title: The modern role of androgen deprivation therapy in the management of localised and locally advanced prostate cancer.
abstract: BACKGROUND
  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 ADTversussurgery in the management of localised and locally advanced prostate cancer, particularly with regards to men with pre-existing comorbidities.
authors.affiliation: Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Gunner
authors.affiliation: Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK.
authors.forename: Aziz
authors.initials: A
authors.lastname: Gulamhusein
authors.affiliation: University of Sheffield, Sheffield, UK.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Rosario
keywords: Adverse effects; androgen deprivation; cardiovascular disease; co-morbidities; localised prostate cancer; locally advanced prostate cancer; prostate cancer; radiotherapy; review; survival