sensitive to castration resistance is critical. Also, the requirement to both identify and mitigate side effects of ADT as well as the importance of quality of life maintenance are essential to the optimization of patient care, especially as more combinatorial therapeutic strategies with ADT continue to emerge.
KW - androgen deprivation therapy
KW - cancer
KW - consensus
KW - prostate
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UR - http://www.scopus.com/inward/citedby.url?scp=85080906273&partnerID=8YFLogxK
U2 - 10.1002/pros.23967
DO - 10.1002/pros.23967
M3 - Review article
C2 - 32130741
AN - SCOPUS:85080906273
SN - 0270-4137
VL - 80
SP - 527
EP - 544
JO - Prostate
JF - Prostate
IS - 6
ER -
