Acute toxicity from ADT remains a primary concern. Patients on ADT will typically experience hot flashes, weight gain, fatigue and sexual side effects for at least a year. ADT is also associated with increased risks for the development or exacerbation of cardiovascular disease, osteoporosis, and diabetes. Optimal patient selection suggests patients with intermediate and high risk prostate cancer are more likely to benefit from ADT.
In discussion, Dr. Krauss said of the two treatment approaches, each has been shown separately to be beneficial; however, in combination no data is currently published from any multicenter phase III studies on dose-escalated radiotherapy with added ADT. Retrospective analysis suggests ADT adds little to no benefit for patients treated locally with brachytherapy - and more recently with dose-escalated external beam radiation therapy.
Overall technology development in prostate cancer has outpaced the clinical outcomes that objectively demonstrate effectiveness. An example of this is intensity-modulated radiotherapy (IMRT) and image-guided radiation therapy (IGRT). These technologies safely deliver increased doses to target tissues providing increased assurance that the dose delivered more closely approximates the dose planned.
Krauss concluded it remains to be seen whether merging dose-escalated radiotherapy and ADT to manage intermediate and high-risk prostate cancer will prove significant in the context of modern radiotherapy. Unfortunately current randomized controlled trials have included limited image guidance in any of the ADT or dose escalation studies to date. For those that ask ADT, why not? Questions remain regarding the optimal dose required to biologically eradicate prostate cancer.
Presented by Daniel J. Krauss, MD1 at the 2012 Genitourinary Cancers Symposium - February 2 - 4, 2012 - San Francisco Marriott Marquis - San Francisco, California
1Oakland University William Beaumont School of Medicine, Rochester, MI
Reported for UroToday by Karen Roberts, Medical Writer
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