Role of early adjuvant hormonal therapy after radical prostatectomy for prostate cancer

Purpose: Recent prospective randomized studies have shown that adjuvant hor monal therapy combined with local treatment can significantly improve overa ll survival in patients with locally advanced disease. This finding challen ges the previous belief that adjuvant hormonal therapy may not be beneficia l for minimal stages TxN + M0 or less prostate cancer, particularly when co mbined with local treatment. We reviewed the benefits of adjuvant hormonal therapy in patients at risk for disease progression, especially when admini stered after radical prostatectomy. Materials and Methods: We retrospectively reviewed the current literature a nd evaluated clinical information on stage pT3b cancer from a large single institution prostate cancer database to determine the current role of adjuv ant hormonal therapy after radical prostatectomy for prostate cancer. Results: Retrospective experimental and clinical studies have proved the im pact of adjuvant hormonal therapy for decreasing prostate specific antigen (PSA) and clinical disease progression in patients with regionally limited prostatic cancer. This finding applies to stage pT3b as well as to lymph no de positive cancer. Our literature review and current data from the Mayo Cl inic database show that adjuvant hormonal therapy after prostatectomy has a significant impact on prostate specific antigen (PSA) progression but it a lso decreases systemic progression and cause specific death in patients wit h stage pT3b and lymph node positive disease. After adjusting for preoperat ive PSA, margins, grade, ploidy and patient age the risk ratio for stage pT 3b disease in 707 cases was 0.3 (95% confidence interval 0.2 to 0.7). A rec ent prospective randomized trial showed a significant decrease in cancer de ath in N+ cases when adjuvant hormonal therapy was administered after radic al prostatectomy, supporting previous Mayo Clinic data on N+ disease that f avors combination therapy. In the PSA era, that is 1987 and after, our data base data on stage pTxN+ cancer indicates that radical prostatectomy and ho rmonal therapy for single node positive disease resulted in 94% 10-year cau se specific survival, which was not significantly different from the rate i n patients with NO disease after adjusting for local stage, Gleason grade, margins, ploidy, PSA and adjuvant hormonal therapy. Conclusions: Our literature review, including prospective randomized studie s, and more recent results in the PSA era from our database indicate that e arly adjuvant hormonal therapy has a significant impact on time to progress ion and cause specific survival in patients with seminal vesicle invasion a nd limited lymph node disease who undergo radical prostatectomy, although i n a retrospective nonrandomized study. Future prospective studies with long er followup are needed to evaluate the potential benefit of adjuvant treatm ent in regard to survival for stages pT2 and pT3a disease with unfavorable pathological variables.