From the Guidelines
Adjuvant LHRH agonist therapy is not recommended for all patients after radical prostatectomy, but may be considered for high-risk patients with adverse pathological features. The decision to use adjuvant LHRH therapy should be individualized based on the patient's specific risk factors, pathology results, and overall health status 1.
Key Considerations
- The use of adjuvant LHRH agonist therapy is primarily recommended for patients with high-risk features such as positive surgical margins, seminal vesicle invasion, extracapsular extension, or lymph node involvement 1.
- Common LHRH agonists include leuprolide, goserelin, and triptorelin, with treatment duration typically ranging from 18-36 months depending on risk factors.
- Patients should be informed about potential side effects including hot flashes, sexual dysfunction, bone density loss, metabolic changes, and cardiovascular risks.
- Regular monitoring of PSA levels, testosterone levels, bone density, and metabolic parameters is essential during treatment.
Recent Guideline Updates
- The 2019 ASTRO/AUA guideline amendment recommends offering hormone therapy to patients who have had radical prostatectomy and are candidates for salvage radiotherapy, with consideration of potential benefits and side effects 1.
- The guideline emphasizes the importance of individualized decision-making, taking into account the patient's history, values, preferences, quality of life, and functional status.
Clinical Implications
- Adjuvant LHRH agonist therapy may be beneficial for high-risk patients, but its use should be carefully considered in the context of each patient's unique clinical profile.
- Clinicians should discuss the potential benefits and risks of adjuvant LHRH therapy with patients, including the impact on quality of life and overall health status.
- Ongoing monitoring and evaluation are crucial to ensure optimal outcomes and minimize adverse effects.
From the Research
Adjuvant Luteinizing Hormone-Releasing Hormone (LHRH) Agonist Post Radical Prostatectomy
- The use of adjuvant LHRH agonist post radical prostatectomy is not directly addressed in the provided studies, however, the role of adjuvant androgen deprivation therapy (ADT) is discussed in several studies 2, 3.
- A study published in 2018 found that adjuvant ADT with or without mitoxantrone plus prednisone did not improve overall survival in patients with high-risk prostate cancer after radical prostatectomy 2.
- Another study published in 2014 found that a multimodality tailored treatment based on radical prostatectomy and adjuvant therapy with radiation therapy + androgen deprivation therapy achieved similar results in terms of overall survival after 5-years of follow-up compared to exclusive radical prostatectomy in high-risk prostate cancer patients 3.
Role of Adjuvant Therapy
- Adjuvant therapy, including radiation therapy and androgen deprivation therapy, may be considered in patients with high-risk prostate cancer after radical prostatectomy to reduce the risk of recurrence 4, 5, 6.
- The decision to use adjuvant therapy should be based on individual patient characteristics, including pathological features and clinical risk factors 4, 5, 6.
Radiation Therapy
- Radiation therapy plays a key role in the treatment of prostate cancer, and may be used as adjuvant or salvage therapy after radical prostatectomy 4, 5, 6.
- The use of radiation therapy after radical prostatectomy has been shown to reduce the risk of recurrence and improve disease-free survival in patients with high-risk prostate cancer 4, 5, 6.