Combination of Androgen Deprivation Therapy and Radiation Therapy for Locally Advanced and Localized Prostate Cancer

Abstract

In high-risk prostate cancer (PCa), the aim of androgen deprivation therapy (ADT) is to improve the therapeutic ratio of RT by potentiating irradiation whatever its technique and destroying the infraclinical disease located outside the irradiated volume. Many phase III randomized trials have paved the way for establishing the indications of the combination of ADT with external irradiation. For locally advanced PCa, long-term ADT≥or =(≥2 years) with LHRH agonists combined with external irradiation is a gold standard (level 1a of evidence); should there be a significant comorbidity, a reticence of the patients who want to remain potent or a poor tolerance, a 6-month duration may be proposed unless to choose an antiandrogen monotherapy. For high-risk localized PCa 4–6-month complete ADT is recommended (level 2a evidence). For intermediate-risk localized PCa, patients may benefit from a combined approach with a short-term ADT. IMRT has replaced conventional irradiation and allows a dose escalation recommended for high-risk PCa, offering also the opportunity to treat intermediate-risk localized PCa without ADT. Patients have to be informed of the potential morbidity of ADT, and a close cooperation is needed with general practitioners and specialists to prevent or minimize as much as possible harmful side effects to maintain quality of life.