Immediate vs. delayed androgen deprivation for prostate cancer.
Androgen ablation has been the standard treatment of symptomatic patients with metastatic prostate cancer for more than 50 years. Within the last 15 years, the introduction of prostate-specific antigen (PSA) has induced a stage migration toward less extensive disease and a dramatic decrease in the proportion of men presenting with N+/M+ disease. Historical studies, conducted during the pre-PSA era, are therefore of limited interest in counseling modern patients. The routine use of radical therapies such as radical prostatectomy and radiotherapy has considerably expanded the problem of timing of endocrine treatment in range and complexity. Advanced disease is now diagnosed in patients with limited involvement of extraprostatic sites and even in patients presenting an isolated elevation of PSA after radical treatment. In the absence of clear guidelines, data from past literature and ongoing modern studies were compiled in the present review in an attempt to generate practical considerations.
Van Cangh
P J
PJ
Department of Urology, Cliniques Universitaires St. Luc, Université Catholique de Louvain, Brussels, Belgium. vancangh@chex.ucl.ac.be
Gala
J L
JL
Tombal
B
B
D000726:Androgen Antagonists / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D005544:Forecasting; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D009362:Neoplasm Metastasis; D017430:Prostate-Specific Antigen / Q000032:analysis; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D013997:Time Factors
D000726:Androgen Antagonists; D017430:Prostate-Specific Antigen