COMMENTARY

Advances in Prostate Cancer: 2014

Gerald Chodak, MD

Disclosures

December 11, 2014

In This Article

Treatment of Locally Advanced Disease

The management of locally advanced disease has been well studied in previous years, with reports demonstrating that combining androgen deprivation therapy (ADT) with radiation results in improved overall survival compared with radiation alone. Ongoing work has been directed at determining the optimal duration of ADT, to improve survival while minimizing morbidity. Some experts have questioned whether the radiation is really necessary.

A Scandinavian study[9] provided additional support for the value of including radiation with ADT. Men received 3 months of combined ADT using flutamide plus leuprolide, followed by daily flutamide. After the 3 months, these men were randomly assigned to receive radiation or no radiation. Prostate cancer mortality at 10 years was 39.4% for the ADT alone group vs. 29.6% for the men who also received radiation.

It is now clear that men with locally advanced disease need both ADT and radiation to maximize survival. The question of the optimal duration of ADT remains unanswered, however.

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