Harnessing the potential of multimodal radiotherapy in prostate cancer

Radiotherapy in combination with androgen deprivation therapy (ADT) is a standard treatment option for men with localized and locally advanced prostate cancer. However, emerging clinical evidence suggests that radiotherapy can be incorporated into multimodality therapy regimens beyond ADT, in combinations that include chemotherapy, radiosensitizing agents, immunotherapy and surgery for the treatment of men with localized and locally advanced prostate cancer, and those with oligometastatic disease, in whom the low metastatic burden in particular might be treatable with these combinations. This multimodal approach is increasingly recognized as offering considerable clinical benefit, such as increased antitumour effects and improved survival. Thus, radiotherapy is becoming a key component of multimodal therapy for many stages of prostate cancer, particularly oligometastatic disease. Radiotherapy is a common treatment for men with prostate cancer, particular in combination with androgen deprivation. However, various factors can limit the dose of radiation that can be administered, so the effect might be suboptimal. In this Review, the authors discuss how radiotherapy could be optimized by combining with other treatments in a multimodal approach, particularly in the setting of oligometastatic disease. Key points Radiotherapy combined with androgen deprivation therapy (ADT) is a common treatment option for men with prostate cancer. In many patients, the use of radiotherapy is hindered by tumour resistance and a reduction in quality of life caused by toxic effects to normal tissue, which limits the radiation dose that can be delivered safely. Tumour control could be improved by using radiotherapy in combination with other treatments beyond ADT, including chemotherapy, radiosensitizing agents, immunotherapy and surgery. This multimodality approach could be beneficial in men with many stages of prostate cancer, including oligometastatic disease. A survival benefit from using a multimodality therapy approach seems to be achievable in the context of the low metastatic burden of oligometastatic prostate cancer.