Androgenic suppression combined with radiotherapy for the treatment of prostate adenocarcinoma: a systematic review

Abstract

BackgroundLocally advanced prostate cancer is often associated with elevated recurrence rates. Despite the modest response observed, external-beam radiotherapy has been the preferred treatment for this condition. More recent evidence from randomised trials has demonstrated clinical benefit with the combined use of androgen suppression in such cases. The aim of this meta-analysis is to compare the combination of distinct hormone therapy modalities versus radiotherapy alone for overall survival, disease-free survival and toxicity.MethodsDatabases (MEDLINE, EMBASE, LILACS, Cochrane databases and ClinicalTrials.gov) were scanned for randomised clinical trials involving radiotherapy with or without androgen suppression in local prostate cancer. The search strategy included articles published until October 2011. The studies were examined and the data of interest were plotted for meta-analysis. Survival outcomes were reported as a hazard ratio with corresponding 95% confidence intervals.ResultsData from ten trials published from 1988 to 2011 were included, comprising 6555 patients. There was a statistically significant advantage to the use of androgen suppression, in terms of both overall survival and disease free survival, when compared to radiotherapy alone. The use of long-term goserelin (up to three years) was the strategy providing the higher magnitude of clinical benefit. In contrast to goserelin, there were no trials evaluating the use of other luteinizing hormone-releasing hormone (LHRH) analogues as monotherapy. Complete hormonal blockade was not shown to be superior to goserelin monotherapy.ConclusionsBased on the findings of this systematic review, the evidence supports the use of androgen suppression with goserelin monotherapy as the standard treatment for patients with prostate cancer treated with radiotherapy, which are at high risk of recurrence or metastases.

Ten-year outcomes of intensity-modulated radiation therapy combined with neoadjuvant hormonal therapy for intermediate- and high-risk patients with T1c-T2N0M0 prostate cancer

“…This finding has resulted in decreased incidence and severity of rectal adverse events [3,4]. It has also been confirmed that combining HT with EBRT significantly improved not only biochemical control but also survival outcomes compared with EBRT alone [5,6]. These benefits were observed with both short-term (3-6 months) and long-term (>1 year) HT [5].…”

“…Meanwhile, the survival benefits of adding hormonal therapy (HT) to the standard doses of EBRT had also been confirmed [5,6]. The survival benefit of combining HT with EBRT over EBRT alone was observed in both…”

“…The 10-year likelihoods of developing grade 2 late urinary and rectal toxicities were 13.7 % and 4.2 %, respectively. Compared with the outcomes of a cohort of historical controls who were locally irradiated with 70 Gy by three-dimensional conformal radiotherapy, short-term (≤6 months) and long-term (>1 year) HT groups [5]. In addition, it has been suggested that the sensitivity of HT may differ between East Asian and Caucasian men [7].…”

Management of Biochemical Recurrence after Primary Curative Treatment for Prostate Cancer: A Review

“…Rates of BCR may be reduced with adjuvant or neoadjuvant ADT in carefully selected patients with intermediate- or high-risk localised PCa [1, 73], and the decision to use adjuvant or neoadjuvant ADT with RT in such patients should therefore be based upon individualised assessment.…”

Hybrid Nanoparticles Inhibit Growth of Human Prostate Cancer Cells by Induction of Apoptosis

“…Hormone therapy, also known as androgen deprivation therapy, can be used to treat prostate cancer after surgery or radiation therapy [1]. However, hormone therapy alone does not eradicate prostate cancer and metastatic prostate cancer does not respond to hormone therapy or chemotherapy [2].…”