Prostate cancer: risk categories and role of hormones and radiotherapy

The Genito-Urinary Radiation Oncologists of Canada (GUROC) have produced a consensus statement on radiotherapy in prostate cancer. This paper summarizes the consensus statement with regard to risk grouping and the role of hormones and radiotherapy. Survival is the most important outcome in the assessment of patients treated with radiotherapy. Other outcomes of interest include disease-free survival, metastatic-free survival, local control, biochemical measures, toxicity, efficacy, and quality of life. Risk groupings based on prognostic data are increasingly used in the management of prostate cancer. These groupings have been correlated to prognosis in several studies, and are helpful in identifying optimum treatments, and as a research tool to evaluate new treatments and modalities. Adjuvant hormone treatment with radiotherapy has been demonstrated in two studies (Bolla and RTOG 85-31) to be beneficial in patients with locally advanced prostate cancer. Neoadjuvant hormone treatment in patients with low- and intermediate-risk disease is being evaluated in a RTOG study and its utility in these patients will be clarified when the study results are available. The GUROC consensus statement recommends that patients with high-risk non-metastatic prostate cancer be treated with adjuvant hormone therapy for 2-3 years. Part of this hormone treatment may be administered in a neoadjuvant fashion. Adjuvant hormone treatment should not be routinely used in low- and intermediate-risk prostate cancer. Neoadjuvant hormone treatment is recommended prior to radiotherapy in patients with bulky tumors. The results of ongoing research will further clarify the use of hormone treatment with radiotherapy.