Hormone naïve prostate cancer: predicting and maximizing response intervals.
Abstract
Hormone naïve advanced prostate cancer is subdivided into two disease states: biochemical
recurrence and traditional M1 (metastatic) prostate cancer and characterized by no
prior hormonal therapy or androgen deprivation therapy (ADT). In biochemical recurrence/prostate-specific
antigen (PSA) recurrence, men should be risk-stratified based on their PSA doubling
time, the Gleason score and the timing of the recurrence. In general, only men who
are at high risk should be considered for early/immediate ADT although this is best
done using shared decision with the patient. The type of ADT to be used in biochemical
recurrence ranging from oral-only peripheral blockade (peripheral androgen deprivation)
to complete hormonal therapy (combined androgen blockade [CAB]) remains in debate
owing to lack of randomized controlled trials (RCT). However, there is good RCT support
for use of intermittent hormonal therapy (IHT). There is also limited research on
biomarker response (PSA and testosterone decline) to predict prognosis. On the other
hand, in the setting of M1 hormone naïve prostate cancer, there are many more RCT's
to inform our decisions. CAB and gonadotrophin-releasing hormone antagonists perhaps
provide a slight efficacy advantage while IHT may be slightly inferior with minimal
M1 disease. The PSA nadir at 7 months after starting ADT is a powerful prognostic
tool for M1 patients. There is growing recognition that serum testosterone (T) control
while on ADT is linked to the development of castrate-resistant prostate cancer. Especially
for a M1 patient, maintaining a serum T below 20-30 ng dl-1 prolongs the response
to ADT. Novel oral agents (abiraterone and enzalutamide) may soon find use in hormone
naïve disease and may alter the treatment landscape. Despite over 75 years of experience
with ADT, many questions remain, and the field continues to evolve.
Type
Journal articleSubject
HumansProstatic Neoplasms
Neoplasm Metastasis
Disease Progression
Testosterone
Kallikreins
Prostate-Specific Antigen
Antineoplastic Agents, Hormonal
Prognosis
Male
Gonadotropin-Releasing Hormone
Neoplasm Grading
Prostatic Neoplasms, Castration-Resistant
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https://hdl.handle.net/10161/18522Published Version (Please cite this version)
10.4103/1008-682X.152821Publication Info
Moul, Judd W (2015). Hormone naïve prostate cancer: predicting and maximizing response intervals. Asian journal of andrology, 17(6). pp. 929-933. 10.4103/1008-682X.152821. Retrieved from https://hdl.handle.net/10161/18522.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Judd Wendell Moul
James H. Semans, M.D. Distinguished Professor of Urologic Surgery, in the School of
Medicine
Dr Judd Moul joined the Duke faculty in mid 2004 after a career in the US Army Medical
Corps mainly at Walter Reed Army Medical Center. He is a retired colonel and a noted
researcher and clinician in the area of prostate cancer and is a urologic oncologist.
He served as the division chief of Duke Division of Urology from 2004 to 2011 and
was named the James H Semans MD Professor of surgery in 2009 becoming Duke's first
named endowed chair for urology. He was awarded the Gold Cystosco

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