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Expert Interviews
Prostate Cancer CE/CME accredited

Experts answer questions with in-depth advice on the current clinical landscape and how new therapies and guidance might impact regional clinical practice. Useful tips below will show how to navigate the activity. Close

Optimizing androgen deprivation therapy (ADT) in advanced prostate cancer

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Dr Tanya Dorff is a professor in the Department of Medical Oncology & Therapeutics Research and serves as section chief of the Genitourinary Disease Program at City of Hope Comprehensive Cancer Center. She is an internationally recognized leader in prostate cancer and is renowned for her work in other genitourinary tumour types, including kidney, bladder and penile cancer. read more

Dr Dorff has written over 75 publications in top-tier journals, including Cancer, Lancet Oncology and Journal of Clinical Oncology. She has been invited to speak at multiple national and international meetings, and serves on the National Comprehensive Cancer Network Prostate Cancer Guidelines Committee and the National Cancer Institute Prostate Cancer Task Force.

Dr Dorff’s research interests in prostate cancer are wide-ranging, including immunotherapy, treatment combinations, lifestyle (supplements, exercise) and treatment side effects (cognitive function). Recently, she was awarded a Prostate Cancer Foundation/Pfizer grant to study talazoparib specifically in an ethnically diverse population.

Dr Dorff leads City of Hope’s joint effort with the Prostate Cancer Foundation to develop novel immune-based strategies for prostate cancer. 

Dr Tanya Dorff discloses: Advisory board or panel fees from Astellas Pharma (relationship terminated), AstraZeneca, Bayer, Janssen and Sanofi (relationship terminated).

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Ms Brenda Martone is a nurse practitioner at Northwestern Medicine, where she provides direct patient care, consultation and education to collaboratively formulate care plans for patients with genitourinary malignancies. read more

Ms Martone is a member of the Advanced Practitioner Society for Hematology and Oncology, the American Association of Nurse Practitioners and the Oncology Nursing Society (ONS).

She has presented on castration-resistant prostate cancer at the ONS 44th Annual Congress. In addition, she has co-authored publications in journals such as the Journal of Clinical Oncology, Clinical Cancer Research and Clinical Genitourinary Cancer.

Ms Brenda Martone has no interests/relationships or affiliations to disclose in relation to this activity.

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Dr Stephen Freedland is director of the Center for Integrated Research in Cancer and Lifestyle, co-director of the Cancer Genetics and Prevention Program and associate director for Faculty Development at the Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai. He is also a faculty physician in the Division of Urology at the Cedars-Sinai Department of Surgery. read more

Dr Freedland’s clinical expertise focuses on urological diseases, particularly benign prostatic hyperplasia and prostate cancer. His approach toward cancer prevention and awareness focuses on treating the whole patient, not just the disease, by combining traditional Western medicine with complementary holistic interventions. His research interests include urological diseases and the role of diet, lifestyle and obesity in prostate cancer development and progression, as well as prostate cancer among racial groups and risk stratification for men with prostate cancer.

Dr Freedland has published over 400 studies and his research has appeared in the Journal of the American Medical Association, Journal of the National Cancer Institute, Journal of Clinical Oncology, Journal of Urology, Cancer Prevention Research, Cancer and BJU International, among others. Dr Freedland is an active reviewer for more than 50 journals. He sits on the editorial board for Cancer Prevention Research, European Urology, International Journal of Urology, Nature Reviews Urology and BJU International, and serves as editor-in-chief for Prostate Cancer and Prostatic Diseases and as a consulting editor for European Urology.

Dr Stephen Freedland discloses: Consultancy fees from Astellas Pharma, AstraZeneca, Bayer, Janssen, Merck, Myovant Sciences, Pfizer and Sanofi.

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  • Downloads including slides are available for this activity in the Toolkit
Learning Objectives

After watching this activity, participants should be better able to:

  • Review the risks and benefits of gonadotropin-releasing hormone agonists and antagonists in the treatment of advanced prostate cancer
  • Discuss strategies to promote equitable care and address disparities in prostate cancer treatment outcomes
  • Evaluate ways to incorporate patient preferences and improve adherence to ADT in clinical practice

In this activity, an oncologist, a nurse and a urologist provide their insights on the risks and benefits of GnRH agonists and antagonists for the treatment of advanced prostate cancer, including the barriers to equitable care and the potential reasons for disparities in treatment outcomes, as well as how to improve adherence to ADT in clinical practice.

This activity is jointly provided by USF Health and touchIME. read more

Target Audience

Validated prostate cancer specialists, including medical oncologists, radiation oncologists, urologists and specialist nurses involved in the management of advanced prostate cancer.


USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.


Dr Tanya Dorff discloses: Advisory board or panel fees from Astellas Pharma (relationship terminated), AstraZeneca, Bayer, Janssen and Sanofi (relationship terminated).

Ms Brenda Martone has no interests/relationships or affiliations to disclose in relation to this activity.

Dr Stephen Freedland discloses: Consultancy fees from Astellas Pharma, AstraZeneca, Bayer, Janssen, Merck, Myovant Sciences, Pfizer and Sanofi.

