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RATIONALE for combining EBRT and ADT:
-(neo-adjuvant ADT) improves the geometry of the prostate target by decreasing the
volume juxtaposed to adjacent OAR
-If given before EBRT (in experimental setting), the anti-angiogenesis effect of ADT
may
- ‘normalize’ the vasculature and lead to better perfusion
- increase the oxygenation
- increase the radiation tumor sensistivity
- increase the LC. Reducing local failure may reduce second-wave metastatic
spread and thus improve OS
-The synergistic relationship in concurrent administration might produce a biologic
advantage
-Several RCTs show an improvement in bPFS and LC but also in DSS and 0S … so
…
ADT might have an influence on local and systemic disease
-Clinical evidence supports the hypothesis that
ADT can eliminate subclinical micro-
metastases.