The case for adjuvant therapy for prostate cancer

Purpose: The rationale for adjuvant therapy for prostate cancer was reviewed. Materials and Methods: A selective review of the successful experience with adjuvant therapy in other epithelial neoplasms is presented along with discussion of the increasing success of chemotherapy to improve outcomes in advanced prostate cancer. Results: Adjuvant therapy could be effective for prostate cancer if men with high risk features, such as Gleason score 8 or greater, prostate specific antigen more than 20 ng/ml, positive surgical margins with Gleason score 7 or greater, seminal vesicle invasion or positive lymph nodes, were selectively given additional therapy after primary surgery or radiation. These individuals are easily identified by routine pathological findings and precise recurrence risks can be calculated with available nomograms. For primary radiotherapy hormonal adjuvant treatment has now been shown to produce improved disease-free and overall survival. Adjuvant radiotherapy following prostatectomy decreases biochemical relapse and local disease recurrence. Adjuvant hormonal therapy after prostatectomy is also beneficial in select patients. Adjuvant chemotherapy now has a powerful rationale since it has been shown to improve survival in other common epithelial cancers, such as those of the breast, colon and lung. Newer agents produce significant response rates in patients with advanced metastatic prostate cancer, even prolonging overall survival. Conclusions: Only through dedication to a multimodality approach with all disciplines, including surgical urology, radiation therapy and medical oncology, will the promise of adjuvant therapy for prostate cancer be fully realized.