Debate 1: High-Risk Localized Prostate Cancer: Why Combination Hormone Therapy and Radiotherapy is the Optimal...

Area of Science:

• Urology
• Oncology
• Radiation Oncology

Background:

• Prostate cancer is the most common male malignancy, with high-risk localized disease posing significant recurrence and metastasis risks.
• Radical prostatectomy (RP) and radiotherapy with androgen deprivation therapy (RT+ADT) are primary treatments, but direct comparative data are limited.
• Existing evidence is often from observational studies with methodological limitations.

Purpose of the Study:

• To synthesize current evidence comparing RP and RT+ADT for high-risk localized prostate cancer.
• To evaluate oncologic outcomes, treatment toxicities, and quality of life.
• To propose a preferred first-line treatment strategy based on available data.

Main Methods:

• Review of existing observational studies and analyses using causal inference frameworks.
• Synthesis of data on oncologic outcomes, including locoregional recurrence and distant metastases.
• Evaluation of treatment-related toxicities and patient-reported quality of life.

Main Results:

• Recent analyses suggest RT+ADT may provide improved distant metastatic control compared to RP.
• RT+ADT is associated with fewer early and long-term urinary side effects and less treatment regret.
• RT+ADT can cause transient hormone-related and bowel symptoms during treatment.

Conclusions:

• RT+ADT may offer biological advantages for addressing micrometastases.
• Under shared decision-making, RT+ADT is proposed as a preferred first-line treatment for high-risk localized prostate cancer.
• RT+ADT can achieve favorable oncologic control while preserving quality of life, especially with advanced radiotherapy techniques.