The management of early prostate cancer is one of the most controversial areas in the field of cancer medicine with surgery, radiotherapy, primary hormonal therapy (achieved either by medication or by the surgical removal of the testes - orchidectomy) and watchful waiting, all being acceptable forms of initial treatment. Treatment decision making is often based on patient and provider preferences taking into account the risks and benefits of therapies and disease progression. Since prostate cancer is driven, in part by male sex hormones, the use of hormonal treatment to reduce the level of circulating male hormones is a potentially very useful method of treating all stages of this disease. Recently, research on the use of such hormonal therapy in combination with both surgery and radiotherapy has increased. This systematic review combines the results of all the important trials looking at the role of hormones in combination with surgery and radiotherapy for localised and locally advanced prostate cancer.
The results of this review indicate that neo-adjuvant hormone therapy administered three to six months before the primary curative therapy (radical prostatectomy radical radiotherapy) did not, as yet, result in a detectable improvement in overall survival or disease-specific survival. There was, however, a significant improvement in disease-free survival (approximately 90%) when given before radiotherapy. Neo-adjuvant hormone therapy prior to radical prostatectomy also significantly improved pathological variables associated with poor prognosis, such as the positive surgical margin rate and the proportion of patients with positive lymph nodes. Adjuvant hormone therapy following prostatectomy did not change overall or disease-specific survival compared to prostatectomy alone. However, adjuvant therapy following radiotherapy significantly improved overall survival and disease-specific survival up to 10 years post-treatment. Disease-free survival was also significantly improved at 10 years. Hormone therapy is associated with a number of side effects including hot flushes and gynaecomastia. The decision to use these agents has to be made after a full discussion between the patient and the physician regarding the disease risk of the patient, the benefits from the use of additional hormones and the side effects of hormonal therapy.