Androgen Deprivation Therapy for Prostate Cancer

In the past, androgen deprivation therapy (ADT) was used for the conservative treatment of prostatic cancer, but now also used in the setting of neoadjuvant and adjuvant treatment in combination with radiotherapy. Another use is for loco-regional or distant recurrence after primary treatment of surgery or radiotherapy. ADT is an alternative for local failure after radical treatment and it compares favorably with cryotherapy or high-intensity focused ultrasound therapy. Traditionally gonadotropin releasing hormone (GnRH) agonists are used. A new class of agent in clinical use is the gonadotrophin antagonist degarelix. Newer choices for castrate resistant prostate cancer include abiraterone and enzalutamide. The emphasis of this review is on drug discovery, design and clinical trials. The indication and rationale for choosing the appropriate first and second line drugs will be discussed for easy access at point of care. This chapter summarizes the recent developments and the controversies to be explored in the future which will be of interest to all health care professionals, colleagues in the pharmaceutical industry, family physicians, urologists, radiation and medical oncologists. We also add our clinical experience of use of different ADT throughout this review to make it practical for bedside management. Common questions from physicians and patients are answered in this review.

Keywords: Androgen deprivation therapy, Anti-androgens, Agonist, Antagonist, Adjuvant, Biochemical failure, Clinical trials, Degarelix, Gonadotropin-releasing hormone, Metastasis, Prostate cancer, Prostate-specific antigen, Primary treatment.