Current Status of Combined Radiation Therapy and Androgen Suppression in Locally Advanced Prostate Cancer: What Is the Way Forward?

Abstract

Context Androgen-deprivation therapy (ADT) as an adjuvant to radiation therapy (RT) is an established treatment for locally advanced prostate cancer (PCa). Objective To examine the established clinical evidence on the use of short-term and/or long-term adjuvant ADT plus external irradiation and discuss recent data devoted to the duration of ADT with RT. Evidence acquisition During the 2010 Annual Congress of the European Association of Urology (EAU) in Barcelona, Spain, a satellite symposium was held on the individualised management of patients with PCa. This paper is based on one of the presentations given at the symposium. Data were retrieved from recent review articles, original articles, and abstracts on the use of ADT in the neoadjuvant and/or concomitant and adjuvant settings with RT in patients with locally advanced PCa. Evidence synthesis A number of studies have evaluated the survival benefits of short-term and long-term adjuvant ADT with RT in locally advanced PCa. European Organisation for Research and Treatment of Cancer (EORTC) study 22863 demonstrated that immediate androgen suppression given during and for 3 yr after external irradiation improved disease-free survival (DFS) and overall survival (OS) of patients with locally advanced PCa out to 10 yr. The OS benefits of long-term adjuvant ADT with RT were subsequently shown in Radiation Therapy Oncology Group (RTOG) protocols 85-31 and 92-02. More recently, EORTC study 22961 provided a definitive observation that 6-mo androgen suppression in association with three-dimensional conformal RT (3D-CRT) resulted in inferior survival compared with RT and 3 yr of ADT in the treatment of locally advanced PCa. Not only was OS improved but there was a significant improvement in all parameters of progression-free survival (PFS). Conclusions Locally advanced PCa should be managed with 3D-CRT plus concomitant and adjuvant 3-yr androgen suppression.