NEOADJUVANT ANDROGEN SUPPRESSION WITH RADIATION IN THE MANAGEMENT OF LOCALLY ADVANCED ADENOCARCINOMA OF THE PROSTATE - EXPERIMENTAL AND CLINICAL-RESULTS

Conventional radiotherapy has been a standard treatment for the manage ment of locally advanced T2c-4 prostatic carcinoma for over 2 decades. The routine use of serum PSA in follow-up makes it clear that >80% of these patients will show evidence of failure by 10 years. Rebiopsy of those with a rising PSA shows locally persistent disease in the major ity of cases. Increasing the radiation dose applied to the prostate in creases local control but at the risk of higher morbidity. Experimenta l data using the Shionogi tumor mouse model suggest a potential gain f rom neoadjuvant androgen suppression without any increase in normal ti ssue morbidity. Two randomized trials comparing neoadjuvant androgen s uppression prior to radiation therapy with radiation alone in humans s how considerable short-term gains in local control and disease-free su rvival but mature data are still awaited. It is currently unknown whet her the positive interaction between radiation and androgen suppressio n is synergistic or simply additive. (C) 1997 by Elsevier Science Inc.