Endocrine therapy is indicated for patients with varying degrees of progression of prostate cancer. It is often used for patients with prostate cancer who want better outcomes after surgery or radiation therapy or who do not want to undergo other treatment modalities, for patients with advanced prostate cancer, and for patients undergoing neoadjuvant endocrine therapy before radical prostatectomy or radical radiation therapy.
In recent years, new drugs have emerged in the treatment of prostate cancer, and in response, the National Comprehensive Cancer Network (NCCN) has continued to update its prostate cancer guidelines, and the following is the latest version (2018. V2) of the guidelines on androgen deprivation therapy (androgen deprivation treatment (ADT)) treatment recommendations, so let’s take a look at how the recommended ADT therapy differs for patients with different conditions.
For limited disease, or as adjuvant therapy for lymph node metastases, or for patients in the observation period who need treatment, the following ADT regimens are available:
- Orchiectomy.
- LHRH (luteinizing hormone-releasing hormone) receptor agonists alone, such as
- Goserelin
- Histrelin
- Leuprolide
- Triprolene
As neoadjuvant, concurrent, or adjuvant treatment options to radiotherapy for patients with limited prostate cancer, the following ADT regimens are available:
- LHRH receptor agonists alone, such as
- Goserelin
- Histrelin
- Leuprolide
- Triprolene
- LHRH agonists (such as those listed above) in combination with first-generation antiandrogens, such as
- Nilutrimide
- Flutamide
- bicalutamide
For patients with stage M0 or M1 prostate cancer not treated with debulking therapy, the following ADT regimen is available:
- Orchiectomy.
- LHRH receptor agonists alone (first-generation antiandrogens must be administered continuously for >7 days to prevent testosterone rebound in patients with weight-bearing bone metastases).
- Goserelin
- Histrelin
- Leuprolide
- Triprolene
- LHRH agonists (such as those listed above) in combination with first-generation antiandrogens, such as
- Nilutrimide
- Flutamide
- bicalutamide
- LHRH antagonists.
- Digarelix
- Orchiectomy, LHRH agonist, or LHRH antagonist (as above) combined with abiraterone + prednisone (for patients with stage M1).
Second-line endocrine therapy for stage M0 or M1 debulking-resistant prostate cancer (CRPC), the following ADT regimen is recommended:
Continued use of an LHRH agonist or antagonist to maintain desmoplastic serum testosterone levels (<50 ng/dL) in combination with the following agents:
- Second-generation antiandrogen drugs.
- Apalutamide (for stage M0 patients)
- Enzalutamide (for patients in stage M1)
- Androgen metabolism inhibitor (for patients in stage M1)
- Abiraterone + prednisone
- First-generation anti-androgen drugs, such as
- Nilumet
- Flutamide
- Bicalutamide
- Ketoconazole
- Ketoconazole + hydrocortisone
- Corticosteroids (hydrocortisone, prednisone, dexamethasone)
- Hexenestrol or other estrogens
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