Hormonal therapy and radiotherapy for localized prostate cancer: who, where and how long?

The results from recent randomized trials were used to identify subpopulations of patients most likely to benefit from long versus short-term hormonal therapy with external beam radiotherapy.

Radiation Therapy Oncology Group study 9413 included 1,323 men with prostate cancer and a risk of lymph node involvement greater than 15%. In this study the hypotheses tested were that whole pelvis radiotherapy would improve progression-free survival (PFS) compared to prostate only radiotherapy and that neoadjuvant and concurrent hormone therapy (N&CHT) with radiotherapy would improve PFS compared to radiotherapy with adjuvant hormone therapy. The conclusions of this study were compared to other studies using long-term hormonal therapy.

At a median followup of almost 5 years, when all 4 treatment arms from study 9413 were compared, the group receiving whole pelvis radiotherapy plus N&CHT had a significant PFS advantage (p = 0.008).

Intermediate risk patients should receive N&CHT in combination with external beam radiotherapy while high risk patients require the addition of long-term adjuvant hormone therapy.