Controversies in the Treatment of High-Risk Prostate Cancer-what Is the Optimal Combination of Hormonal Therapy and Radiotherapy: A Review of Literature

Abrahim Al-Mamgani, JV Lebesque, WD Heemsbergen, Lisa Tans, WJ (Wim) Kirkels, Peter Levendag, Luca Incrocci

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10 Citations (Scopus)


BACKGROUND. In high-risk prostate carcinoma, there is controversy whether these patients should be treated with escalated-dose (>= 74 Gy) or conventional-dose radiotherapy (<74 Gy) combined with hormonal therapy. Furthermore, the issue of the optimal duration and timing of hormonal therapy are not well crystallized. PATIENTS AND METHODS. A search for evidence from randomized- and large non-randomized studies in order to address these issues, was therefore initiated. For this purpose, MedLine, EMbase, and PubMed and the data base of the Dutch randomized dose-escalation trial, were consulted. RESULTS AND CONCLUSIONS. From this search it was concluded that the benefit of hormonal therapy in combination with conventional-dose radiotherapy (<74 Gy) in high-risk prostate cancer is evident (Level 2 evidence); Levels 2 and 3 evidence were provided by several studies supporting the use of escalated-dose radiotherapy in high-risk prostate cancer. For the combination of hormonal therapy with escalated-dose radiotherapy in these patients, there is Level 2 evidence for moderately escalated dose (74 Gy) and high escalated dose (>= 78 Gy). The optimal duration and timing of hormonal therapy are not well defined. More randomized-controlled trials and meta-analyses are therefore needed to clearly determine the independent role of dose-escalation in high-risk patients treated with hormonal therapy and the optimal duration and timing of hormonal therapy. Prostate 70: 701-709, 2010. (C) 2009 Wiley-Liss, Inc.
Original languageUndefined/Unknown
Pages (from-to)701-709
Number of pages9
Issue number7
Publication statusPublished - 2010

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