Fast Five Quiz: Do You Know the Current Guidelines for the Screening and Treatment of Prostate Cancer?

Tan Winston, MD; Bradley Schwartz, DO


April 18, 2022

Androgen deprivation is considered the primary approach to the treatment of metastatic prostate cancer, but has been found to be palliative, not curative. Combined androgen blockade (CAB), a controversial treatment option, recognizes 5%-10% contribution of adrenal androgens to total body testosterone.

Current AUA guidelines note that first-generation antiandrogens (bicalutamide, flutamide, nilutamide) should not be offered in combination with luteinizing hormone-releasing hormone (LHRH) agonists in patients with mHSPC, except to block testosterone flare. The addition of an antiandrogen to LHRH agonist treatment can minimize the risk for flare response (ie, temporary rise in testosterone levels) that can occur with LHRH treatment. As opposed to LHRH agonists alone, gonadotropin-releasing hormone antagonists and orchiectomy as monotherapy have a rapid onset of action and avoid a testosterone flare, making them useful in situations needing rapid hormone ablation, such as impending spinal cord compression.

Active surveillance, watchful waiting, radiation therapy, and radical prostatectomy are treatment options for localized prostate cancer.

Learn more about the treatment of prostate cancer.


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