According to the National Cancer Center, prostate cancer has been the most prevalent tumor in the urological system since 2008. For patients with prostate cancer, radical treatment alone has limitations, and some patients are prone to recurrence.
Endocrine therapy for prostate cancer pioneered endocrine therapy for malignant solid tumors and has been used for more than 70 years, making it one of the most reproducible and longest-standing treatments for prostate cancer.
There is a lot of evidence-based medical evidence that long-term adjuvant endocrine therapy can provide significant benefits to prostate cancer patients. However, there are still questions or controversies that need to be confirmed by additional clinical studies.
Adjuvant endocrine therapy is defined as adjuvant endocrine therapy after radical prostatectomy or radical radiotherapy for prostate cancer. The goal of adjuvant endocrine therapy is to treat residual lesions at the cut edge, residual positive lymph nodes, and small metastatic lesions to improve long-term survival.
However, in actual clinical practice, there is some controversy surrounding adjuvant endocrine therapy after radical prostate cancer surgery. In order to standardize treatment, the Chinese Society of Urology organized experts to discuss and reach consensus on some hot issues, and these issues and consensus opinions are organized as follows:
Which patients need to receive adjuvant endocrine therapy?
Expert consensus:
- Patients with positive lymph nodes after radical prostatectomy and high-risk patients after radiotherapy are recommended to receive immediate adjuvant endocrine therapy;
- Patients with positive margins and seminal vesicle invasion are controversial, and most experts believe that immediate adjuvant endocrine therapy is needed;
- Adjuvant endocrine therapy in intermediate-risk patients after radical surgery is more controversial, with most agreeing that they should receive delayed endocrine therapy.
When does “immediate” adjuvant endocrine therapy begin?
Expert consensus.
Expert consensus:
- Based on the current clinical studies, the consensus is that “immediate” adjuvant endocrine therapy is the best way to start.
- Based on current clinical studies, immediate adjuvant endocrine therapy is 2 to 3 months after radical surgery.
How are the options for adjuvant endocrine therapy chosen?
Expert consensus:
- Combined androgen blockade (CAB) therapy, which is a combination of nonsteroidal antiandrogen drugs and depot therapy, is recommended for patients with preferred conditions;
- Depot treatment alone may also be a clinical option, and anti-androgen therapy alone is generally not recommended.
How long does adjuvant endocrine therapy need to last?
Expert consensus:
- Adjuvant endocrine therapy is recommended for a minimum of 18 months.