Androgen Deprivation Therapy for Patients with Intact Prostates Undergoing Radiation Therapy

Androgen deprivation therapy (ADT) has the goal of lowering androgens to mitigate growth of prostate cancer. Parameters to consider in determining whether to add ADT to radiation and the duration of hormone therapy include prostate cancer risk group, prior therapy, comorbidities, and the adverse effects of ADT. In this chapter, we discuss ADT for patients with intact prostates undergoing radiotherapy. We consider the use of ADT with external beam radiation therapy (EBRT) for select healthy patients with favorable intermediate-risk prostate cancer. We generally use 4–6 months of ADT with EBRT for most patients with unfavorable intermediate-risk prostate cancer. We generally use 2 years ADT with EBRT for high-risk and locally advanced prostate cancer, although ADT may be stopped at 18 months if the patient tolerates ADT poorly. Genomics-based risk scores may help decision-making, although the predictive value of genomic risk scores is still being tested prospectively. Adverse effects of ADT include hot flashes, gynecomastia, metabolic changes such as weight gain and increased fat mass, and increased risk of fractures. Some data also suggest increased risk of cardiovascular adverse effects with ADT.