Use of Androgen Deprivation Therapy (ADT) and Radiotherapy in post-operative prostate cancer patients:

Prostate cancer is the most common cancer in older men. According to the American Cancer Society, it
is a leading cause of cancer-related deaths among male patients. The stage of prostate cancer dictates
the treatment plan. The treatment options range from surgery and radiotherapy to hormone therapy.

The Goal of Treatment:

The primary goal of treatment for the prostate is freedom from disease and freedom from disease
progression. Research shows, that about 30% of all surgical patients have disease progression.
Progression is defined as biochemical failure (High PSA levels), clinical failure (local, regional, or distant),
or death from any cause. PSA levels are monitored as part of the follow-up after treatment of the
prostate by radical prostatectomy.

A combination of treatments is used to stop disease progression and recurrence. That include, Radical
prostatectomy, internal or external radiotherapy, salvage radiotherapy, Androgen deprivation therapy
(ADT), and pelvic lymph node radiotherapy (PLNRT).

Radical Prostatectomy:

Radical prostatectomy is the surgical removal of part or complete prostate gland. It is the treatment of
choice in case of benign, non- metastasized disease or hyperplasia. Radical prostatectomy is known to
provide long-term disease control in a majority of cases.

Postoperative Radiotherapy:

Radiation treatment is offered to patients after radical prostatectomy where there is a suspected chance
of recurrence. To improve oncological outcomes, radiotherapy may be delivered immediately after
surgery, adjuvant radiotherapy, when the patient has adverse pathological features, or it is done in a
salvage setting. Early salvage radiotherapy (SRT) is an effective treatment for biochemically recurrent
prostate cancer where there are recorded high PSA levels even after the surgical treatment.
Radiation is delivered in the form of photons. The different techniques of radiotherapy are 3D conformal
radiotherapy and intensity-modulated therapy IMRT. The target areas of radiotherapy include:

? Prostate bed (thus the name prostate bed radiotherapy PBRT)

? Cancer site

? Remnants of seminal vesicles

? Lymph nodes

Androgen Deprivation Therapy (ADT):

Testosterone, the male sex hormone, is an androgen. Prostate cancer needs testosterone to grow.
Reducing the amount of testosterone the body makes is known to slow the rate of growth of cancer.
ADT may be used after radical prostatectomy or with radiotherapy. It is also known to help control the
advanced stage of the disease.

Radiotherapy with androgen deprivation therapy has traditionally been the treatment of choice for
patients with a high chance of local or biochemical recurrence of the disease.

Combination of Radiotherapy, Androgen deprivation therapy ADT and PLNRT:
A new combination of treatments has been studied to have greater oncological outcomes. It includes
Salvage radiotherapy SRT, Androgen deprivation therapy ADT, and pelvic lymph node radiotherapy
(PLNRT. This combination is known to have an effective outcome in patients with biochemical
recurrence that is persistently high PSA levels. PBRT + ADT + PLNRT and PBRT + ADT have improved freedom from progression rates vs PBRT alone. The rate of 5-year freedom from disease progression with the PBRT, ADT, and PLNRT group is 87.4%. With PBRT + ADT, it is 81.3% and 70.9% with PBRT alone.

Consult your very own radiation oncologist, Dr. Rajiv Dahiya to see what treatment option is best
suitable for you to have a disease-free healthy life that you can enjoy.

Contact Info:

You can contact Dr. Rajiv Dahiya, MD at the following: www.rajivdahiyamd.com or www.
urologyclinics.com/providers/raj-dahiya-md.

References:

Prof Alan Pollack, Prof Theodore G K et al. The addition of androgen deprivation therapy and pelvic
lymph node treatment to prostate bed salvage radiotherapy: a randomized control trial. The Lancet,
2022 DOI: https://doi.org/10.1016/S0140-6736(21)01790-6
Kim, M., Song, C., Jeong, I.G. et al. Androgen deprivation therapy during and after post-prostatectomy
radiotherapy in patients with prostate cancer: a case-control study. BMC Cancer 18, 271 (2018).
https://doi.org/10.1186/s12885-018-4189-9

To know more about Proton Therapy for Cancer click here Dr Raj Dahiya