Prognostic value of biochemical response to neoadjuvant androgen deprivation before external beam radiotherapy for prostate cancer: A systematic review of the literature |
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| Affiliation: | 1. Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland;2. Faculty of Medicine, Geneva University, Switzerland;3. Department of Radiation Oncology, Bern University Hospital, Bern, Switzerland;1. Department of Radiation Oncology, Geneva University Hospital, Switzerland;2. Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland;3. Department of Radiation Oncology, Cantonal Hospital of Fribourg – HFR, Switzerland;4. Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Switzerland;5. Department of Radiation Oncology, Kantonsspital Graubünden, Chur, Switzerland;6. Radiation Oncology Center, Bienne-Seeland-Jura Bernois, Switzerland;7. Department of Radiation Oncology, Hirslanden Clinique Bois-Cerf, Lausanne, Switzerland;8. Department of Radiation Oncology, Hôpital de La Tour, Geneva, Switzerland;9. Department of Radiation Oncology, KSA-KSB, Kantonspital Aarau, Switzerland;10. Department of Radiation Oncology, Réseau Hospitalier Neuchâtelois, La Chaux-de-Fonds, Switzerland;11. Department of Radiation Oncology, Cantonal Hospital of Winthertur, Switzerland;12. Department of Radiation Oncology, Clinica Luganese Moncucco, Lugano, Switzerland;13. Department of Radiation Oncology, Hôpital Riviera-Chablais, Rennaz, Switzerland;14. Department of Radiation Oncology, Hôpital du Valais, Sion, Switzerland;15. Department of Radiation Oncology, Clinique de Genôlier - Centre Médical des Eaux Vives, Geneva, Switzerland;p. Department of Radiation Oncology, Hirslanden Clinique Grangettes, Geneva, Switzerland;q. Department of Radiation Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland;r. Department of Radiation Oncology, Cantonal Hospital of St. Gallen, St. Gallen and Department of Radiation Oncology, University of Bern, Switzerland;s. Department of Radiation Oncology, Spital Thurgau AG, Kantonsspitäler Frauenfeld und Münsterlingen, Switzerland;t. Radiotherapy Institute, Hirslanden Klinik, Zürich, Switzerland;u. Department of Radiation Oncology, City Hospital Triemli, Zürich and Department of Radiation Oncology, University of Bern, Switzerland;v. Department of Radiation Oncology, University Hospital Basel, Switzerland;w. Faculty of Medicine, Geneva University, Switzerland;1. Department of Oncology, Queen’s University, Canada;2. Cancer Centre of Southeastern Ontario, Canada;3. Canadian Cancer Trials Group, Queen’s Cancer Research Institute, Canada;4. Cancer Care and Epidemiology, Queen’s Cancer Research Institute, Canada;5. Department of Urology, Queen’s University, Canada |
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| Abstract: | External beam radiation therapy (EBRT) in combination with androgen deprivation therapy (ADT) is considered a standard treatment option for patients with aggressive localized and locally-advanced prostate cancer. Randomized phase III trials have provided evidence for combining EBRT to short-term ADT for intermediate-risk disease and to long-term ADT for patients harboring high-risk tumors. Even if several improvements and developments have been made in the last years in terms of radiotherapy delivery techniques, image-guided radiotherapy, and better sparing of the organs at risk the current use of ADT remains still linked to a therapeutic algorithm based on the prostate cancer risk classification as proposed by clinical trials.Emerging literature has recently shown that the biochemical response to a course of neoadjuvant ADT before EBRT, called the “prostate-specific antigen (PSA) nadir” (lowest value after treatment), may influence the long-term biochemical tumor-control outcomes of prostate cancer patients. An individualized approach adapting the duration of hormonal treatment according to the PSA response during the neoadjuvant phase, as well using new generation hormonal agents, may represent a new therapeutic strategy and a future way to improve the therapeutic ratio for prostate cancer patients.In this systematic review of the literature we explored the prognostic value of the PSA response to the neoadjuvant ADT phase and the rationale to adjust the use of ADT and EBRT in patients with intermediate- and high-risk prostate cancer based on the biochemical response to the neoadjuvant androgen ablation phase. |
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| Keywords: | Prostate cancer Biochemical response Androgen deprivation PSA Radiotherapy |
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