title: Androgen deprivation therapy in the treatment of locally advanced, nonmetastatic prostate cancer: practical experience and a review of the clinical trial evidence.
abstract: Following new scientific insights, initial management for patients with high-risk nonmetastatic prostate cancer has changed considerably and rapidly over the last few years. Several clinical and pathologic variables should be taken into account when deciding the best treatment choice for those patients. These variables are summarized and discussed in detail. High radiation doses to the prostate are essential to achieve good local control in patients with high-risk nonmetastatic disease. Addition of androgen deprivation therapy (ADT) to radiation therapy has significantly improved overall survival and cancer-specific survival compared with radiation therapy alone without significantly increasing toxicity. Long-term neo(adjuvant) ADT (2-3 years) to radiation therapy significantly improved cancer-specific survival compared with short-term ADT (4-6 months). Radical prostatectomy with extended pelvic lymph node dissection is considered a reasonable option in experienced hands. ADT alone is an inappropriate treatment option for patients with high-risk nonmetastatic disease. Management decisions for these patients should be discussed by a multidisciplinary team.
authors.affiliation: Department of Urology, Jules Bordet Institute, Université Libre de Bruxelles, 1 Rue Héger Bordet, 1000 Brussels, Belgium.
authors.forename: Fouad
authors.initials: F
authors.lastname: Aoun
authors.affiliation: Department of Urology, Hôtel Dieu de France, Saint Joseph University, Beirut, Lebanon.
authors.forename: Ali
authors.initials: A
authors.lastname: Bourgi
authors.affiliation: Department of Urology, Hôtel Dieu de France, Saint Joseph University, Beirut, Lebanon.
authors.forename: Elias
authors.initials: E
authors.lastname: Ayoub
authors.affiliation: Department of Oncology, Hôtel Dieu de France, Saint Joseph University, Beirut, Lebanon.
authors.forename: Elie
authors.initials: E
authors.lastname: El Rassy
authors.affiliation: Department of Urology, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Roland
authors.initials: R
authors.lastname: van Velthoven
authors.affiliation: Department of Urology, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Peltier
keywords: androgen deprivation therapy; hormonotherapy; locally advanced; prostate cancer