Review of Current Treatment Intensification Strategies for Prostate Cancer Patients

Overview

Journal Cancers (Basel)

Publisher MDPI

Specialty Oncology

Date 2023 Dec 9

PMID 38067321

Authors

Sobia Wasim

Jieun Park

Seungyoon Nam

Jaehong Kim

Affiliations

Soon will be listed here.

Abstract

Prostate cancer (PCa) used to be one of the most common nondermatologic cancers in men that can be treated only with surgery. However, a revolutionary breakthrough came in the 1980s with the introduction of long-acting luteinizing hormone-releasing hormone (LHRH) agonists for the curative treatment of PCa. This paradigm shift contributed to the combined use of androgen deprivation therapy (ADT), chemotherapy, and radiotherapy for the treatment. The latest data highlight the use of treatment intensification (TI), i.e., combined use of radiotherapy (RT) and hormonal or drug treatments, for localized or locally advanced PCa. Indeed, the results of combined modality treatments have shown a reduction in disease-specific mortality and improved overall survival. Although TI seems promising, more research studies are warranted to confirm its efficacy. This review summarizes the latest available outcome results of pivotal trials and clinical studies on the efficacy of TI.

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References

Spratt D, Liu V, Michalski J, Davicioni E, Berlin A, Simko J . Genomic Classifier Performance in Intermediate-Risk Prostate Cancer: Results From NRG Oncology/RTOG 0126 Randomized Phase 3 Trial. Int J Radiat Oncol Biol Phys. 2023; 117(2):370-377. PMC: 10949135. DOI: 10.1016/j.ijrobp.2023.04.010. View

Kishan A, Wang X, Sun Y, Romero T, Michalski J, Ma T . High-dose Radiotherapy or Androgen Deprivation Therapy (HEAT) as Treatment Intensification for Localized Prostate Cancer: An Individual Patient-data Network Meta-analysis from the MARCAP Consortium. Eur Urol. 2022; 82(1):106-114. DOI: 10.1016/j.eururo.2022.04.003. View

Fizazi K, Tran N, Fein L, Matsubara N, Rodriguez-Antolin A, Alekseev B . Abiraterone plus Prednisone in Metastatic, Castration-Sensitive Prostate Cancer. N Engl J Med. 2017; 377(4):352-360. DOI: 10.1056/NEJMoa1704174. View

Yuan Z, Fernandez D, Dhillon J, Abraham-Miranda J, Awasthi S, Kim Y . Proof-of-principle Phase I results of combining nivolumab with brachytherapy and external beam radiation therapy for Grade Group 5 prostate cancer: safety, feasibility, and exploratory analysis. Prostate Cancer Prostatic Dis. 2020; 24(1):140-149. PMC: 7882397. DOI: 10.1038/s41391-020-0254-y. View

Dignam J, Hamstra D, Lepor H, Grignon D, Brereton H, Currey A . Time Interval to Biochemical Failure as a Surrogate End Point in Locally Advanced Prostate Cancer: Analysis of Randomized Trial NRG/RTOG 9202. J Clin Oncol. 2018; 37(3):213-221. PMC: 6338393. DOI: 10.1200/JCO.18.00154. View

Corkum M, Achard V, Morton G, Zilli T . Ultrahypofractionated Radiotherapy for Localised Prostate Cancer: How Far Can We Go?. Clin Oncol (R Coll Radiol). 2021; 34(5):340-349. DOI: 10.1016/j.clon.2021.12.006. View

Bolla M, Collette L, Blank L, Warde P, Dubois J, Mirimanoff R . Long-term results with immediate androgen suppression and external irradiation in patients with locally advanced prostate cancer (an EORTC study): a phase III randomised trial. Lancet. 2002; 360(9327):103-6. DOI: 10.1016/s0140-6736(02)09408-4. View

Denham J, Joseph D, Lamb D, Spry N, Duchesne G, Matthews J . Short-term androgen suppression and radiotherapy versus intermediate-term androgen suppression and radiotherapy, with or without zoledronic acid, in men with locally advanced prostate cancer (TROG 03.04 RADAR): an open-label, randomised, phase 3.... Lancet Oncol. 2014; 15(10):1076-89. DOI: 10.1016/S1470-2045(14)70328-6. View

Gong L, Zhang Y, Liu C, Zhang M, Han S . Application of Radiosensitizers in Cancer Radiotherapy. Int J Nanomedicine. 2021; 16:1083-1102. PMC: 7886779. DOI: 10.2147/IJN.S290438. View

10.

