Open Access

ARTICLE

The case for dose escalation versus adjuvant androgen deprivation therapy for intermediate risk prostate cancer

Tom Pickles¹, Alan Pollack²

1 Radiation Program, BC Cancer Agency, Vancouver, BC, Canada
2 Radiation Oncology, Fox Chase Cancer Centre, Philadelphia, USA
Address correspondence to Dr. Tom Pickles, Radiation Oncology, BC Cancer Agency, 600 West 10th Avenue, Vancouver, BC V6R 2T9 Canada

Canadian Journal of Urology 2006, 13(Suppl.2), 68-71.

Abstract

Patients with intermediate-risk prostate cancer have a significant risk of biochemical failure after treatment with external beam radiation therapy. Two strategies to improve outcomes are radiation dose escalation and androgen deprivation therapy (ADT). This article discusses the evidence in favor of dose escalation.
The case for radiation dose escalation has been established by several randomized studies, which show improved biochemical control (bNED) rates. Although late toxicity was also increased, it remains at clinically acceptable levels. The use of more focal methods of radiation, such as proton therapy and intensity modulated radiation therapy (IMRT), allows safe dose escalation to 80 Gy. The role of adjuvant ADT is most clearly established in high-risk disease. Advantages in the intermediate-risk group are less pronounced. It is probable that therapeutic gain seen from dose escalation in intermediate-risk patients might allow them to be spared the toxicity of ADT and yet achieve good PSA and clinical control rates. Further randomized trials comparing and or combining the two treatment strategies are required.

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