Risk-Adapted Androgen Deprivation and Escalated Three-Dimensional Conformal Radiotherapy for Prostate Cancer: Does Radiation Dose Influence Outcome of Patients Treated With Adjuvant Androgen Deprivation? A GICOR Study

Abstract

The results of combined AAD plus high-dose 3DCRT are encouraging. To our knowledge, this is the first study showing an additional benefit of high-dose 3DCRT when combined with long-term AD for unfavorable disease.

High-dose-rate brachytherapy in combination with conformal external beam radiotherapy in the treatment of prostate cancer

“…Several randomized trials showed that adjuvant ADT combined with standard-dose RT for high-risk disease was associated with improved overall survival (22,26). Recently, Zapatero et al reported that this synergistic effect seemed to persist when longterm adjuvant ADT was combined with dose escalation of more than 70 Gy for unfavorable disease (27). However, in our study, actuarial analysis could not demonstrate improved BC or overall survival in patients in either group treated with adjuvant ADT for a period of 2 years; hence, our data support the finding by others that the effect of HDR brachytherapy dose escalation might be independent of that from ADT (4).…”

Retrospective Comparison of External Beam Radiotherapy and Radical Prostatectomy in High-Risk, Clinically Localized Prostate Cancer

“…To address one of the possible drawbacks regarding the use of the 9-month ADT regimen in the EBRT group, the benefit from neoadjuvant or adjuvant ADT has not been demonstrated with RP, and the benefit of ADT combined with greater-thanstandard radiation doses is questionable (26,27) and needs to be confirmed. Notwithstanding, a selected group of RP patients with adverse pathologic findings underwent adjuvant EBRT with or without long-term ADT and, therefore, were not undertreated with respect to the EBRT patients.…”

Factors associated with downgrading in patients with high grade prostate cancer

“…As the yield of positive nodes at lymphadenectomy continues to decline, the concept of over-grading adds to the argument that the risk/benefit ratio and cost effectiveness of lymphadenectomy continues to decline [25]. Finally, radiation protocols often include risk-adapted strategies for the use of whole pelvis radiation, prostate boost, and androgen deprivation [26]. Understanding which patients may be over-graded could decrease the need for each.…”