Androgen deprivation therapy for prostate cancer.
BACKGROUND
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.


METHODS
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.


RESULTS
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.
Sharifi
Nima
N
Medical Oncology Clinical Research Unit, National Cancer Institute, Bethesda, MD 20892, USA.
Gulley
James L
JL
Dahut
William L
WL
D000726:Androgen Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D009919:Orchiectomy / Q000009:adverse effects; D010166:Palliative Care; D011471:Prostatic Neoplasms / Q000628:therapy*; D011788:Quality of Life
D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal