The Case for Systemic Therapy Alone for Prostate Cancer

Abstract

This review details clinical scenarios that may be appropriate for the use of primary androgen deprivation alone for organ confined prostate cancer. The Medline and National Cancer Institute clinical trials databases were used. Searches were made regarding current and potential data to guide therapeutic decision making. Data integration that incorporates patient comorbidities and cancer histological features can identify patients at low vs high risk for death from prostate cancer. Observational databases have documented an increase in the use of primary androgen deprivation for low and high risk disease. Outcome data on androgen deprivation therapy alone in patients with metastatic as well as localized disease were reviewed. The potential of newer therapies, including chemotherapy, and therapies that target aberrant signaling pathways was also reviewed. The latter holds the potential to more effectively eradicate distant metastatic disease. Patients with high risk prostate cancer are those with a high chance of relapse with systemic disease despite treatment with definitive local therapy. Moreover, a patient with multiple comorbidities, and associated short life expectancy and high risk cancer may be a suitable candidate for systemic therapy alone with the goal of local and systemic disease control. In contrast, deferred systemic therapy alone until local progression and/or metastatic disease can be considered in a patient with low risk, indolent disease and a life expectancy of less than 10 years with the goal of avoiding over treating most patients, who often do not require any therapy during life.