scholarly journals Management of locally advanced prostate cancer: appraisal of current paradigms and future directions

2021 ◽  
Author(s):  
Maria L Sandoval ◽  
Ammoren Dohm ◽  
Kosj Yamoah
Keyword(s):  
Prostate Cancer ◽  
Advanced Prostate Cancer ◽  
Disease Risk ◽  
Early Stage ◽  
Locally Advanced ◽  
Treatment Strategies ◽  
Current Standard ◽  
Patient Centered ◽  
Locally Advanced Prostate Cancer

The current standard for the management of locally advanced and early-stage metastatic prostate cancer relies on a backbone of androgen deprivation therapy (ADT) combined with radiotherapy (RT), a regimen that at a glance appears relatively straightforward. The emergence of newer diagnostic, genomic and imaging modalities have allowed for better disease risk-stratification and opened avenues for the development of more patient-centered treatment strategies. This review aims to highlight the central role of RT as part of a multi-modal approach, and discuss established and emerging data for the management of locally advanced disease, biochemical recurrence, and oligometastatic disease, as well as the use of immunotherapies and radio-isotopes. This review will also briefly discuss ongoing clinical trials that provide new insights into the paradigm shift in the management of locally advanced prostate cancer.

scholarly journals The modern role of androgen deprivation therapy in the management of localised and locally advanced prostate cancer

2016 ◽  
Vol 9 (2_suppl) ◽  
pp. 24-29 ◽  
Author(s):  
Charlotte Gunner ◽  
Aziz Gulamhusein ◽  
Derek J Rosario
Keyword(s):  
Prostate Cancer ◽  
Androgen Deprivation Therapy ◽  
Advanced Prostate Cancer ◽  
Locally Advanced ◽  
Androgen Deprivation ◽  
Locally Advanced Prostate Cancer ◽  
Curative Intent ◽  
Cardiovascular Morbidity And Mortality ◽  
Increased Risk

Introduction: Approximately 50% of men diagnosed with prostate cancer will be exposed to androgen deprivation therapy (ADT) at some stage. The role of ADT in the management of metastatic disease has long been recognised, and its place in the management of localised and locally advanced disease has become clearer in the past few years. Nevertheless, concerns remain that some men might not benefit from ADT in earlier-stage disease. The purpose of the current article is to provide a brief narrative review of the role of ADT as part of a strategy of treatment with curative intent, concentrating mainly on key recent developments in the area. Methods: Narrative literature review of key publications in the English language relating to ADT in the management of localised and locally advanced prostate cancer. Results: In locally advanced and high-risk localised prostate cancer, the use of ADT in combination with radiotherapy improves disease-specific and overall survival. There is no evidence to support the use of ADT in the treatment of low-risk localised prostate cancer. There appears to be an increased risk of cardiovascular morbidity and mortality associated with luteinizing hormone-releasing hormone agonists, particularly in men with pre-existing cardiovascular disease, but the relevance of this in the adjuvant/neoadjuvant setting is currently unclear. Conclusions: Future studies should focus on identification of men who are at risk from cardiovascular complications associated with ADT and on the comparison of radiotherapy with ADT versus surgery in the management of localised and locally advanced prostate cancer, particularly with regards to men with pre-existing comorbidities.

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