Fast Five Quiz: Advanced and Metastatic Prostate Cancer Treatment

Daniel S. Schwartz, MD, MBA


May 02, 2022

Virtually all patients with metastatic prostate cancer will become resistant to ADT. In rare cases, a rise in PSA level may be indicative of failure of LHRH treatment to control testosterone secretion rather than the development of castration-resistant disease; consequently, testosterone level should be measured when the PSA level increases. If the serum testosterone level exceeds castration levels, changing the antiandrogen therapy may decrease the PSA level and postpone the need for other therapy.

Three-dimensional conformal RT minimizes exposure of the bladder and rectum to radiation while increasing the radiation delivered to the prostate, and it may be a viable option for the management of locally advanced prostate cancer. Additionally, brachytherapy may be added to external beam radiotherapy in the treatment of patients with locally advanced prostate cancer. A 2021 retrospective study showed promising disease control and tolerability with high-dose brachytherapy added to external beam radiation therapy in clinically locally advanced and/or lymph node–positive prostate cancer.

As noted in the NCCN Guidelines, studies have suggested adjunct ADT produces improvement in progression-free survival in patients with advanced prostate cancer.

Learn more about the management of advanced or metastatic disease.


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