title: Radiotherapy and Hormone Treatment in Prostate Cancer.
abstract: BACKGROUND
  Prostate cancer has the highest incidence of any type of cancer in Germany; an estimated 67 000 new diagnoses of prostate cancer will be made in 2016. In the current German S3 guideline for the treatment of prostate cancer, radiotherapy-sometimes in combination with androgen deprivation therapy (ADT)-is one of the two recommended options for treatment with curative intent (the other is radical prostatectomy). There have been many publications on this subject, yet it is still often unclear in routine practice how ADT should be administered, and for how long.
  
  
  METHODS
  This review is based on publications retrieved by a selective literature search, with special attention to controlled trials.
  
  
  RESULTS
  For low risk patients, radiotherapy without ADT is indicated (evidence level 1). Patients with localized prostate cancer and an intermediate risk benefit from radiotherapy combined with a four-to-six-month course of ADT. In this situation, a higher radiation dose might be an effective substitute for ADT (evidence level 1-2). For patients at high risk, radiotherapy combined with long-term hormonal treatment is the standard therapy, as it significantly improves all oncological end points (evidence level 1). For example, in the largest randomized and controlled trial, this form of treatment reduced cancer-specific mortality from 19% to 9% . Higher radiation doses of 66-74 Gy and longer ADT can improve local control at the cost of increased urethral toxicity.
  
  
  CONCLUSIONS
  Androgen deprivation combined with external beam radiotherapy is a curative standard option for patients with prostate cancer who are at high risk of recurrence. The modern radiotherapeutic techniques that are now available, such as intensity-modulated radiotherapy, enable a further improvement of the risk/benefit ratio.
authors.affiliation: Department of Radiation Oncology and Radiotherapy, Charité-Universitätsmedizin Berlin, Department of Urology, University Hospital Carl Gustav Carus, Dresden, Department of Urology, Charité Universitätsmedizin, Berlin, Department of Urology, Uniklinik RWTH Aachen, Department of Radiation Oncology, University Hospital Ulm.
authors.forename: Dirk
authors.initials: D
authors.lastname: Böhmer
authors.forename: Manfred
authors.initials: M
authors.lastname: Wirth
authors.forename: Kurt
authors.initials: K
authors.lastname: Miller
authors.forename: Volker
authors.initials: V
authors.lastname: Budach
authors.forename: Axel
authors.initials: A
authors.lastname: Heidenreich
authors.forename: Thomas
authors.initials: T
authors.lastname: Wiegel
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000008:administration & dosage*; D059248:Chemoradiotherapy / Q000379:methods* / Q000401:mortality*; D018572:Disease-Free Survival; D019317:Evidence-Based Medicine; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000628:therapy*; D011879:Radiotherapy Dosage; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000726:Androgen Antagonists