HORMONAL-THERAPY IN THE MANAGEMENT OF PROSTATE-CANCER - FROM HUGGINS TO THE PRESENT

Hormonal therapy has been the mainstay of treatment for advanced forms of prostate cancer. Although early clinical studies suggested that ma jor improvements and even cure could occur, later randomized prospecti ve investigations showed that hormonal treatments were palliative rath er than curative. Subsequent studies have suggested, but not conclusiv ely proven, that earlier initiation of hormonal therapy for patients w ith early forms of metastatic disease may prolong disease-free and ove rall survival. The choice of hormonal agents, either alone as monother apy or in combination with agents of differing mechanisms of action, s uggests that further improvements in survival can be achieved with com binations of hormonal agents. Many studies have suggested that the use of hormonal therapy with localized forms of prostate cancer may provi de pathologic benefit in decreasing the amount of tumor found at the t ime of radical prostatectomy or treated during radiation therapy. Alth ough short-term outcomes looking at tumor ''downstaging'' have been po sitive, longer follow-up will be necessary before definitive conclusio ns can be made regarding the ultimate utility of preoperative or prera diation therapy hormonal treatments (neoadjuvant hormonal therapy). (C ) 1997 by Elsevier Science Inc.