ADT Optimizing its Role in Advanced P Ca: Challenges beyond Guidelines
I am providing an article published on March 4th by Neal Shore and his panel of over 14 members who have looked into â€˜Optimizing the role of androgen deprivation therapy in advanced prostate cancer: Challenges beyond the guidelinesâ€™.
https://onlinelibrary.wiley.com/doi/pdf/10.1002/pros.23967 (PDF available)
Practicing Urologists have used ADT in various forms for ~80 years from localized P ca to its most advanced stage. Initially it was Bil. Orchidectomy followed by Oestrogens prior to ADT taking over in 1980â€™s. Even today there is no consensus as regards the superiority of CAB over Bil. Orchidectomy even though volumes have been written on this subject. Since the turn of the century, especially since 2010, There have been several molecules introduced into the realms of treatment claiming longer overall survival. Today we talk about Abiraterone, Enzalutamide as monotherapy and even in combination. Drugs like Apalutamide/Darolutamide are being touted as the drugs for prolonging survival. Chemo hormonal therapies are touted as specific under special circumstances. So many more, including Checkpoint inhibitors, are on the anvil and time will inform us regarding their utility.
However, even today, Hormonal therapies rule the roost as regards management of Advanced P Ca.
This panel consensus on optimising the role of ADT in advanced P ca is a must read and understanding. They opine that â€˜In the medical literature, there is a lack of level 1 evidence to make conclusive statements about ADT use in all settingsâ€™.
I am sure this consensus will inform us regarding the usefulness and limitations of use of ADT in todays context.
With warm Regards,