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Role of combined radiation and androgen deprivation therapy in intermediate-risk prostate cancer

Statement from the DEGRO working group on prostate cancer
  • Marcus Beck
  • Dirk Böhmer
  • Daniel M. Aebersold
  • Clemens Albrecht
  • Michael Flentje
  • Ute Ganswindt
  • Stefan Höcht
  • Tobias Hölscher
  • Arndt-Christian Müller
  • Peter Niehoff
  • Michael Pinkawa
  • Felix Sedlmayer
  • Daniel Zips
  • Sebastian Zschaeck
  • Volker Budach
  • Thomas Wiegel
  • Pirus GhadjarEmail author
  • the Prostate Cancer Expert Panel of the German Society of Radiation Oncology (DEGRO) and the Working Party Radiation Oncology of the German Cancer Society (DKG-ARO)
Original Article

Abstract

Objective

This article aims to provide an overview of the role of combined radiation and androgen deprivation (ADT) therapy in patients with intermediate-risk prostate cancer.

Materials and methods

The current German, European, and NCCN (National Comprehensive Cancer Network) guidelines as well as relevant literature in the PubMed database which provide information on sub-classification within the intermediate-risk group and the use of ADT in terms of oncological outcome were reviewed.

Results

Different recommendations for risk-group assessment of patients with localized prostate cancer are available. Subdivision of intermediate risk into a favorable and an unfavorable group seems to be justified to allow for a more individualized therapy in a quite heterogenous group of patients. So far, multiple randomized trials have shown a benefit when radiation therapy (RT) is combined with ADT. The use of dose-escalated RT without ADT also appears to be an adequate therapy associated with a very low rate of cancer-specific deaths. Therefore, taking into account the increased rate of toxicity associated with ADT, dose-escalated RT alone might be justified, especially in favorable intermediate-risk patients.

Conclusion

Dose-escalated RT alone appears to be an appropriate treatment in favorable intermediate-risk patients. Addition of short course ADT (4–6 months) might improve outcomes in unfavorable intermediate-risk patients.

Keywords

Prostate cancer Intermediate risk Radiation therapy Androgen deprivation therapy Dose-escalation 

Notes

Compliance with ethical guidelines

Conflict of interest

A.-C. Müller and D. Zips mention the cooperation with Siemens Healthcare, Philips, and Elekta in a research project. M. Beck, D. Böhmer, D.M. Aebersold, C. Albrecht, M. Flentje, U. Ganswindt, S. Höcht, T. Hölscher, P. Niehoff, M. Pinkawa, F. Sedlmayer, S. Zschaeck, V. Budach, T. Wiegel, and P. Ghadjar declare that they have no competing interests.

Ethical standards

This article does not contain any studies with human participants or animals performed by any of the authors.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Marcus Beck
    • 1
  • Dirk Böhmer
    • 1
  • Daniel M. Aebersold
    • 2
  • Clemens Albrecht
    • 3
  • Michael Flentje
    • 4
  • Ute Ganswindt
    • 5
  • Stefan Höcht
    • 6
  • Tobias Hölscher
    • 7
  • Arndt-Christian Müller
    • 8
  • Peter Niehoff
    • 9
  • Michael Pinkawa
    • 10
  • Felix Sedlmayer
    • 11
  • Daniel Zips
    • 8
  • Sebastian Zschaeck
    • 1
    • 12
  • Volker Budach
    • 1
  • Thomas Wiegel
    • 13
  • Pirus Ghadjar
    • 1
    Email author
  • the Prostate Cancer Expert Panel of the German Society of Radiation Oncology (DEGRO) and the Working Party Radiation Oncology of the German Cancer Society (DKG-ARO)
  1. 1.Department of Radiation OncologyCharité Universitätsmedizin BerlinBerlinGermany
  2. 2.Department of Radiation Oncology, InselspitalUniversity of BernBernSwitzerland
  3. 3.Klinikum Nürnberg NordNürnbergGermany
  4. 4.Universitätsklinikum WürzburgWürzburgGermany
  5. 5.Innsbruck Medical UniversityInnsbruckAustria
  6. 6.Xcare Praxis für Strahlentherapie SaarlouisXcare GruppeSaarlouisGermany
  7. 7.Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Universitätsklinikum Carl Gustav CarusTechnische Universität DresdenDresdenGermany
  8. 8.Universitätsklinikum TübingenTübingenGermany
  9. 9.Sana Klinikum OffenbachOffenbachGermany
  10. 10.MediClin Robert Janker KlinikBonnGermany
  11. 11.Landeskrankenhaus, Universitätsklinikum der Paracelsus Medizinischen Privatuniversität, SalzburgSalzburgAustria
  12. 12.Berlin Institute of HealthBerlinGermany
  13. 13.Universitätsklinikum UlmUlmGermany

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