Navigating Newer ADT Combination Therapies in the Absence of Prospective Data

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The rapidly evolving landscape of prostate cancer treatment presents challenges in keeping pace with emerging data and incorporating new combination therapies into clinical practice. While prospective data specifically examining newer oral androgen deprivation therapy (ADT) agents in combination with androgen receptor pathway inhibitors or chemotherapy may be limited, the fundamental principle of achieving adequate testosterone suppression remains consistent across different ADT formulations. The HERO study demonstrated that relugolix achieved equivalent or superior testosterone suppression compared to leuprolide, providing confidence for its use in combination regimens.

Clinical implementation of combination therapies requires practical workflow considerations and gradual adoption of new treatment paradigms. Many providers benefit from a staged approach, starting with ADT monotherapy to assess patient tolerance before adding additional agents. This strategy allows for better adverse effect attribution and patient education while navigating prior authorization processes for newer agents. The insurance approval process has become more streamlined over recent years, with NCCN guideline adherence facilitating coverage for evidence-based combination therapies.

The absence of specific prospective data should not preclude the use of oral ADT in combination regimens, given the equivalent mechanism of action and superior pharmacokinetic profile compared to injectable alternatives. Urologists can confidently adapt their practice based on available evidence while maintaining focus on patient-centered outcomes. The key is developing familiarity with versatile agents that can be used across multiple disease states, thereby simplifying treatment algorithms and improving patient care continuity throughout the disease trajectory.