[Reassessing androgen deprivation therapy (ADT) in older men with advanced prostate cancer: when to use, when to discontinue, and role as monotherapy?].

BACKGROUND

Androgen deprivation therapy (ADT) remains the standard of care for the treatment of advanced and metastatic prostate cancer (PC). However, in older patients, the choice of treatment must be made carefully, as they often have comorbidities and are at risk of potential side effects. Newer hormonal therapies (androgen receptor pathway inhibitors, ARPIs) have expanded the treatment spectrum, raising questions about optimal therapy for older patients.

OBJECTIVE

This article provides an overview of the evidence-based use of ADT and ARPI in older patients, with a particular focus on relevant guideline recommendations and study results across different stages of prostate cancer. It also describes how individualized treatment decisions can be made in clinical practice.

MATERIALS AND

METHODS

Selective literature review on ADT and ARPI in older patients. Data from relevant clinical trials, current evidence, and recommendations from international and national guidelines (e.g., EAU, S3) are considered.

RESULTS

For metastatic hormone-sensitive prostate cancer (mHSPC), the combination of ADT and ARPI has proven beneficial, particularly for patients with a life expectancy of more than 1 year and a good performance status. Network meta-analyses show that dual- and triple-agent therapies improve overall survival in older patients, while side effects increase.

CONCLUSION

The use of ADT + ARPI improves survival rates but requires a nuanced assessment of side effects and quality of life, particularly in very old patients. Geriatric assessment helps classify patients into different risk groups and plays a central role in treatment decisions.