Adjuvant and neoadjuvant hormonal therapy for prostate cancer

Many men with early stage prostate cancer suffer relapse and/or die of thei r disease despite potentially curative surgery or radiotherapy. Early hormo nal therapies are being combined with these local therapies, with the aim o f facilitating local control and improving survival. In the surgical settin g, neoadjuvant hormonal therapy reduces the rate of positive margins and ex tracapsular penetration, but most studies have failed to demonstrate an adv antage with respect to biochemical progression. Further studies are needed to clarify the role of adjuvant therapy in surgical patients. In the radiot herapy setting, neoadjuvant hormonal therapy improves local control, althou gh survival data is not available, and can be considered for stage T2b dise ase or higher. Adjuvant luteinizing hormone-releasing hormone (LH-RH) agoni sts improve both local control and survival after radiotherapy and should b e offered to all patients. Currently, the LH-RH agonists are the drugs of c hoice for adjuvant thera py, whereas combined androgen blockade has general ly been used as neoadjuvant therapy. Monotherapy with a nonsteroidal antian drogen has considerable potential in both settings. Areas for future studie s include appropriate endpoints for clinical studies, comparative drug effi cacy and the effect of treatment on quality of life. Copyright (C) 1999 S. Karger AG, Basel.