Therapeutic strategies for localized and locally advanced prostate cancer: combining androgen suppression with definitive local therapy.
Patients with locally advanced prostate cancer (clinical category T3,4) managed with external beam radiation therapy (EBRT) and 3 years of androgen suppression therapy (AST) compared with patients managed with EBRT alone have been shown to have a survival benefit. Studies addressing the same question in patients with clinically localized disease (T1,2) are now completed and await follow-up. A decrease in positive surgical margins has been noted; however, no benefit in prostate-specific antigen (PSA) control has been documented in any of several randomized studies in which the addition of 3 months of neoadjuvant AST was administered before radical prostatectomy. Randomized data now show that dose-escalated radiation provides superior PSA control rates compared with conventional-dose radiation therapy for patients with localized prostate cancer. How best to administer high-dose radiation (eg, intensity modulated radiation therapy, or 3-dimensional conformal radiation therapy with or without a brachytherapy boost), and how best to integrate high-dose radiation for patients with high-risk localized or locally advanced prostate cancer remain under investigation.
D'Amico
Anthony V
AV