Duration of Androgen Suppression in the Treatment of Prostate Cancer

Abstract

The combination of radiotherapy plus 6 months of androgen suppression provides inferior survival as compared with radiotherapy plus 3 years of androgen suppression in the treatment of locally advanced prostate cancer. (ClinicalTrials.gov number, NCT00003026.)

Therapeutic outcomes of neoadjuvant and concurrent androgen‐deprivation therapy and intensity‐modulated radiation therapy with gold marker implantation for intermediate‐risk and high‐risk prostate cancer

“…The use of long-term hormone therapy in combination with conventional doses (65-70 Gy) of external beam radiation therapy has been shown to contribute to improved therapeutic outcomes in patients with localized prostate cancer, particularly those at high risk, whereas short-term neoadjuvant hormone therapy is believed to contribute to improved therapeutic outcomes in patients at moderate risk. [17][18][19][20][21][22][23][24] However, the evidence for these indications is based on radiation doses of 65-70 Gy, and the value of ADT in combination with !76 Gy radiation doses remains unclear. Opinions on this point are divided, as some studies have found no association between ADT and therapeutic outcomes of !76 Gy IMRT, whereas others have reported improved DMFS.…”

EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent

“…The standard of care is IMRT combined with long term ADT, as it results in better OS [69][70][71]. The combination is clearly better than EBRT or ADT monotherapy [72].…”

Beyond Castration—Defining Future Directions in the Hormonal Treatment of Prostate Cancer

“…Unlike surgery, there is a clear paradigm for the use of androgen deprivation therapies to improve outcomes in the setting of high-risk disease with primary radiation therapy [47]. Whilst this may seem an avenue to expand the approved indication for these agents, the commercial incentive to do so may be limited by the limited remaining patent in abiraterone in the USA (2014)(2015)(2016)(2017) The critical scientific issue is whether the further reduction in functional androgen signalling achievable with CYP 17 inhibition or MDV3100 will further add to the putative mechanisms of synergy with radiation to achieve better outcomes.…”

“…The optimal duration of ADT in men undergoing RT has been addressed in at least four trials, all of which suggest benefit from prolonged therapy [47,[53][54][55][56]. For example, in the largest trial, RTOG 92-02, 1,554 men with T2c-T4 disease received 4 months of goserelin and flutamide (2 months before and during EBRT) and were then randomly assigned to no further therapy or 24 months of additional goserelin.…”