Who Benefits from Neoadjuvant or Adjuvant Hormone Therapy?☆

Context

Although there is an increasing interest in the use of neoadjuvant or adjuvant hormone therapy (HT) combined with curative treatment for patients with prostate cancer (PCa), the issue of who may benefit from such therapy is still open.

Objective

To summarise the current status of neoadjuvant and adjuvant HT as a curative treatment for patients with PCa.

Evidence acquisition

This manuscript is based on a presentation given at a satellite symposium on PCa held at the 2009 European Association of Urology (EAU) Congress in Stockholm, Sweden. Data were retrieved from recent original articles, review papers, and abstracts on neoadjuvant or adjuvant HT to local treatment for PCa.

Evidence synthesis

Neoadjuvant HT to radical prostatectomy does not offer a survival benefit over surgery alone in patients with localised and locally advanced PCa. Neoadjuvant HT to radiation therapy (RT) appears to improve treatment outcomes, except overall survival (OS), over RT alone in patients with locally advanced PCa, without increasing the risk of fatal cardiac events. Several large, randomised phase 3 studies have shown that adjuvant HT with RT increases OS compared with RT alone in patients with high-risk localised or locally advanced PCa. However, the added value of HT to RT seems to pertain only to men with no or minimal comorbidity. With regard to the optimal duration, long-term adjuvant HT appears superior over short-term adjuvant HT with RT, especially in patients with poor-risk PCa.

Conclusions

Neoadjuvant or adjuvant HT to RT may improve treatment outcomes, including OS in appropriately selected patients with PCa.

Neoadjuvant or adjuvant hormone therapy to radiation therapy may improve treatment outcomes in carefully selected patients with prostate cancer.