Hormone naïve prostate cancer: predicting and maximizing response intervals.

dc.contributor.author

Moul, Judd W

dc.date.accessioned

2019-05-01T19:50:22Z

dc.date.available

2019-05-01T19:50:22Z

dc.date.issued

2015-11

dc.date.updated

2019-05-01T19:50:20Z

dc.description.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.

dc.identifier

152821

dc.identifier.issn

1008-682X

dc.identifier.issn

1745-7262

dc.identifier.uri

https://hdl.handle.net/10161/18522

dc.language

eng

dc.publisher

Medknow

dc.relation.ispartof

Asian journal of andrology

dc.relation.isversionof

10.4103/1008-682X.152821

dc.subject

Humans

dc.subject

Prostatic Neoplasms

dc.subject

Neoplasm Metastasis

dc.subject

Disease Progression

dc.subject

Testosterone

dc.subject

Kallikreins

dc.subject

Prostate-Specific Antigen

dc.subject

Antineoplastic Agents, Hormonal

dc.subject

Prognosis

dc.subject

Male

dc.subject

Gonadotropin-Releasing Hormone

dc.subject

Neoplasm Grading

dc.subject

Prostatic Neoplasms, Castration-Resistant

dc.title

Hormone naïve prostate cancer: predicting and maximizing response intervals.

dc.type

Journal article

duke.contributor.orcid

Moul, Judd W|0000-0001-9228-8344

pubs.begin-page

929

pubs.end-page

933

pubs.issue

6

pubs.organisational-group

School of Medicine

pubs.organisational-group

Duke

pubs.organisational-group

Duke Cancer Institute

pubs.organisational-group

Institutes and Centers

pubs.organisational-group

Anesthesiology

pubs.organisational-group

Clinical Science Departments

pubs.organisational-group

Surgery, Urology

pubs.organisational-group

Surgery

pubs.publication-status

Published

pubs.volume

17

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