ESTRO Brachytherapy for Prostate Cancer 2018

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.