Traditional androgen ablation approaches to advanced prostate cancer: new insights.

INTRODUCTION: Androgen deprivation therapy (ADT) is a mature therapy for the treatment of advanced prostate cancer, and yet despite many years of use, there is still much about its use, side effects, efficacy, and outcomes for which the urology community does not have answers. MATERIALS AND METHODS: A literature search was performed to review ADT use in the modern era, specifically examining adjuvant ADT after primary therapy, continuous versus intermittent ADT, disadvantages of luteinizing hormone releasing hormone (LHRH) agonists versus newer LHRH antagonists, and controversies of combined androgen blockade. RESULTS: ADT has little role as primary therapy in North American populations. Evidence for the use of neoadjuvant/adjuvant ADT with radical prostatectomy is less compelling than that for radiation therapy. Data supporting combined androgen blockade over LHRH agonist therapy alone are mixed. Newer LHRH antagonists have a faster onset of reduction in serum testosterone and demonstrate other effects on serum follicle stimulating hormone (FSH) that may impact prostate cancer outcomes. CONCLUSIONS: ADT remains a mainstay of treatment in prostate cancer, and our knowledge of its effectiveness has improved with time. There are still scenarios where not enough information is available and study is ongoing.