Picking the Optimal Duration of Hormonal Therapy in Men With High-Risk and Locally Advanced Prostate Cancer Treated With Radiotherapy

The optimal duration of hormonal therapy when combined with radiation for men with high-risk and locally advanced prostate cancer remains under active study. Based on the results of randomized controlled trials, durations of androgen suppression therapy of at least 6 months have been shown to prolong survival in men with Gleason score 7 prostate cancer, irrespective of clinical stage. For men with locally advanced prostate cancer and 2 high-risk factors (particularly Gleason 8-10 tumors with evidence of extracapsular extension or seminal vesicle invasion on digital rectal examination) or pelvic nodal involvement, longer durations of 28-36 months appear best, although shorter durations (eg, 18 months) remain under study. Trials are also ongoing to determine whether radiation dose escalation and/or nonhormonal agents, such as zoledronic acid and docetaxel, will reduce the need for supplementary androgen suppression therapy.