Combination of androgen deprivation therapy and radiation therapy for locally advanced and localized prostate cancer

Abstract

High-risk prostate cancer requests external beam irradiation combined with androgen deprivation therapy (ADT) to potentiate irradiation, whatever its technique, and to destroy the infra-clinical disease located outside the planning treatment volume. Randomized phase III trials have paved the way for establishing the indications and the duration of androgen deprivation therapy. Image-guided intensity modulated radiotherapy is the gold standard. Long term androgen deprivation therapy (=2 years) with luteinizing hormone-releasing hormone agonists combined with external irradiation should be recommended for high-risk prostate cancer. For intermediate-risk localized prostate cancer, patients may benefit from a combined approach with a short term ADT (4-6 month); for patients unsuitable for ADT, due to co-morbidities or unwilling to accept androgen deprivation therapy to preserve their sexual health, the recommended treatment is intensity modulated radiotherapy at a dose of 76-80 Gy or a combination of intensity modulated radiotherapy and brachytherapy. The patients need to be informed of the potential morbidity of ADT and a close cooperation is needed with general practitioners and specialists to prevent and mitigate side effects and maintain quality of life.