Editing Prostate Cancer: Management of Locally Advanced Prostate Cancer (section)

== Primary ADT ==
* '''Unlike radical prostatectomy or radiation with ADT, ADT monotherapy has not been conclusively shown to improve overall survival in patients with locally advanced disease'''
* '''Bicalutamide Early Prostate Cancer Programme'''
** '''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 bicalutamide 150mg daily vs. placebo'''
** '''Outcomes: progression-free and overall survival'''
** '''Results:'''
*** '''Localized-disease subgroup:'''
**** '''No significant difference in progression-free survival''' (HR 0.93 (0.82–1.06))
**** '''Almost significantly reduced overall survival''' (HR 1.15 (1.00-1.32))
*** '''Locally-advanced subgroup:'''
**** '''Significantly improved progression-free survival''' (HR 0.67 (0.56–0.80))
**** '''No significant difference in overall survival''' (HR 0.89 (0.74–1.07))
** 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.
* '''Timing of ADT'''
** '''The most appropriate PSA level at which to institute hormone therapy is unknown'''
** '''MRC Prostate Cancer Working Party Investigators Group trial'''
*** Population: 934 men with locally advanced or asymptomatic prostate cancer (500 M0, 261 M1, and 173 Mx)
*** Randomized to immediate vs. delayed ADT
*** Results:
**** Immediate ADT associated with significant improved OS and CSS
*** Br J Urol. 1997 Feb;79(2):235-46. Immediate versus deferred treatment for advanced prostatic cancer: initial results of the Medical Research Council Trial.
** '''EORTC 30891'''
*** Population: 986 men not suitable for local treatment (refused local treatment; had decreased life expectancy, advanced local tumor stage, and/or severe comorbidities)
*** Randomized to immediate vs.  delayed ADT
*** Results:
**** Immediate ADT resulted in a significant, albeit small, improvement in overall survival but no difference in prostate cancer–specific mortality or overall symptom-free survival
* Compared to castration in men with locally advanced but nonmetastatic disease, both sexual interest and physical capacity were better with bicalutamide (150 mg) monotherapy