Optimizing hormone therapy in localized prostate cancer: focus on external beam radiotherapy

The use of hormone therapy combined with radiotherapy (RT) and prior to radical prostatectomy was explored as part of the management of localized prostate cancer.

Recent randomized studies and ongoing clinical trials of hormone therapy were reviewed to help identify patients who will benefit from combined treatment.

Although short-term androgen ablation improves cause specific survival in low Gleason score, bulky prostatic neoplasms, long-term androgen ablation is required for high grade prostate cancer. Whole pelvic RT may be important for maximizing the biochemical interaction between RT and androgen ablation in patients at high risk for pelvic lymph node involvement. Ongoing studies will contribute to our overall understanding of combined modality treatment.

Androgen ablation is an important part of the management of prostate cancer when external beam RT is used. Long-term androgen ablation should be performed in bulky, high Gleason score cases, while short-term androgen ablation should be used in bulky, low Gleason score cases. Patients at intermediate risk are candidates for short-term androgen ablation but there are as yet no definitive randomized trials assessing an overall treatment benefit. Patients with low risk prostate cancer should probably not receive androgen ablation unless additional data support a substantial clinical benefit. The lack of advantage observed in patients undergoing preoperative androgen ablation compared with the advantages seen in patients who undergo androgen ablation and RT seems to indicate that at least in some situations there is an advantageous biological interaction between RT and androgen ablation. This mechanism remains to be elucidated.