Radiotherapy combined with hormonal therapy in prostate cancer: the state of the art

Abstract

Androgen-deprivation therapy (ADT) is used routinely in combination with definitive external beam radiation therapy (EBRT) in patients with high-risk clinically localized or locally advanced disease. The combined treatment (ADT–EBRT) also seems to play a significant role in improving treatment results in the intermediate-risk group of prostate cancer patients. On the other hand, there is a growing body of evidence that treatment with ADT can be associated with serious and lifelong adverse events including osteoporosis, cardiovascular disease, diabetes, and many others. Almost all ADT adverse events are time dependant and tend to increase in severity with prolongation of hormonal manipulation. Therefore, it is crucial to clearly state the optimal schedule for ADT in combination with EBRT, that maintaining the positive effect on treatment efficacy would keep the adverse events risk at reasonable level. To achieve this goal, treatment schedule may have to be highly individualized on the basis of the patient-specific potential vulnerability to adverse events. In this study, the concise and evidence-based review of current literature concerning the general rationales for combining radiotherapy and hormonal therapy, its mechanism, treatment results, and toxicity profile is presented.

Strategies for Imaging Androgen Receptor Signaling Pathway in Prostate Cancer: Implications for Hormonal Manipulation and Radiation Treatment

“…Despite their technical improvements, Pca recurrence is not uncommon [ 3 ] after these treatments. Historically, hormonal manipulation has been used for the management of advanced and/or recurrent Pca [ 3 ] especially in association with radiotherapy [ 4 ]. We now have a greater understanding of mechanisms sustaining CRPC upon hormonal manipulation [ 5 ].…”

Radiotherapy in Prostate Cancer

“…Androgen deprivation therapy is used routinely in combination with radiotherapy for locally advanced prostate cancer, but recent studies show that it improves treatment result is localized and intermediate-risk disease. (Milecki et al, 2010). Hormone therapy, that is in fact androgen deprivation, can be realized in several ways: orchyectomy, blockade of the hypothalamus-hypophysis-gonade path (with gonadothropin 188 realizing hormone agonist) or by direct blockade of androgen receptors with androgen antagonists.…”

Molecularly Targeted Agents as Radiosensitizers in Cancer Therapy—Focus on Prostate Cancer

“…Results showed that mean tumor doubling time was most suppressed for the group receiving neoadjuvant ADT, even when compared with groups receiving concurrent or adjuvant ADT. The authors concluded that in addition to potential increased overall cell killing, ADT may decrease growth velocity of surviving cancer cells when combined with RT [175,176]. …”