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Controversies in the treatment of high‐risk prostate cancer—what is the optimal combination of hormonal therapy and radiotherapy: a review of literature
Author(s) -
AlMamgani Abrahim,
Lebesque Joos V.,
Heemsbergen Wilma D.,
Tans Lisa,
Kirkels Wim J,
Levendag Peter C.,
Incrocci Luca
Publication year - 2009
Publication title -
the prostate
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.295
H-Index - 123
eISSN - 1097-0045
pISSN - 0270-4137
DOI - 10.1002/pros.21102
Subject(s) - medicine , hormonal therapy , radiation therapy , prostate cancer , randomized controlled trial , oncology , prostate , hormone therapy , cancer , breast cancer
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. © 2009 Wiley‐Liss, Inc.