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Lucas K. Vitzthum, Chris Straka, Reith R. Sarkar, Rana McKay, J. Michael Randall, Ajay Sandhu, James D. Murphy and Brent S. Rose

combined androgen blockade (CAB) for at least the first 6 months of ADT, and it is not clear whether the addition of an antiandrogen improved outcomes compared with a gonadotropin-releasing hormone agonist (GnRH-A) alone. Accordingly, the optimal ADT

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Charles J. Ryan and Eric J. Small

Androgen deprivation is the foundation for the systemic therapy of advanced prostate cancer. Multiple trials have tested combined androgen blockade versus androgen deprivation alone in patients with advanced disease. These studies suggest a slight advantage to the combined approaches that contain flutamide and bicalutamide, but the lack of dramatic differences in outcome makes monotherapy reasonable, especially in patients with more indolent disease. Intermittent androgen deprivation is an alternative that may allow patients to reduce the total time on androgen suppression as well as possibly delay the onset of androgen independence. A number of secondary hormonal therapies, including deferred and secondary antiandrogens, ketoconazole, and estrogens have shown modest response proportions. Patients with less advanced disease such as a rising prostate-specific antigen have varied outcomes, and no standard approach exists. In this group, noncastrating forms of hormonal therapy are being evaluated. Patients undergoing definitive local therapy who have high-risk features may benefit from early, as opposed to deferred, androgen deprivation. This review examines the evidence for the current state of the art in hormonal therapy in patients with prostate cancer and focuses, in particular, on treatment composition and timing as well as the rationale for the use of hormonal therapy in early stage disease.

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progression by prostate-specific antigen (PSA) or bony metastasis and who are currently receiving combined androgen blockade with bicalutamide will receive temsirolimus weekly for 13 weeks. Because evaluating new therapies in prostate cancer is uniquely

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1496 1496 jnccn18286 10.6004/jnccn.2019.7333 Combined Androgen Blockade in Localized Prostate Cancer Treated With Definitive Radiation Therapy Vitzthum Lucas K. a MD Straka Chris a MD Sarkar Reith R. a MD McKay Rana b MD Randall J. Michael b MD Sandhu

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Philip J. Saylor and Matthew R. Smith

resistance during combined androgen blockade for prostate cancer . Urology 2008 ; 71 : 318 – 322 . 28. Smith MR Lee H Nathan DM . Insulin sensitivity during combined androgen blockade for prostate cancer . J Clin

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James L. Mohler

, benefit to this approach, though many physicians still prescribe combined androgen blockade (CAB) with an LHRH agonist plus an antiandrogen. “Adding an antiandrogen just increases side effects and costs; for that reason I am against it,” he said

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Brandon A. Mahal, Ming-Hui Chen, Andrew A. Renshaw, Marian J. Loffredo, Philip W. Kantoff and Anthony V. D'Amico

fractions of 1.8 Gy per fraction to the prostate and seminal vesicles. Combined androgen blockade included 2 injections of a luteinizing hormone–releasing hormone (LHRH) agonist (leuprolide acetate, 22.5 mg every 3 months or goserelin, 10.8 mg every 3 months

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James Mohler, Robert R. Bahnson, Barry Boston, J. Erik Busby, Anthony D'Amico, James A. Eastham, Charles A. Enke, Daniel George, Eric Mark Horwitz, Robert P. Huben, Philip Kantoff, Mark Kawachi, Michael Kuettel, Paul H. Lange, Gary MacVicar, Elizabeth R. Plimack, Julio M. Pow-Sang, Mack Roach III, Eric Rohren, Bruce J. Roth, Dennis C. Shrieve, Matthew R. Smith, Sandy Srinivas, Przemyslaw Twardowski and Patrick C. Walsh

commonly used for treating prostate cancer. ADT can be accomplished using a luteinizing hormone–releasing hormone (LHRH) agonist (medical castration) or bilateral orchiectomy (surgical castration), which are equally effective. Combined androgen blockade

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Miren Gaztañaga and Juanita Crook

-releasing hormone analogues and cyproterone acetate: a randomized controlled trial . BJU Int 2002 ; 90 : 427 – 432 . 11 Cherrier MM Rose AL Higano C . The effects of combined androgen blockade on cognitive function during the first cycle of

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Julie R. Gralow, J. Sybil Biermann, Azeez Farooki, Monica N. Fornier, Robert F. Gagel, Rashmi N. Kumar, Charles L. Shapiro, Andrew Shields, Matthew R. Smith, Sandy Srinivas and Catherine H. Van Poznak

-releasing hormone agonists for prostatic carcinoma . J Urol 1999 ; 161 : 1219 – 1222 . 130 Diamond T Campbell J Bryant C Lynch W . The effect of combined androgen blockade on bone turnover and bone mineral densities in men treated for prostate