Editing Management of Localized Prostate Cancer (section)

=== ADT Monotherapy ===

* See Hormonal Therapy in Prostate Cancer Chapter Notes
* '''<span style="color:#ff0000">Definition of primary hormonal therapy: administration of ADT to men without metastases as sole therapy at the time of diagnosis</span>'''
* '''<span style="color:#ff0000">Does not provide a survival benefit for most men with clinically localized prostate cancer</span>'''
** '''<span style="color:#ff00ff">Bicalutamide Early Prostate Cancer Programme</span>'''
*** '''Population: 3,292 men with T1b-4, N0-Nx (N+ not allowed) M0 prostate cancer who had undergone radical prostatectomy or radiotherapy'''
**** '''657 men with locally advanced prostate cancer'''
*** '''Randomized to <span style="color:#ff0000">bicalutamide 150mg</span> daily vs. placebo'''
*** '''Outcomes: progression-free and overall survival'''
*** '''Results:'''
**** '''<span style="color:#ff0000">Localized-disease subgroup:</span>'''
***** '''<span style="color:#ff0000">No significant difference in progression-free survival</span>''' (HR 0.93 (0.82–1.06))
***** '''<span style="color:#ff0000">Almost significantly reduced overall survival</span>''' (HR 1.15 (1.00-1.32))
**** '''<span style="color:#ff0000">Locally-advanced subgroup:</span>'''
***** '''<span style="color:#ff0000">Significantly improved progression-free survival</span>''' (HR 0.67 (0.56–0.80))
***** '''<span style="color:#ff0000">No significant difference in overall survival</span>'''(HR 0.89 (0.74–1.07))
*** [https://pubmed.ncbi.nlm.nih.gov/22129214/ Iversen, Peter, et al.] "Antiandrogen monotherapy in patients with localized or locally advanced prostate cancer: final results from the bicalutamide Early Prostate Cancer programme at a median follow‐up of 9.7 years." ''BJU international'' 105.8 (2010): 1074-1081.
* ADT therapy is never curative; nevertheless, many patients experience long-term remissions
*'''<span style="color:#ff0000">Indications</span>'''
**'''<span style="color:#ff0000">2022 AUA Guidelines on Clinically Localized Prostate Cancer</span>'''
***'''<span style="color:#ff0000">Palliative ADT alone may be recommended for patients with high-risk prostate cancer, local symptoms, and limited life expectancy.</span>'''
****Primary ADT should only be recommended for palliation of local disease-related symptoms in select patients with a limited life expectancy for whom definitive local therapy is not advised.
****For such patients, the primary goals of care include symptom control/palliation and maintenance of QOL. As such, ADT may be used to manage urinary tract sequelae of local tumor growth through (albeit transient) cytoreduction.
* Cardiovascular evaluation is prudent before treatment of men at risk for cardiovascular complications