https://www.europeanurology.com/article/S0302-2838(13)01199-8/pdf/eau-guidelines-on-prostate-cancer-part-ii-treatment-of-advanced-relapsing-and-castration-resistant-prostate-cancer

EAU guidelines on prostate cancer. Part II: Treatment of advanced, relapsing, and castration-resistant prostate cancer ☆

The introduction of an effective blood test, prostate specific antigen (PSA), has made it possible to diagnose more and more men in an earlier stage where they can be offered potentially curative treatments. The other side of the coin is that if effective diagnostic procedures are used unselectively in elderly men with a short life expectancy, a problem with over diagnosis and over treatment might occur. Thus the same stage of prostate cancer may need different treatment strategies, pending on the patient’s life expectancy. This, and many other issues regarding the disease, is the subject of the EAU guidelines on prostate cancer. G UI DE LI N ES O N P RO ST AT E CA N CE R 10

/pdf/guidelines-on-prostate-cancer-xdnunn4th8.pdf

Guidelines on Prostate Cancer

ContextProstate cancer is the most common nonskin cancer and second most common
cause of cancer mortality in US men. Androgen deprivation therapy (ADT), specifically
surgical or medical castration, is the first line of treatment against advanced
prostate cancer and is also used as an adjuvant to local treatment of high-risk
disease.ObjectiveTo review systematically the evidence on the risks and benefits of ADT
for prostate cancer as well as clinical management of its adverse effects.Evidence AcquisitionWe performed MEDLINE searches of English-language literature (1966 to
March 2005) using the terms androgen deprivation therapy, hormone treatment, and prostate cancer. We reviewed bibliographies of literature to extract
other relevant articles. Studies were selected based on clinical pertinence,
with an emphasis on controlled study design.Evidence SynthesisAndrogen deprivation therapy is effective for palliation in many patients
with advanced prostate cancer and improves outcomes for high-risk patients
treated with radiation therapy for localized disease. Although patients with
increasing prostate-specific antigen levels after local treatment without
metastatic disease frequently undergo ADT, the benefits of this strategy are
not clear. Adverse effects of ADT include decreased libido, impotence, hot
flashes, osteopenia with increased fracture risk, metabolic alterations, and
changes in cognition and mood.ConclusionsAndrogen deprivation therapy has clear roles in the management of advanced
prostate cancer and high-risk localized disease. The benefits of ADT in other
settings need to be weighed carefully against substantial risks and adverse
effects on quality of life.

https://jamanetwork.com/journals/jama/articlepdf/201192/JCR50004.pdf

Androgen Deprivation Therapy for Prostate Cancer

Background Combined androgen blockade for the treatment of metastatic prostate cancer consists of an antiandrogen drug plus castration. In a previous trial, we found that adding the antiandrogen flutamide to leuprolide acetate (a synthetic gonadotropin-releasing hormone that results in medical ablation of testicular function) significantly improved survival as compared with that achieved with placebo plus leuprolide acetate. In the current trial, we compared flutamide plus bilateral orchiectomy with placebo plus orchiectomy. Methods We randomly assigned patients who had never received antiandrogen therapy and who had distant metastases from adenocarcinoma of the prostate to treatment with bilateral orchiectomy and either flutamide or placebo. Patients were stratified according to the extent of disease and according to performance status. Results Of the 1387 patients who were enrolled in the trial, 700 were randomly assigned to the flutamide group and 687 to the placebo group. Overall, the incidence of tox...

Bilateral orchiectomy with or without flutamide for metastatic prostate cancer

IN the 12 years since the topic was last reviewed in the Journal,1 prostatic cancer has become the most common newly diagnosed cancer in men It is the cause of death in more than 28,000 men per year, accounting for 11 percent of cancer deaths, third in men after lung and colon cancer2 Important questions remain about the cause and prevention of prostatic cancer, but new advances permit earlier diagnosis and more accurate staging Curative therapy is possible for localized disease with much less morbidity than previously In advanced disease, androgen-deprivation therapy remains the mainstay of treatment Biology and   

Carcinoma of the Prostate

Gonadotropin-releasing hormone (GnRH) analogues administered for the treatment of advanced prostatic cancer induce a transient increase in plasma testosterone levels during the first week of treatment, often with a secondary rise in plasma levels of prostatic acid phosphatase and a flareup of disease. To determine whether the antiandrogen nilutamide (Anandron) blocks these effects, we carried out a multicenter, placebo-controlled study of nilutamide in men with prostatic cancer treated with the GnRH analogue buserelin. Thirty-six men with disseminated prostatic cancer and elevated plasma levels of prostatic acid phosphatase were randomly assigned to two groups. Group 1 included 17 men who received buserelin (500 micrograms daily subcutaneously) and nilutamide (300 mg daily by mouth); group 2 included 19 men treated with buserelin and placebo. Symptoms were assessed, and plasma was collected before treatment, daily for 14 days, and on days 18, 22, and 29 after the initiation of treatment. Bone pain appeared or worsened in 5 of the 17 men in group 1 and in 12 of the 19 men in group 2 (P less than 0.05). Acute urinary obstruction occurred in one man in group 2. Despite similar changes in the plasma testosterone levels in both groups, the median concentration of plasma prostatic acid phosphatase decreased almost immediately in group 1, but increased transiently, then decreased on day 14 in group 2. Median levels of prostate-specific antigen decreased immediately in group 1 and decreased on day 8 in group 2. We conclude that nilutamide can prevent the adverse consequences of the buserelin-induced transient rise in plasma testosterone levels in men with advanced prostate cancer treated with a GnRH analogue.

Prevention of the Transient Adverse Effects of a Gonadotropin-Releasing Hormone Analogue (Buserelin) in Metastatic Prostatic Carcinoma by Administration of an Antiandrogen (Nilutamide)

A. Moulonguet

Papers

Prevention of the Transient Adverse Effects of a Gonadotropin-Releasing Hormone Analogue (Buserelin) in Metastatic Prostatic Carcinoma by Administration of an Antiandrogen (Nilutamide)

Combining the antiandrogen anandronR with LHRH agonist; Sequential assays of hormones and prostate markers during a double-blind study