Context Prostate cancer is the most common nonskin cancer and second most common
cause of cancer mortality in US men. Androgen deprivation therapy (ADT), specifically
surgical or medical castration, is the first line of treatment against advanced
prostate cancer and is also used as an adjuvant to local treatment of high-risk
Objective To review systematically the evidence on the risks and benefits of ADT
for prostate cancer as well as clinical management of its adverse effects.
Evidence Acquisition We performed MEDLINE searches of English-language literature (1966 to
March 2005) using the terms androgen deprivation therapy, hormone treatment, and prostate cancer. We reviewed bibliographies of literature to extract
other relevant articles. Studies were selected based on clinical pertinence,
with an emphasis on controlled study design.
Evidence Synthesis Androgen deprivation therapy is effective for palliation in many patients
with advanced prostate cancer and improves outcomes for high-risk patients
treated with radiation therapy for localized disease. Although patients with
increasing prostate-specific antigen levels after local treatment without
metastatic disease frequently undergo ADT, the benefits of this strategy are
not clear. Adverse effects of ADT include decreased libido, impotence, hot
flashes, osteopenia with increased fracture risk, metabolic alterations, and
changes in cognition and mood.
Conclusions Androgen deprivation therapy has clear roles in the management of advanced
prostate cancer and high-risk localized disease. The benefits of ADT in other
settings need to be weighed carefully against substantial risks and adverse
effects on quality of life.