This article aims to provide an overview of the role of combined radiation and androgen deprivation (ADT) therapy in patients with intermediate-risk prostate cancer.
The current German, European, and NCCN (National Comprehensive Cancer Network) guidelines as well as relevant literature in the PubMed database which provide information on sub-classification within the intermediate-risk group and the use of ADT in terms of oncological outcome were reviewed.
Different recommendations for risk-group assessment of patients with localized prostate cancer are available. Subdivision of intermediate risk into a favorable and an unfavorable group seems to be justified to allow for a more individualized therapy in a quite heterogenous group of patients. So far, multiple randomized trials have shown a benefit when radiation therapy (RT) is combined with ADT. The use of dose-escalated RT without ADT also appears to be an adequate therapy associated with a very low rate of cancer-specific deaths. Therefore, taking into account the increased rate of toxicity associated with ADT, dose-escalated RT alone might be justified, especially in favorable intermediate-risk patients.
Dose-escalated RT alone appears to be an appropriate treatment in favorable intermediate-risk patients. Addition of short course ADT (4-6 months) might improve outcomes in unfavorable intermediate-risk patients.
Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al]. 2019 Nov 29 [Epub ahead of print]
Marcus Beck, Dirk Böhmer, Daniel M Aebersold, Clemens Albrecht, Michael Flentje, Ute Ganswindt, Stefan Höcht, Tobias Hölscher, Arndt-Christian Müller, Peter Niehoff, Michael Pinkawa, Felix Sedlmayer, Daniel Zips, Sebastian Zschaeck, Volker Budach, Thomas Wiegel, Pirus Ghadjar, Prostate Cancer Expert Panel of the German Society of Radiation Oncology (DEGRO) and the Working Party Radiation Oncology of the German Cancer Society (DKG-ARO)
Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany., Department of Radiation Oncology, Inselspital, University of Bern, Bern, Switzerland., Klinikum Nürnberg Nord, Nürnberg, Germany., Universitätsklinikum Würzburg, Würzburg, Germany., Innsbruck Medical University, Innsbruck, Austria., Xcare Praxis für Strahlentherapie Saarlouis, Xcare Gruppe, Saarlouis, Germany., Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany., Universitätsklinikum Tübingen, Tübingen, Germany., Sana Klinikum Offenbach, Offenbach, Germany., MediClin Robert Janker Klinik, Bonn, Germany., Landeskrankenhaus, Universitätsklinikum der Paracelsus Medizinischen Privatuniversität, Salzburg, Salzburg, Austria., Universitätsklinikum Ulm, Ulm, Germany., Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. .