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.
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