Does neoadjuvant and adjuvant treatment improve outcome in localised prostatic cancer?

Objectives: This paper reviews neoadjuvant and adjuvant hormone therapy in localised or locally advanced prostate cancer. Methods: We 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, MO, comparing neoadjuvant or adjuvant hormonal deprivation in combination with primary therapy (radical radiotherapy or radical prostatectomy) versus primary therapy alone were reviewed. Results: Neoadjuvant 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 improvementin disease-specific survival and disease-free survival at 5 yr and a significant overall survival gain at 5 and 10 yr. Conclusions: Hormone 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. (c) 2008 European Association of Urology. Published by Elsevier B.V. All rights reserved.