Abstract
Interest has been increasing in the use of androgen deprivation therapy (ADT) combined with radiation therapy (RT) in the management of localized prostate cancer. Preclinical studies have provided some rationale for the use of this combination. In patients with high-risk disease, the benefit of a combined approach, with the addition of adjuvant hormonal therapy, is supported by results of randomized trials. In contrast, for patients with low-risk disease, there is no obvious therapeutic advantage except for cytoreduction. The usefulness of short-term hormonal therapy in association with rt for intermediate-risk patients is still debatable, particularly in the context of doseescalated RT. The optimal timing and duration of ADT, in the neoadjuvant and adjuvant settings alike, are still under investigation. In view of the potential side effects with ADT, further studies are being performed to better identify subsets of patients who will definitely benefit from this therapy in combination with rt.
Highlights
The worldwide incidence rates of prostate cancer vary greatly, in Western countries, where screening programs are more developed, pca remains one of the most frequent cancers and a leading cause of cancer death 1
After a study published by Huggins and Hodges 8 in 1941 demonstrated the androgen dependence of prostatic cells, the use of hormonal therapy was widely explored in the management of pca, and since the mid-1970s, pharmacologic castration has been used as an alternative to surgical castration
We critically review the results of randomized trials of rt combined with adt for the treatment of localized pca
Summary
The worldwide incidence rates of prostate cancer (pca) vary greatly, in Western countries, where screening programs are more developed, pca remains one of the most frequent cancers and a leading cause of cancer death 1. Rt alone has been used in the curative treatment of localized pca 2; approximately one third of patients with localized disease will present with treatment failure within 5 years of treatment [3,4]. These failures are probably related to known predictive factors such as prostate-specific antigen (psa), Gleason score (gs), and T stage, and to factors associated with intrinsic tumour radioresistance or micrometastatic disease at diagnosis (or both) 5–7. Various classes of drugs are available in the market, including luteinizing hormone–releasing hormone (lhrh) agonists (the most commonly used agents), lhrh antagonists, and anti-androgens
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