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  • Review Article
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Synergistic action of image-guided radiotherapy and androgen deprivation therapy

Nature Reviews Urology volume 12, pages 193–204 (2015)Cite this article

Subjects

Key Points

  • Genomic signatures, molecular imaging techniques and the presence or absence of disseminated and circulating tumour cells can identify patients harbouring occult metastases who can benefit from combined therapies

  • In high-risk and/or locally advanced prostate cancer, the combination of image-guided radiotherapy (IGRT) and androgen deprivation therapy (ADT) improves overall survival compared with monotherapies

  • ADT with IGRT can improve outcomes by eradicating occult systemic metastases, improving local and systemic control and decreasing the ability of prostate cancer cells to repair IGRT-induced DNA damage

  • No biomarkers are currently in clinical use to help decide which patients will benefit from ADT

  • Biomarkers of occult metastatic disease and of the efficacy of ADT in individual patients would enable a more bespoke approach to the use, duration and timing of ADT–IGRT

Abstract

The combined use of androgen deprivation therapy (ADT) and image-guided radiotherapy (IGRT) can improve overall survival in aggressive, localized prostate cancer. However, owing to the adverse effects of prolonged ADT, it is imperative to identify the patients who would benefit from this combined-modality therapy relative to the use of IGRT alone. Opportunities exist for more personalized approaches in treating aggressive, locally advanced prostate cancer. Biomarkers—such as disseminated tumour cells, circulating tumour cells, genomic signatures and molecular imaging techniques—could identify the patients who are at greatest risk for systemic metastases and who would benefit from the addition of systemic ADT. By contrast, when biomarkers of systemic disease are not present, treatment could proceed using local IGRT alone. The choice of drug, treatment duration and timing of ADT relative to IGRT could be predicated on these personalized approaches to prostate cancer medicine. These novel treatment intensification and reduction strategies could result in improved prostate-cancer-specific survival and overall survival, without incurring the added expense of metabolic syndrome and other adverse effects of ADT in all patients.

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Figure 1: Investigations and interventions for progressing states of metastatic prostate cancer.
Figure 2: Mechanisms of ADT and IGRT synergy.

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Authors and Affiliations

  1. Department of Urologic Sciences, University of British Columbia, Gordon & Leslie Diamond Health Care Centre, Level 6, 2775 Laurel Street, Vancouver, V5Z 1M9, BC, Canada

    Jennifer A. Locke

  2. Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 4, Bern, CH-3010, Switzerland

    Alan Dal Pra

  3. Department of Radiation Oncology, Institut de Cancérologie de l'Ouest, Nantes-St-Herblain, 8 quai Moncousu, BP 70721, Nantes, 44000, France

    Stéphane Supiot

  4. Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, M5G 2M9, ON, Canada

    Padraig Warde & Robert G. Bristow

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  1. Jennifer A. Locke
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  2. Alan Dal Pra
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  3. Stéphane Supiot
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  4. Padraig Warde
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  5. Robert G. Bristow
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Contributions

J.A.L., A.D.P. and R.G.B. researched the data for the article. J.A.L. and R.G.B. contributed to discussions of the content of the article and contributed equally to writing the article. R.G.B. assisted with writing the article, and all authors contributed to reviewing and editing the manuscript before submission.

Corresponding author

Correspondence to Robert G. Bristow.

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The authors declare no competing financial interests.

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Locke, J., Pra, A., Supiot, S. et al. Synergistic action of image-guided radiotherapy and androgen deprivation therapy. Nat Rev Urol 12, 193–204 (2015). https://doi.org/10.1038/nrurol.2015.50

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