Editing Hormonal Therapy (section)

== Indications ==

* '''In low-risk, localized prostate cancer, there is no survival benefit to primary, immediate ADT in low-risk, localized prostate cancer'''
** Males treated with primary ADT have significantly worse OS than those spared ADT in this setting.
* '''In locally advanced, asymptomatic metastatic, the role of ADT is controversial'''
** In clinically present but undefined prostate cancer treated in a community setting with limited disease monitoring, immediate ADT results in significantly better prostate cancer–specific survival but not better overall survival.
** On the other hand, in patients deemed not suitable for local treatment, immediate ADT improved overall survival but not prostate cancer–specific survival.
* '''In N+ disease,'''
** '''Without primary treatment (cN+), there is no significant advantage to immediate ADT'''
** '''After radical prostatectomy (pN+), there is a significant survival advantage favoring immediate ADT, with a 2.6-year difference in median overall survival (ECOG 3886 Messing et al.).'''
*'''ADT is indicated in symptomatic, metastatic disease'''

=== AUA ===
* '''2022 AUA Guidelines on Clinically Localized Prostate Cancer'''
**'''<span style="color:#ff0000">Palliative ADT monotherapy may be recommended for patients with high-risk prostate cancer, local symptoms, and limited life expectancy.</span>'''
*'''2023 AUA Guidelines on Advanced Prostate Cancer'''
**'''Metastatic hormone-sensitive prostate cancer'''
**'''Metastatic castrate-resistant prostate cancer'''
**'''Biochemical recurrence without metastatic disease after exhaustion of local treatment: ADT should not be routinely initiated'''