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Second generation anti-androgens and androgen deprivation therapy with radiation therapy in the definitive management of high-risk prostate cancer.

Publication ,  Journal Article
Wang, EC; Lee, WR; Armstrong, AJ
Published in: Prostate Cancer Prostatic Dis
March 2023

BACKGROUND: Evolving data suggest that men with high-risk localized prostate cancer may benefit from more potent androgen receptor inhibition in the context of curative intent radiotherapy. Recently updated American Society for Clinical Oncology (ASCO) evidence-based guidelines and the National Comprehensive Cancer Network (NCCN) Guidelines have updated recommendations for the consideration of adding second generation anti-androgens to androgen deprivation therapy (ADT) in men receiving radiation therapy (RT) for noncastrate locally advanced high and very high risk nonmetastatic or node positive prostate cancer. METHODS AND RESULTS: We conducted a comprehensive review of existing published and abstract presented evidence behind RT with ADT for the definitive management of high-risk prostate cancer, particularly focused on the current phase II and III trial evidence for the addition of second generation anti-androgens to ADT in definitive RT treatment of high-risk prostate cancer and specifically focused on the recent STAMPEDE trial results with abiraterone acetate. We review the biological mechanisms in which second generation anti-androgens may help mitigate ADT resistance and provide radiosensitization through inhibition of DNA repair. Finally, we discuss ongoing clinical trials of potent androgen receptor (AR) inhibitors with ADT in this non-metastatic high-risk radiotherapy setting that may inform on future treatment guidelines. CONCLUSIONS: Recent data suggest an overall survival benefit as well as increased probabilities of disease free and metastasis free survival in men with high and very high-risk localized, node positive, and oligometastatic hormone sensitive prostate cancer with abiraterone acetate and prednisone and support the use of potent AR inhibitors in this setting after informed decision making.

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Published In

Prostate Cancer Prostatic Dis

DOI

EISSN

1476-5608

Publication Date

March 2023

Volume

26

Issue

1

Start / End Page

30 / 40

Location

England

Related Subject Headings

  • Urology & Nephrology
  • Receptors, Androgen
  • Prostatic Neoplasms
  • Prednisone
  • Male
  • Humans
  • Androgen Receptor Antagonists
  • Androgen Antagonists
  • Abiraterone Acetate
  • 3211 Oncology and carcinogenesis
 

Citation

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Wang, E. C., Lee, W. R., & Armstrong, A. J. (2023). Second generation anti-androgens and androgen deprivation therapy with radiation therapy in the definitive management of high-risk prostate cancer. Prostate Cancer Prostatic Dis, 26(1), 30–40. https://doi.org/10.1038/s41391-022-00598-3
Wang, Edina C., W Robert Lee, and Andrew J. Armstrong. “Second generation anti-androgens and androgen deprivation therapy with radiation therapy in the definitive management of high-risk prostate cancer.Prostate Cancer Prostatic Dis 26, no. 1 (March 2023): 30–40. https://doi.org/10.1038/s41391-022-00598-3.
Wang, Edina C., et al. “Second generation anti-androgens and androgen deprivation therapy with radiation therapy in the definitive management of high-risk prostate cancer.Prostate Cancer Prostatic Dis, vol. 26, no. 1, Mar. 2023, pp. 30–40. Pubmed, doi:10.1038/s41391-022-00598-3.

Published In

Prostate Cancer Prostatic Dis

DOI

EISSN

1476-5608

Publication Date

March 2023

Volume

26

Issue

1

Start / End Page

30 / 40

Location

England

Related Subject Headings

  • Urology & Nephrology
  • Receptors, Androgen
  • Prostatic Neoplasms
  • Prednisone
  • Male
  • Humans
  • Androgen Receptor Antagonists
  • Androgen Antagonists
  • Abiraterone Acetate
  • 3211 Oncology and carcinogenesis