This article is addressing the role of androgen deprivation therapy (ADT) in prostate brachytherapy. No randomized trials to date evaluating the efficacy of hormonal therapy combined with brachytherapy. Many retrospective trials assessed the role of neoadjuvant androgen deprivation and interstitial permanent prostate brachytherapy in an effort to shrink the prostate gland and to facilitate the brachytherapy procedure in patients with large glands. Hormone ablation has been reported to downsize the prostate gland by 25-40%. Findings in regards to urinary toxicity, mainly urinary retention, related to shrinkage of the prostate are contradictory. Hormonal therapy in combination with brachytherapy is also used for patients with intermediate and high risk features as a result of extrapolation from the external beam radiation therapy data, as brachytherapy alone seems to be suboptimal treatment for men with high-risk prostate cancer. The effect of this combination on biochemical free survival is a matter of debate and varies from one study to another.
Until prospective, randomized studies are done, the role of androgen deprivation therapy (ADT) in conjunction with brachytherapy, specifically in relation to improvement in outcome, remains unclear.