How to cite: Stone NN. Radiation Therapy: When Should Hormone Therapy Be Used and for How Long? Grand Rounds in Urology.” October 23, 2025. Accessed Oct 2026. https://grandroundsinurology.com/radiation-therapy-when-should-hormone-therapy-be-used-and-for-how-long/
Summary
Nelson N. Stone, MD, Professor of Urology, Radiation Oncology, and Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, reviews when androgen deprivation therapy (ADT) should be combined with radiation therapy for prostate cancer and how long hormonal therapy should be continued in the modern era of dose-escalated radiation. He synthesizes decades of randomized evidence with long-term institutional biopsy data to clarify the interaction between radiation dose, biologic effective dose (BED), and the incremental value of ADT.
Dr. Stone focuses on the concept that radiation dose, rather than hormone duration, may be the dominant driver of local control. By converting external beam and brachytherapy doses into BED, he demonstrates that contemporary combination strategies can exceed a BED threshold of approximately 200 Gy. Institutional post-treatment biopsy data, including serial biopsies performed years after therapy, show that when this BED threshold is achieved, local control is excellent, and the addition of prolonged ADT does not meaningfully reduce residual cancer on biopsy.
The presentation highlights the TRIP randomized trial, which directly compared 6 months versus 30 months of ADT in high-risk patients receiving combination brachytherapy and external beam radiation with tightly controlled BED. With long-term follow-up, no differences were observed in biochemical progression, metastasis, or overall survival between arms. Testosterone recovery was significantly faster and more complete in the short-term ADT arm, with age, body mass index, baseline testosterone, and ADT duration identified as key predictors of delayed recovery.
Dr. Stone asserts that high-quality radiation delivery with sufficient BED may allow substantial de-escalation of ADT duration for many patients, reducing morbidity without compromising cancer control. He cautions that longer ADT may still be appropriate in selected settings, particularly when advanced imaging identifies nodal disease or when combination therapy is used for systemic control.
About the 28th Annual Southwest Prostate Cancer Symposium:
Presented by Program Chairs Nelson N. Stone, MD, Richard G. Stock, MD, and William K. Oh, MD, this conference educated attendees about advances in the management of localized and advanced prostate cancer, with a focus on imaging, technology, and training in the related devices. It included a scientific session, as well as live demonstrations of surgical techniques. You can learn more about the conference here.
ABOUT THE AUTHOR
Nelson N. Stone, MD, is Professor of Urology, Radiation Oncology, and Oncological Sciences at the Icahn School of Medicine at Mount Sinai and chief medical officer at Viomerse, Inc.
Dr. Stone earned his medical degree from the University of Maryland in 1979. He completed a Residency in General Surgery in 1981 at the University of Maryland, followed by a Residency in Urology at the University of Maryland. He then completed a Fellowship in Urologic Oncology at Memorial Sloan-Kettering Cancer Center and a Research Fellowship in Biochemical Endocrinology at Rockefeller University in 1986. He was Chief of Urology at Elmhurst Hospital Queens from 1986-1996.
Dr. Stone has founded several medical companies and serves on the editorial board of many scientific journals. He is a member of many professional societies, including the Prostate Conditions Education Council, the Society for Minimally Invasive Therapy, the New York State Urological Society, the American Association of Clinical Urologists, and the American Urologic Association. Dr. Stone has participated in approximately 25 research studies on prostate cancer and has authored more than 500 articles, abstracts, and book chapters, primarily on prostate cancer. He invented the real-time technique for prostate brachytherapy in 1990 and has trained more than 5,000 physicians worldwide through his company ProSeed. His most recent company, Viomerse, creates synthetic body parts (phantoms) for surgical training and has recently released an extended reality remote training platform.
