Contemporary Role of Endocrine Treatment in Patients with Localized or Locally Advanced Prostate Cancer: A Review

The objetive of this paper is to undertake a review of hormone therapy in localized or locally advanced prostate cancer. We have searched MEDLINE (1996-2009) for randomized or quasi- randomized controlled trials of patients with localised or locally advanced prostate cancer, that is, stages T1-T4, any N, M0, analizing: 1. Primary hormone therapy alone. 2. Neoadjuvant hormone therapy plus prostatectomy. 3. Neoadjuvant +/- concomitant hormone therapy plus radiotherapy. 4. Neoadjuvant hormone therapy plus radiotherapy plus adjuvant hormone therapy. 5. Adjuvant hormone therapy to primary curative intent. a. Radical prostatectomy and adjuvant hormone therapy. b. Radiotherapy and adjuvant hormone therapy. c. Adjuvant hormone therapy with bicalutamide. d. Duration of adjuvant hormone therapy to radiotherapy. 6. Early vs deferred hormonal treatment. 7. Hormone therapy and brachyterapy or cryotherapy. Until very recently it was known that endocrine therapy could improve progression free survival but few studies could demostrate a survival advantage in patients treated wih early endocrine therapy. Treatment of locally advanced prostate cancer (T3-4 N0 M0, T1-4 N1 M0) just with early androgen deprivation has shown not to be superior to deferred androgen deprivation in terms of neither overall nor prostate cancer specific survival. In locally advanced prostate cancer in order to gain benefit of early androgen deprivation, either radical prostatectomy or radiotherapy must be added. Results of several randomized and non-randomized clinical trials published in the English literature suggest that neoadjuvant hormone therapy prior to prostatectomy does not improve overall survival. The use of longer duration of neoadjuvant hormone therapy has any impact in patients survival. Patients treated with radiotherapy show a different outcome. Neo-adjuvant hormones prior to radiotherapy significantly improves both clinical disease-free survival and overall survival at 5 and 10 years.