. Maximum androgen blockade in advanced prostate cancer: an overview of the randomised trials. Prostate Cancer Trialists' Collaborative Group. Lancet. 2000; 355(9214):1491-8. View

11.

Sharma A, Good D, Alan McNeill S . Re: Patient-reported Outcomes 12 Years after Localized Prostate Cancer Treatment. Eur Urol. 2023; 85(2):179. DOI: 10.1016/j.eururo.2023.09.026. View

12.

Beckendorf V, Guerif S, Le Prise E, Cosset J, Bougnoux A, Chauvet B . 70 Gy versus 80 Gy in localized prostate cancer: 5-year results of GETUG 06 randomized trial. Int J Radiat Oncol Biol Phys. 2010; 80(4):1056-63. DOI: 10.1016/j.ijrobp.2010.03.049. View

13.

Lawton C, Lin X, Hanks G, Lepor H, Grignon D, Brereton H . Duration of Androgen Deprivation in Locally Advanced Prostate Cancer: Long-Term Update of NRG Oncology RTOG 9202. Int J Radiat Oncol Biol Phys. 2017; 98(2):296-303. PMC: 5603177. DOI: 10.1016/j.ijrobp.2017.02.004. View

14.

Miyake M, Tanaka N, Hori S, Ohnishi S, Takahashi H, Fujii T . Dual benefit of supplementary oral 5-aminolevulinic acid to pelvic radiotherapy in a syngenic prostate cancer model. Prostate. 2018; 79(4):340-351. DOI: 10.1002/pros.23740. View

15.

Vuky J, Pham H, Warren S, Douglass E, Badiozamani K, Madsen B . Phase II study of long-term androgen suppression with bevacizumab and intensity-modulated radiation therapy (IMRT) in high-risk prostate cancer. Int J Radiat Oncol Biol Phys. 2012; 82(4):e609-15. DOI: 10.1016/j.ijrobp.2011.09.002. View

16.

Narayan V, Ross A, Parikh R, Nohria A, Morgans A . How to Treat Prostate Cancer With Androgen Deprivation and Minimize Cardiovascular Risk: A Therapeutic Tightrope. JACC CardioOncol. 2022; 3(5):737-741. PMC: 8702790. DOI: 10.1016/j.jaccao.2021.09.014. View

17.

Ganguly S, Lone Z, Muskara A, Imamura J, Hardaway A, Patel M . Intratumoral androgen biosynthesis associated with 3β-hydroxysteroid dehydrogenase 1 promotes resistance to radiotherapy in prostate cancer. J Clin Invest. 2023; 133(22). PMC: 10645386. DOI: 10.1172/JCI165718. View

18.

Ghadjar P, Hocht S, Wiegel T . Postoperative radiotherapy in prostate cancer. Lancet. 2021; 397(10285):1623. DOI: 10.1016/S0140-6736(21)00273-7. View

19.

Tzortzis V, Samarinas M, Zachos I, Oeconomou A, Pisters L, Bargiota A . Adverse effects of androgen deprivation therapy in patients with prostate cancer: focus on metabolic complications. Hormones (Athens). 2017; 16(2):115-123. DOI: 10.14310/horm.2002.1727. View

20.

Michalski J, Moughan J, Purdy J, Bosch W, Bruner D, Bahary J . Effect of Standard vs Dose-Escalated Radiation Therapy for Patients With Intermediate-Risk Prostate Cancer: The NRG Oncology RTOG 0126 Randomized Clinical Trial. JAMA Oncol. 2018; 4(6):e180039. PMC: 5885160. DOI: 10.1001/jamaoncol.2018.0039. View