Androgen deprivation therapy

Androgen deprivation therapy (ADT) is the upfront systemic therapy for advanced prostate cancer. ADT is administered medically or through surgical castration, and it suppresses serum testosterone levels. Furthermore, ADT may be given alone or in combination with an androgen receptor antagonist. Adverse effects include hot flashes, sexual dysfunction, increased risk of fracture, metabolic syndrome and increased risk of cardiovascular events. The timing of administration of early versus late ADT is still contentious and under active debate. Intermittent ADT may be an alternative to continuous testosterone depletion; although intermittent therapy decreases adverse effects, the comparative efficacy of each is still under active study. The study of germline genetic determinants in response to ADT is in its early phase. However, these studies have the potential to allow for patient selection for the type and timing of ADT.