Does Neoadjuvant and Adjuvant Treatment Improve Outcome in Localised Prostatic Cancer?

ObjectivesThis paper reviews neoadjuvant and adjuvant hormone therapy in localised or locally advanced prostate cancer.MethodsWe searched MEDLINE (1966–2007). Randomised or quasi-randomised controlled trials of patients with localised or locally advanced prostate cancer, that is, stages T1–T4, any N, M0, comparing neoadjuvant or adjuvant hormonal deprivation in combination with primary therapy (radical radiotherapy or radical prostatectomy) versus primary therapy alone were reviewed.ResultsNeoadjuvant hormonal therapy prior to prostatectomy does not improve overall survival. However, a significant reduction was noted in the positive surgical margin rate and a significant improvement in other pathologic variables such as lymph node involvement, pathologic staging, and organ-confined rates. The use of longer duration of neoadjuvant hormones, that is, either 6 or 8 mo prior to prostatectomy, is associated with a significant reduction in positive surgical margins. Neoadjuvant hormones before radiotherapy significantly improves both clinical disease-free survival and biochemical disease-free survival. Adjuvant androgen deprivation following prostatectomy significantly improves disease-free survival at both 5 and 10 yr but does not improve overall survival at 5 yr. Adjuvant therapy following radiotherapy results in a significant improvement in disease-specific survival and disease-free survival at 5 yr and a significant overall survival gain at 5 and 10 yr.ConclusionsHormone therapy combined with either prostatectomy or radiotherapy is associated with significant clinical benefits in patients with local or locally advanced prostate cancer. It not only provides a method for local control, but evidence also suggests a significant survival advantage if radiotherapy is the primary form of local therapy.