Alternative endocrine therapies for castration-resistant prostate cancer
- Nancy A Dawson, MD
Nancy A Dawson, MD
- Professor of Medicine
- Lombardi Comprehensive Cancer Center
- Georgetown University
- Section Editors
- Nicholas Vogelzang, MD
Nicholas Vogelzang, MD
- Section Editor — Prostate Cancer
- Professor of Medicine
- University of Nevada School of Medicine
- US Oncology Research
- W Robert Lee, MD, MS, MEd
W Robert Lee, MD, MS, MEd
- Section Editor — Prostate Cancer
- Professor of Radiation Oncology
- Duke University Medical Center
- Jerome P Richie, MD, FACS
Jerome P Richie, MD, FACS
- Section Editor — Cancer of the Urethra, Penis, and Ureter; Urologic Surgery; Prostate Cancer
- Elliott Carr Cutler Professor of Surgery
- Harvard Medical School
Androgen deprivation therapy (ADT) is generally the initial treatment for men with advanced prostate cancer, either alone or in combination with chemotherapy. Standard approaches to the initial treatment with ADT include orchiectomy, a gonadotropin-releasing hormone (GnRH) agonist, or a combination of a GnRH agonist plus an antiandrogen (combined androgen blockade).
Despite initial response rates of 80 to 90 percent, nearly all men eventually develop castration-resistant disease. Patients who develop progressive disease after their initial ADT are considered to have castration-resistant prostate cancer (CRPC), although their disease may respond to secondary endocrine therapies. In this setting, two new agents, abiraterone (an inhibitor of androgen synthesis) and enzalutamide (a potent and selective inhibitor of the androgen receptor), have been shown to prolong overall survival and are the preferred systemic therapy when endocrine therapy is indicated (table 1). (See "Castration-resistant prostate cancer: Treatments targeting the androgen pathway", section on 'Abiraterone' and "Castration-resistant prostate cancer: Treatments targeting the androgen pathway", section on 'Enzalutamide'.)
Several alternative endocrine approaches (other older antiandrogens, antiandrogen withdrawal, ketoconazole, glucocorticoids, megestrol acetate, estrogens) appear to be less effective and have not been demonstrated to improve survival. However, these approaches may induce clinical responses or stable disease. These alternative endocrine therapies are often used sequentially and may be useful in postponing interventions such as chemotherapy, with its associated toxicity, or after chemotherapy when no other effective options are available.
These alternative endocrine approaches are discussed in this topic.
Overviews of the management of advanced castration-sensitive prostate cancer and CRPC are presented separately. (See "Overview of the treatment of disseminated castration-sensitive prostate cancer" and "Overview of the treatment of castration-resistant prostate cancer (CRPC)".)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- CONTINUATION OF ADT
- ANTIANDROGENS AND ANTIANDROGEN WITHDRAWAL
- Older antiandrogens
- - Bicalutamide
- - Nilutamide
- - Flutamide
- - Cyproterone acetate
- Antiandrogen withdrawal
- OTHER AGENTS
- Megestrol acetate
- SURVEILLANCE DURING TREATMENT
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS