Prognostic factors during androgen deprivation therapy in patients with hormone naive metastatic prostate cancer: is changes in hemoglobin level significant?

Androgen deprivation therapy (ADT) or combined with first-generation anti-androgen drugs such as bicalutamide and flutamide have been chosen as first line for hormone naïve metastatic prostate cancer. Recently, adding chemotherapeutic agent, docetaxel, to ADT improved patient survival, and is becoming a new standard for patients with hormone naïve metastatic high volume disease (1). In more recent studies, adding second generation androgen receptor targeting agent such as abiraterone to ADT had a similar benefit to docetaxel with less toxicities, and some experts recommend to use this agent for patients with hormone naïve metastatic high volume prostate cancer as first line (2). However, ADT is a still gold standard care for hormone naïve metastatic prostate cancer in worldwide.