Androgen Deprivation Therapy for Prostate Cancer

Sharifi, Nima MD
Gulley, James L. MD, PhD
Dahut, William L. MD

Medical Oncology Clinical Research Unit (Drs Sharifi, Gulley, and Dahut) and Laboratory of Tumor Immunology and Biology (Dr Gulley), National Cancer Institute, Bethesda, Md; Cytokine Molecular Mechanisms Section, Laboratory of Molecular Immunoregulation, National Cancer Institute, Frederick, Md (Dr Sharifi).

Corresponding Author: James L. Gulley, MD, PhD, Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, 10 Center Dr, 8B09 MSC 1750, Bethesda, MD 20892 ([email protected]).

Financial Disclosures: None reported.

JAMA: The Journal of the American Medical Association 294(2):p 238-244, July 13, 2005.

Context

Prostate cancer is the most common nonskin cancer and second most common cause of cancer mortality in US men. Androgen deprivation therapy (ADT), specifically surgical or medical castration, is the first line of treatment against advanced prostate cancer and is also used as an adjuvant to local treatment of high-risk disease.

Objective

To review systematically the evidence on the risks and benefits of ADT for prostate cancer as well as clinical management of its adverse effects.

Evidence Acquisition

We performed MEDLINE searches of English-language literature (1966 to March 2005) using the terms androgen deprivation therapy, hormone treatment, and prostate cancer. We reviewed bibliographies of literature to extract other relevant articles. Studies were selected based on clinical pertinence, with an emphasis on controlled study design.

Evidence Synthesis

Androgen deprivation therapy is effective for palliation in many patients with advanced prostate cancer and improves outcomes for high-risk patients treated with radiation therapy for localized disease. Although patients with increasing prostate-specific antigen levels after local treatment without metastatic disease frequently undergo ADT, the benefits of this strategy are not clear. Adverse effects of ADT include decreased libido, impotence, hot flashes, osteopenia with increased fracture risk, metabolic alterations, and changes in cognition and mood.

Conclusions

Androgen deprivation therapy has clear roles in the management of advanced prostate cancer and high-risk localized disease. The benefits of ADT in other settings need to be weighed carefully against substantial risks and adverse effects on quality of life.