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

Chapter

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.

Keywords

Gleason Score Androgen Deprivation Therapy Radiation Therapy Oncology Group LHRH Agonist Radiation Therapy Oncology Group Trial 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Abbreviations

ADT

Androgen deprivation therapy

CTV

Clinical target volume

CADT

Combined androgen deprivation therapy

DVH

Dose volume histogram

EORTC

European Organization on Treatment and Research of Cancer

GETUG

Genitourinary tumor group

HT

Hormone therapy

IMRT

Intensity-modulated radiotherapy

LTADT

Long-term androgen deprivation therapy

LHRH

Luteinizing-hormone-releasing hormone

MRC

Medical Research Council

MSKCC

Memorial Sloan-Kettering Cancer Center

NCIC

National Cancer Institute Canada

NCADT

Neoadjuvant concurrent androgen deprivation therapy

PFS

Progression-free survival

PCa

Prostate cancer

PORT

Prostate only radiotherapy

PSA

Prostate-specific antigen

RTOG

Radiation therapy oncology group

RT

Radiotherapy

STADT

Short-term androgen deprivation therapy

TCD 50

Dose which controls 50% of tumors

3D-CRT

Three-dimensional conformal ­radiotherapy

WPRT

Whole-pelvis radiotherapy

WHO

World Health Organization

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Suggested Readings

  1. (2000) Maximum androgen blockade in advanced prostate cancer: an overview of the randomised trials. Prostate Cancer Trialists’ Collaborative Group. Lancet 355:1491–1498Google Scholar
  2. (2009) RTOG 05–21:A phase III protocol of androgen suppression (AS) and 3D CRT/IMRT vs AS and 3D CRT/IMRT followed by chemotherapy with docetaxel and prednisone for localized high risk prostate cancer. [PDF]. http://rtog.org/members/protocols/0521/0521.pdf. Accessed 8 Apr 2010

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© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Clinique Universitaire de Cancérologie-Radiothérapie, Centre Hospitalier Universitaire Albert MichallonCedex 9 GrenobleFrance

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