Combined hormonotherapy with external beam radiotherapy in locally advanced prostate cancer: do side effects overlap the advantages?

Used for more than 60 years in metastatic prostate cancers, hormone therapy is nowadays also an option for the treatment of locally advanced prostate cancer. Adjuvant androgen deprivation combined with external beam radiotherapy has become the gold standard treatment in locally advanced prostate cancer. Combined therapy has been extensively investigated and has shown to improve oncologic outcomes. However, its toxicity is not negligible. Several side effects can be encountered: cardiovascular, bone depletion, metabolic changes and neuropsychologic effects. They may overlap treatment benefits and be responsible of a specific mortality. Nevertheless, randomized studies have demonstrated that there was no increase of specific mortality from combined treatments compared to patients treated by radiotherapy alone. Therefore, these side effects might not be a barrier to adjuvant androgenic deprivation. However, long-term results are still needed and also accurate morbidity studies. In addition, the debate is still ongoing regarding the appropriate duration of hormone therapy. (C) 2010 Published by Elsevier Masson SAS.