Neoadjuvant and Adjuvant Hormone Therapy: How and When?

ContextA significant proportion of patients with prostate cancer (PCa) will experience clinical or biochemical failure after local treatment with radical prostatectomy (RP) or radiotherapy (RT). It is still a matter of debate whether hormone therapy (HT) in either a neoadjuvant or adjuvant setting can offer a survival benefit for these patients.ObjectiveThis review paper discusses how and when neoadjuvant and adjuvant HT could be applied for treatment of PCa. Furthermore, the paper outlines the optimal duration of adjuvant HT to RT for treatment of patients with high-grade localised or locally advanced PCa.Evidence acquisitionThis paper is based on a presentation given at a satellite symposium held at the European Association of Urology (EAU) 2008 annual congress in Milan, Italy. Data were retrieved from recent review articles, original articles, and abstracts on neoadjuvant or adjuvant HT in PCa.Evidence synthesisLuteinising hormone-releasing hormone agonists have become the standard of care in HT. Neoadjuvant androgen deprivation therapy (ADT) to RP seems to have potential to downstage PCa disease but does not offer a survival benefit over RP alone in patients with localised PCa. On the other hand, short-term neoadjuvant ADT to RT appears to improve treatment outcomes compared with RT alone in patients with locally advanced PCa but seems to be specifically indicated in patients with Gleason score 2–6. Adjuvant ADT with RT seems to offer a survival benefit over RT alone in high-risk localised and locally advanced PCa. Recent data indicate that 6-mo ADT is inferior in terms of survival to 3-yr adjuvant ADT after RT for patients with locally advanced PCa. The role of immediate ADT for men with node-positive PCa after RP should be further investigated.ConclusionsNeoadjuvant and adjuvant ADT to local treatment may be indicated in carefully selected patients with PCa.