[First line indications for hormonal therapy in prostate cancer]

Area of Science:

• Oncology
• Urology
• Endocrinology

Context:

• Androgen deprivation therapy (ADT) is a cornerstone in managing advanced prostate cancer.
• Its application has expanded beyond metastatic disease to include locally advanced and high-risk cancers, often in combination with radiation therapy.
• Treatment modalities and timing (neoadjuvant, concomitant, adjuvant) remain subjects of clinical debate.

Purpose:

• To review the evolving role and practical application of androgen deprivation therapy in prostate cancer management.
• To highlight the importance of individualized treatment strategies based on tumor stage, Gleason score, and PSA kinetics.
• To discuss current standards of care, including LHRH agonists and antiandrogens, and emerging therapeutic approaches.

Summary:

• ADT is standard for metastatic and node-positive prostate cancer, and increasingly used for locally advanced/high-risk disease with radiation.
• Treatment sequencing and timing are controversial and should be individualized based on risk stratification (Gleason score, PSA).
• Hormone therapy is also crucial for systemic relapse, particularly with rapid PSA doubling times. LHRH agonists are standard, with potential addition of antiandrogens for complete blockade. Intermittent ADT shows efficacy and may gain wider use with established protocols.

Impact:

• Informs clinical decision-making for optimizing ADT in diverse prostate cancer scenarios.
• Highlights the need for personalized treatment plans considering tumor biology and patient risk.
• Suggests future directions in prostate cancer therapy, including the potential expansion of intermittent ADT protocols.