Integrating hormonal therapy with external-beam radiation and brachytherapy for prostate cancer

The use of hormonal therapy with external-beam radiation (EBRT) to treat prostate cancer is a topic that has been well explored. The potential use of hormonal therapy and brachytherapy in the treatment of prostate cancer, however, continues to be controversial. This review is based on our current interpretation of the available literature assessing the outcomes of patients treated with EBRT and brachytherapy with or without hormonal therapy. Extrapolating from the findings of the Radiation Therapy Oncology Group (RTOG) 9413 trial, there appears to be a favorable interaction between hormonal therapy and irradiation in the lymph nodes. The benefits demonstrated with whole pelvic EBRT and hormonal therapy are likely to extend to patients treated with brachytherapy as well. Studies suggest that the role of hormonal therapy in brachytherapy is limited without the application of whole-pelvic EBRT due to the inability of brachytherapy to address potential lymph nodes at risk. The potential role of hormonal therapy in conjunction with brachytherapy without pelvic radiotherapy, is limited by inconclusive data and abbreviated follow-up times.