What is the optimal duration of ADT for unfavorable intermediate risk or high risk localized prostate cancer treated with SBRT instead of conventionally fractionated or hypofractionated RT?

There is no available data from randomized trials to support any modification in the choice of ADT (GnRH agonist vs antagonist) or use of abiraterone acetate, or on the duration of ADT (4-6 mo vs 2-3 years) based on the form of radiation, and thus I follow the NCCN guidelines that provide recommendations on hormonal therapies in these unfavorable int risk or high/very high risk patients irrespective of the form or fractionation size of the radiation.

Intermediate Risk

The available phase III data validating SBRT does not include concurrent ADT, however, I typically recommend the same duration of ADT as for fractionated EBRT based on generalization from this literature. I am not aware of any comparative trials proving the additional efficacy of ADT for patients with unfavorable intermediate risk prostate cancer in the context of SBRT, however, there were some data presented this past year at ASTRO in Dr. @Dr. First Last's oral presentation of ...

This is a timely question. Currently, there are no published data to suggest that the duration of ADT can be altered in the context of ultrahypofractionation for either UIR or HR disease. Fundamentally, two facts and/or realities of evidence must be appreciated. First, it must be recognized that thus far, neither moderate hypofractionation nor ultrahypofractionation have been shown in randomized trials to consistently offer improved biochemical control over conventionally fractionated dose-escal...

Good discussion.

Perhaps the more pressing question we should be asking our urology colleagues is why they don't routinely offer medical intervention or refer to someone who will offer one when their surgical patients have UIR or more commonly, high or very high risk disease.

There seems to be a disconnect between locoregional and systemic approaches to the management of at-risk prostate cancer.

Will give ADT based upon current NCCN guidelines.