Given the higher risk of local and distant relapse with unfavorable intermediate-risk disease, the use of ADT is recommended for this patient population. Eight randomized trials have evaluated the role of ADT with radiation therapy versus radiation therapy alone.273-286 All eight trials included intermediate-risk patients, with one trial including patients from all risk strata281 and one trial exclusive to intermediate-risk patients only.286 These trials were heterogeneous in terms of radiation therapy dosage (ranging from 65 to 78 Gy) and technique (3DCRT and IMRT), as well as ADT duration (three to six months in all trials except one trial, which treated for three years), ADT timing (neoadjuvant in five trials, concurrent in two trials, and unknown in one trial), and ADT type (LHRH agonist plus antiandrogen in six trials, LHRH agonist alone in one trial, and antiandrogen in one trial). Regardless, these studies collectively demonstrated a consistent benefit regarding oncologic outcomes among the patients who received ADT with radiation. In an analysis stratified by prostate cancer risk category from one of these trials (n= 2,028), radiation therapy plus short-term ADT was associated with improved OS among patients with intermediate-risk disease (HR: 0.81; 95% CI: 0.67 to 0.98).281 The benefit of hormonal therapy was also demonstrated in the published MARCAP meta-analysis, which demonstrated that the addition of ADT to radiotherapy significantly improved MFS (HR: 0.83; 95% CI: 0.77 to 0.89; p<0·0001).287 Toxicity was assessed in seven of the trials indicated above.273-278, 280-286 The use of ADT was associated with expected toxicities during ADT administration. These effects generally diminished or resolved after discontinuation of ADT treatment.286 Notably, late gastrointestinal and genitourinary effects were not impacted using ADT with radiation therapy.275, 282, 286 With regard to the duration of ADT with radiation in unfavorable intermediate-risk disease, six clinical trials assessed very short course ADT (eight weeks to three months) versus standard short course ADT (six months) in intermediate-risk disease, five of which demonstrated that the six-month approach had superior cancer outcomes, including all-cause mortality and/or prostate cancer-specific mortality.276, 279, 288-297 Nevertheless, the Panel acknowledges that a four-month course of ADT is also commonly given to patients with radiation therapy for intermediate-risk disease in an effort to mitigate the deleterious effects of ADT while maintaining the benefit of combination therapy for cancer control.