ADJUVANT HORMONE-THERAPY AFTER RADICAL PROSTATECTOMY - INDICATIONS AND RESULTS

Despite recent advances in staging modalities, nearly 30-40% of patien ts undergoing radical prostatectomy for clinically localized prostate cancer have residual disease. In these cases, one or more of the follo wing conditions may be present: extracapsular disease, positive margin s, invasion of the seminal vesicles, lymph node metastases or the post operative persistence of PSA values above the biological threshold. Th e optimal management for residual prostate cancer remains controversia l and in this setting adjuvant therapy could be appropriate. In the pr esent review we examine the conditions in which hormonal adjuvant ther apy can be indicated and the results available from retrospective or n on-randomized studies. From the data in the literature and in the abse nce of randomized prospective studies, prudent conclusions could be dr awn on the efficacy of adjuvant hormonal therapy. In cases of small vo lume, low grade (Gleason score <7) prostate cancer in stage C or D1, r adical surgery coupled with adjuvant hormonal therapy leads to surviva l rates in stage C similar to those in the intraprostatic stage, and i n stage D1 with minimal lymph involvement, seems to delay clinical dev elopment of metastases. Finally, the quality of life associated with a djuvant therapy and the drug regimens available for this therapy are r eviewed.