Optimizing ADT in High-Risk Prostate Cancer

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Following definitive therapy, approximately 25% to 30% of patients with high-grade prostate cancer experience a biochemical recurrence, as manifested by a rise in PSA. For these patients, notes moderator Raoul S. Concepcion, MD, the next step is usually imaging followed by the initiation of androgen deprivation therapy (ADT).

ADT has improved in recent years with the introduction of new agents, notes E. David Crawford, MD. The ultimate goal of this approach is to effectively reduce testosterone levels, which can be accomplished using optimal therapies or combinations. In addition to this approach, adjuvant radiation or other salvage therapies may also be utilized to avoid the need to administer ADT, notes Vahan Kassabian, MD.

Traditionally, a serum testosterone below 50 ng/dL has been considered castrate level. However newer technology allows for the measurement of testosterone down to 10 ng/dL, suggesting this could be used as a new lower limit, notes David I. Quinn, MD. Overall, the nuances associated with serum testosterone levels still need to be uncovered but a clear shift in how hormonal therapy is administered appears to be on the horizon.

The emphasis in the future will be on shorter treatment periods using more intensive ADT, believes Stephen J. Freedland, MD. To accomplish this, abiraterone acetate or enzalutamide will likely be utilized as a first-line treatment. This approach could lead to cures for some patients who experience biochemical recurrences, believes Freedland.

In one study, patients with high-risk prostate cancer received ADT plus abiraterone for 6 months following radical prostatectomy. The combination achieved a complete response in approximately 25% to 30% of patients compared with 5% for patients treated with ADT plus chemotherapy, states Freedland.