Intermediate-risk profile in prostate cancer. Role of combined radiation and hormone therapy

BackgroundIn the case of intermediate-risk prostate cancer definitive percutaneous radiation therapy (RT) alone or combined with androgen deprivation therapy (ADT) are established treatment options.ObjectiveThis article gives a review of the currently applied different treatment concepts in cases of definitive percutaneous radiation therapy.Material and methodsCurrent guidelines and the relevant literature in the PubMed database were reviewed.ResultsDifferent recommendations for risk group assessment of patients with localized prostate cancer are available. Subdivision of the intermediate risk group into afavorable and an unfavorable stage seems to be useful to enable an individualized therapy in an otherwise heterogeneous patient group. Multiple randomized trials showed abenefit when RT was combined with ADT even in patients in the intermediate-risk group; however, it is important to bear the increased rate of toxicity associated with ADT in mind. The use of dose-escalated RT without ADT appears to be an adequate therapy, especially in favorable intermediate-risk profile patients.ConclusionThe dose-escalated RT in favorable risk profile patients and the combination with short-term ADT (4-6months) in unfavorable intermediate-risk patients seems to be apromising individual treatment option. The results of the RTOG 0815 trial are eagerly awaited in order to strengthen the evidence level in intermediate-risk prostate cancer.