From the Guidelines
The best treatment for aggressive prostate cancer is a multimodal approach combining radiation therapy and androgen deprivation therapy (ADT), with radical prostatectomy considered in selected patients. This approach is based on the most recent and highest quality evidence, which prioritizes the reduction of morbidity, mortality, and improvement of quality of life as the primary outcomes.
Key Considerations
- For localized but aggressive prostate cancer, radiation therapy (RT) in conjunction with 2 to 3 years of ADT is the preferred treatment 1, as it has been shown to improve survival outcomes.
- The combination of external beam radiation therapy (EBRT) and brachytherapy, with or without ADT, is another primary treatment option 1.
- Radical prostatectomy with pelvic lymph node dissection (PLND) remains an option for selected patients with no fixation to adjacent organs 1.
- The optimal duration of ADT in this setting remains unclear, but long-term ADT (2-3 years) is often recommended 1.
Treatment Selection
Treatment selection depends on various factors, including:
- Cancer stage
- Gleason score
- PSA levels
- Overall health
- Patient preferences
- The presence of specific genetic mutations, which may benefit from targeted therapies like PARP inhibitors (olaparib, rucaparib) 1.
Aggressive Approach
The aggressive approach is necessary because higher-grade prostate cancers grow more rapidly and have greater potential to spread beyond the prostate, requiring more intensive intervention to control the disease and improve survival outcomes. The goal of treatment is to reduce morbidity, mortality, and improve quality of life, and the chosen treatment should be based on the most recent and highest quality evidence available.
From the FDA Drug Label
LUPRON INJECTION (leuprolide acetate) is indicated in the palliative treatment of advanced prostatic cancer. The best treatment for aggressive prostate cancer is palliative treatment with leuprolide acetate as indicated in the drug label 2.
- Leuprolide acetate is used for the palliative treatment of advanced prostatic cancer.
- The use of bicalutamide in combination with an LHRH analog may be considered, but it is not the primary treatment indicated for aggressive prostate cancer 3.
From the Research
Treatment Options for Aggressive Prostate Cancer
The treatment for aggressive prostate cancer can involve various approaches, including radiation therapy and androgen deprivation therapy (ADT). The choice of treatment depends on several factors, including the stage and risk of the cancer, as well as the patient's overall health and preferences.
Radiation Therapy
- Radiation therapy is a well-established treatment option for localized prostate cancer, with techniques such as intensity-modulated radiotherapy (IMRT) and image-guided radiotherapy (IGRT) being considered the gold standard 4.
- The optimal dose and target volume for radiation therapy, as well as the potential benefits of combining it with ADT, need to be carefully considered 4, 5.
- Hypofractionated radiotherapy, which involves delivering higher doses of radiation over a shorter period, is also being explored as a potential treatment option 4.
Androgen Deprivation Therapy (ADT)
- ADT is often used in combination with radiation therapy to treat high-risk prostate cancer, with the goal of reducing the size of the tumor and slowing its growth 6, 5, 7.
- The optimal duration of ADT is still being studied, with some research suggesting that longer durations may be more effective in certain cases 6, 7.
- However, ADT can also have significant side effects, and the potential benefits and risks need to be carefully weighed 6, 8.
Combination Therapy
- Combining radiation therapy with ADT may be an effective treatment approach for high-risk prostate cancer, with the potential to improve outcomes such as metastasis-free survival 6, 7.
- The specific details of the treatment regimen, including the dose and duration of ADT, as well as the type and intensity of radiation therapy, will depend on the individual patient's needs and circumstances 5, 7.
Patient-Specific Factors
- The treatment approach for aggressive prostate cancer will depend on a variety of patient-specific factors, including the stage and risk of the cancer, as well as the patient's overall health and preferences 5, 8.
- A multidisciplinary approach, involving input from urologists, radiation oncologists, and other specialists, is often necessary to determine the best course of treatment for each individual patient 5.