Universität zu Köln

Crawford, E. David, Heidenreich, Axel, Lawrentschuk, Nathan, Tombal, Bertrand, Pompeo, Antonio C. L., Mendoza-Valdes, Arturo, Miller, Kurt, Debruyne, Frans M. J. and Klotz, Laurence (2019). Androgen-targeted therapy in men with prostate cancer: evolving practice and future considerations. Prostate Cancer Prostatic Dis., 22 (1). S. 24 - 39. LONDON: NATURE PUBLISHING GROUP. ISSN 1476-5608

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Abstract

Background Androgen deprivation therapy (ADT) is foundational in the management of advanced prostate cancer (PCa) and has benefitted from a recent explosion in scientific advances. These include approval of new therapies that suppress testosterone (T) levels or inactivate its function, improvements in diagnostic and assay technologies, identification of lower therapeutic targets for T, discovery of the relevance of germline genetic mutations and identification of the benefits of sequential and combination therapies. Methods This review discusses the clinical profiles of the most up-to-date options for ADT, best practices for managing patients with advanced PCa and future directions in therapy. Results and conclusions Modern assay technologies reveal that bilateral orchiectomy results in a serum T level of approximately 15 ng/dL as compared to the historical definition of castration of T <50 ng/dL. Evidence shows that lowering T levels to <20 ng/dL improves patient survival and delays disease progression. Routine monitoring of T in addition to prostate-specific antigen throughout treatment is important to ensure continuing efficacy of T suppression. New drugs that inhibit androgen signaling in combination with traditional ADT suppress T activity to near zero and have significantly improved patient survival. When personalizing ADT regimens physicians should consider a number of factors including initiation and duration of ADT, monitoring of T levels and PSA, the possibility of switching monotherapies if a patient does not achieve adequate T suppression, and consideration of intermittent vs. continuous ADT according to patients' lifestyles, comorbidities, risk factors and tolerance to treatment.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Crawford, E. David UNSPECIFIED UNSPECIFIED UNSPECIFIED Heidenreich, Axel UNSPECIFIED UNSPECIFIED UNSPECIFIED Lawrentschuk, Nathan UNSPECIFIED UNSPECIFIED UNSPECIFIED Tombal, Bertrand UNSPECIFIED UNSPECIFIED UNSPECIFIED Pompeo, Antonio C. L. UNSPECIFIED UNSPECIFIED UNSPECIFIED Mendoza-Valdes, Arturo UNSPECIFIED UNSPECIFIED UNSPECIFIED Miller, Kurt UNSPECIFIED UNSPECIFIED UNSPECIFIED Debruyne, Frans M. J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Klotz, Laurence UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-156057
DOI:	10.1038/s41391-018-0079-0
Journal or Publication Title:	Prostate Cancer Prostatic Dis.
Volume:	22
Number:	1
Page Range:	S. 24 - 39
Date:	2019
Publisher:	NATURE PUBLISHING GROUP
Place of Publication:	LONDON
ISSN:	1476-5608
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language FOLLICLE-STIMULATING-HORMONE; ANTIGEN DOUBLING TIME; DEPRIVATION THERAPY; LEUPROLIDE ACETATE; SERUM TESTOSTERONE; OPEN-LABEL; ABIRATERONE ACETATE; SURGICAL CASTRATION; NADIR TESTOSTERONE; INCREASED SURVIVAL Multiple languages Oncology; Urology & Nephrology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/15605