Content reviewer

Gigi Jameel, APRN has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Contributors

Holly Gilbert-Jones and Kathy Day have no financial interests/relationships or affiliations in relation to this activity.

USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

If you have questions regarding credit please contact



This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of 0.75 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (

Advanced Practice Providers

Physician Assistants may claim a maximum of 0.75 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.


USF Health is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

A maximum of 0.75 contact hours may be earned by learners who successfully complete this continuing professional development activity. USF Health, the accredited provider, acknowledges touchIME as the joint provider in the planning and execution of this CNE activity.

This activity is awarded 0.75 ANCC pharmacotherapeutic contact hour.

Date of original release: 21 September 2023. Date credits expire: 21 September 2024.

If you have any questions regarding credit please contact

This activity is CE/CME accredited

To obtain the CE/CME credit(s) from this activity, please complete this post-activity test.

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Optimizing androgen deprivation therapy (ADT) in advanced prostate cancer
0.75 CE/CME credit

Question 1/5
What is the most common side effect when prescribing subcutaneous degarelix?

Based on data from the phase III open-label, randomized trial of degarelix in patients with prostate cancer (NCT00295750), injection site reactions were reported in 35% of patients receiving degarelix 240/80 mg (n=207). In patients treated with degarelix, weight increase was reported in 9%, and both constipation and arthralgia reported in 5% of patients.



FDA. Degarelix PI. Available at: (accessed 17 August 2023).

Question 2/5
Your 82-year-old patient with advanced prostate cancer has been receiving leuprolide for 7 months. The patient has hypertension which is controlled through medication, but had a myocardial infarction while on leuprolide. He is concerned about additional cardiovascular events. Based on prospective findings from the phase III HERO trial, what would you do next to reduce his risk of further cardiovascular events?

ADT, androgen deprivation therapy; CV, cardiovascular; GnRH, gonadotropin-releasing hormone.

The phase III HERO trial (NCT03085095) investigating oral leuprolide (n=308) vs relugolix (n=622) in patients with advanced prostate cancer reported a higher incidence of any grade MACE in patients receiving GnRH agonist leuprolide compared with patients receiving GnRH antagonist relugolix (6.2% vs 2.9%; HR 0.46, 95% CI 0.24–0.88). The incidence of MACEs in patients with a history of MACEs remains higher for patients receiving leuprolide than in patients receiving relugolix (17.8% vs 3.6%).


CI, confidence interval; GnRH, gonadotropin-releasing hormone; HR, hazard ratio; MACE, major adverse cardiovascular event.


Shore ND, et al. N Engl J Med. 2020;382:2187–96.

Question 3/5
Which of these statements best describes factors influencing outcomes in patients with prostate cancer?

Two multi-ethnic studies (N=2,008) demonstrated an increase in the overall risk of death (p<0.05) in patients with lower neighbourhood socioeconomic status and lower education.1 Data from 11,776,699 patients with cancer in the US showed that transgender patients were more likely to have poorer survival after diagnosis with prostate cancer than cisgender patients (HR 1.91, 95% CI 1.06–3.45).2 In the US, patients with cancer aged 18–64 years without insurance were more likely to have advanced disease at diagnosis and worse survival.3 Analysis of 51,049 patients with prostate cancer in Pennsylvania showed that non-urban residents are less likely to receive treatment than urban residents.4


CI, confidence interval; HR, hazard ratio.


  1. DeRouen MC, et al. Cancer Epidemiol. 2018;53:1–11.
  2. Jackson SS, et al. J Natl Cancer Inst. 2021;113:1221–27.
  3. Islami F, et al. CA Cancer J Clin. 2022;72:112–43.
  4. Maganty A, et al. J Urol. 2020;203:108–14.
Question 4/5
What is the real-world non-adherence rate for injectable prostate cancer treatments?

A systematic review of adherence rates to prostate cancer treatments in real-world clinical practice found an overall non-adherence rate of injectable therapies to be over 27%. Mean real-world non-adherence rates to oral therapies were comparable, at between 25% and 51%.


Higano CS, Hafron J. J Urol. 2023;209:485–93.

Question 5/5
Your 62-year-old patient with prostate cancer, who works full time as a teacher, is on relugolix and mentions that they are struggling to remember to take their medication and are missing doses as a result. What would you do to improve their treatment adherence?

A study of the medication habits of 149 older adults taking four or more medications daily found that 91% used activity-based methods to help them remember to take their medications, with most adults embedding their medication routine into mealtime or morning hygiene routines.1 Missed doses of relugolix should not be taken if the dose is missed by more than 12 hours, dosing should resume with the next scheduled dose.2 Injectable therapies require attendance of the patient at the clinic which can lead to scheduling challenges.3


  1. Sanders MJ, Van Oss T. Am J Occup Ther. 2013;67:91–9.
  2. FDA. Relugolix PI. Available at: (accessed 31 August 2023).
  3. Higano CS, Hafron J. J Urol. 2023;209:485–93.
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