Prostate Cancer ADT Decision Support
Evidence-based Androgen Deprivation Therapy Algorithms
Quick Decision Pathway
Assess Disease Stage
Localized vs. Locally Advanced vs. Metastatic
Determine Hormone Sensitivity
HSPC vs. CRPC
Calculate Risk Category
Low vs. High Volume/Risk
Select Therapy
Based on Guidelines + Patient Factors
ADT Drug Classes
| Drug Class | Mechanism | Examples | Key Indications |
|---|---|---|---|
| GnRH Agonists | Suppress LH → ↓ testicular androgen | Leuprolide, Goserelin | First-line, metastatic HSPC |
| GnRH Antagonists | Block GnRH receptor → rapid ↓ androgen | Degarelix, Relugolix | Rapid suppression (no flare), symptomatic spinal mets / cord compression, high-risk metastatic disease |
| AR Blockers (2nd gen) | Block androgen binding to receptor | Enzalutamide, Apalutamide | Combination therapy, CRPC |
| Synthesis Inhibitors | Inhibit CYP17 → block androgen synthesis | Abiraterone | High-risk, CRPC |
| Surgical Castration | Remove testicles → ↓ androgen production | Bilateral orchiectomy | Cost-effective, rapid |
Risk Stratification Criteria
| Risk Model | Low Risk | High Risk | Very High Risk |
|---|---|---|---|
| NCCN | PSA <10, GS ≤6, T1-T2a | Intermediate (simplified): PSA 10–20 and/or GS 7 and/or T2b–T2c | High/Very high (simplified): PSA >20 and/or GS 8–10 and/or ≥T3 (T3b–T4 = very high) |
| STAMPEDE Volume | <4 bone mets, no visceral mets | STAMPEDE high-volume: ≥4 bone mets or any visceral mets (differs from CHAARTED definition) | Liver mets or high-volume bone |
| LATITUDE Risk | ≤2 risk factors | >2 risk factors | ≥3 high-risk factors |
| CAPRA Score | 0-2 | 3-5 | 6-10 |
High-Risk Factors:
- Gleason Score ≥8
- PSA >20 ng/mL
- ≥T3 disease
- ≥4 bone metastases
- Visceral metastases
Evidence-Based Recommendations
mHSPC: Combination Therapy
ADT + ARPI (abiraterone, enzalutamide, apalutamide) or ADT + docetaxel
Level 1 EvidenceHigh-Volume Disease
Consider triplet therapy: ADT + ARPI + docetaxel
Level 1 EvidenceRapid Suppression Needed
Use GnRH antagonist (Degarelix, Relugolix) or surgical castration
Level 1 EvidenceMonitoring Frequency
PSA and testosterone every 3-6 months
Level 2 EvidenceSupporting Clinical Trials:
- STAMPEDE: ADT + Abiraterone/Docetaxel
- LATITUDE: ADT + Abiraterone in high-risk mHSPC
- ARCHES: ADT + Enzalutamide
- TITAN: ADT + Apalutamide
- ARASENS: ADT + Darolutamide + Docetaxel
Algorithm Validation
Validation Sources:
- NCCN Guidelines v4.2025
- STAMPEDE Trial Data
- LATITUDE Trial Data
- ASCO Guideline Updates
- ESMO Clinical Practice Guidelines
Risk Stratification Calculator
Calculate risk category using multiple literature-derived models
Clinical Parameters
Metastatic Disease
Disease History
Treatment Decision Algorithm
Evidence-based treatment selection based on patient characteristics
Disease Characteristics
Risk & Volume Assessment
Patient Factors
Specific Considerations:
Treatment Algorithm Logic:
Localized vs. mHSPC vs. CRPC
High vs. low volume/risk
Performance status, comorbidities
Based on guidelines + trials
Drug Selection Algorithm
Select specific drugs based on clinical scenario and guidelines
Clinical Scenario
High-Volume mHSPC
≥4 bone mets or visceral mets
Low-Volume mHSPC
<4 bone mets, no visceral
Non-metastatic CRPC
Rising PSA, no visible mets
Metastatic CRPC
Progression on ADT with mets
Patient-Specific Factors
Treatment History
Selection Priority (NCCN):
Treatment Monitoring Schedule
Generate personalized monitoring plan based on treatment
Current Treatment
Treatment Timeline
Patient Monitoring Factors
Standard Monitoring (NCCN):
Drug Safety & Contraindications Check
Identify potential safety issues and contraindications
Patient Medical History
Cardiac History
Liver/Renal
Other Conditions
Planned/Current Medications
Concurrent Medications
Key Safety Considerations:
Decision Summary
No decisions recorded yet. Complete assessments to generate summary.