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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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James L. Mohler, Emmanuel S. Antonarakis, Andrew J. Armstrong, Anthony V. D’Amico, Brian J. Davis, Tanya Dorff, James A. Eastham, Charles A. Enke, Thomas A. Farrington, Celestia S. Higano, Eric Mark Horwitz, Michael Hurwitz, Joseph E. Ippolito, Christopher J. Kane, Michael R. Kuettel, Joshua M. Lang, Jesse McKenney, George Netto, David F. Penson, Elizabeth R. Plimack, Julio M. Pow-Sang, Thomas J. Pugh, Sylvia Richey, Mack Roach III, Stan Rosenfeld, Edward Schaeffer, Ahmad Shabsigh, Eric J. Small, Daniel E. Spratt, Sandy Srinivas, Jonathan Tward, Dorothy A. Shead and Deborah A. Freedman-Cass

, as an alternative to the dose of 1,000 mg/day after an overnight fast (see “Abiraterone Acetate in M1 CRPC,” page 493). 165 The cost saving may reduce financial toxicity and improve compliance. Secondary Hormone Therapy for CRPC Most men with

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Peter H. Carroll and James L. Mohler

/prednisone, enzalutamide, and sipuleucel-T are options if not previously received. Additional options are clinical trial, other secondary hormonal therapy, or best supportive care. If patients with no visceral metastases had prior docetaxel, then abiraterone

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Presenter : Sandy Srinivas

. Patients with PSADT >10 months are managed with observation or secondary hormonal therapy, whereas those with PSADT ≤10 months can be treated with any of the 3 agents (all category 1 recommendations): apalutamide, enzalutamide, and darolutamide. More

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Philip W. Kantoff and James L. Mohler

velocity, and secondary hormonal therapies can be considered. Trials with androgen-signaling inhibitors and immunotherapies will soon open. For mCRPC before chemotherapy in asymptomatic patients with slowly progressing disease, sipuleucel-T, abiraterone

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Dawn Goetz

be used for patients with complete androgen blockade. Another valid option, although not currently proven to prolong overall survival, is secondary hormonal therapy with an anti-androgen, ketoconazole with or without steroids, or estrogen

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James L. Mohler, Andrew J. Armstrong, Robert R. Bahnson, Barry Boston, J. Erik Busby, Anthony Victor D’Amico, James A. Eastham, Charles A. Enke, Thomas Farrington, Celestia S. Higano, Eric Mark Horwitz, Philip W. Kantoff, Mark H. Kawachi, Michael Kuettel, Richard J. Lee, Gary R. MacVicar, Arnold W. Malcolm, David Miller, Elizabeth R. Plimack, Julio M. Pow-Sang, Mack Roach III, Eric Rohren, Stan Rosenfeld, Sandy Srinivas, Seth A. Strope, Jonathan Tward, Przemyslaw Twardowski, Patrick C. Walsh, Maria Ho and Dorothy A. Shead

symptoms, secondary hormone therapy is an existing option. Given its favorable toxicity profile compared with ketoconazole, abiraterone acetate is added as an alternative (category 2B). The panel acknowledges that some men with symptomatic metastatic CRPC

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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

response. 161 , 162 Secondary hormonal therapy is also feasible in M0 patients because the androgen receptor may remain active. This can be achieved using an antiandrogen (for patients who initially underwent medical or surgical castration), ketoconazole