Table 6.

Summary of recommendations for the use of androgen deprivation therapy in patients with prostate cancer

Clinical setting	Is androgen deprivation therapy recommended?	LE*	Ref
ADT alone compared with local standard of care
Compared with observation	No	1b	[7–9]
Compared with radiotherapy	No	1a	[10,11]
Compared with surgery	No	3a	[13–16]
RT plus ADT compared with RT alone
Low risk	No	1b	[22,27,28]
Intermediate risk	Yes: 4–6 mo of ADT should be combined to RT	1b	[22,29]
High risk	Yes: 24–36 mo of ADT should be combined to RT	1a	[17,18,20,21, 23,25,30,32]
ADT adjuvant after a local therapy
N+	Yes: patients with multiple LN metastases should receive LHRH-A	1b	[39,40]
Local–regional disease	Consider ADT only in patients at high risk for developing distant metastases (GS ≥8, PSA DT <12 mo)	1b	[44]
PSA failure	Consider ADT only in patients at high risk for developing distant metastases (GS ≥8, PSA DT <12 mo)	3b	[46,47]
ADT in metastatic disease
Start at diagnosis	Yes: surgical or chemical castration with continous LHRH-A	–
Disease flare prevention with AA	Yes in all patients, 2–7 d before LHRH-A start	1b	[57,63]
Abiraterone acetate	Yes in docetaxel-treated patients with CRPC	1b	[81]

AA = antiandrogens; ADT = androgen deprivation therapy; CRPC = castration-resistant prostate cancer; GS = Gleason score; LHRH-A = luteinizing hormone – releasing hormone agonist; LE = level of evidence; LN = lymph node; PSA = prostate-specific antigen; PSA DT = prostate-specific antigen doubling time; Ref = reference; RT = radiation therapy.

^*LE is defined according to the Oxford Centre for Evidence-Based Medicine [104].