Hormone Therapy for Prostate Cancer: Exploring Current Controversies

Context. Although there is increasing interest in the use of neoadjuvant or adjuvant hormone therapy with local treatment for patients with prostate cancer (PCa), the survival benefit of hormone therapy is still debated. In addition, hormone therapy is associated with adverse events, which can have negative effects on a patient's quality of life (QoL). Intermittent hormone therapy is being investigated as an alternative to continuous hormone therapy for advanced PCa with the aims of delaying progression to hormone-refractory PCa and minimising adverse events. Objective: To summarise current controversies on hormone therapy for PCa. Evidence acquisition: This manuscript is based on presentations given at a satellite symposium held at the 2nd World Congress on Controversies in Urology (CURy) in Lisbon, Portugal. Recent English-language reports were identified through a search of Medline and abstracts of scientific congresses on hormone therapy for PCa. Data from review papers, original papers, and abstracts were compiled and interpreted. Evidence synthesis: Neoadjuvant hormone therapy with radical prostatectomy (RP) does not seem to offer a survival advantage over RP alone in patients with localised and locally advanced PCa. Neoadjuvant hormone therapy with radiotherapy (RT) appears to improve treatment outcomes over RT alone in patients with locally advanced PCa, but the impact on overall survival is still unclear. Adjuvant hormone therapy with RT seems to increase overall survival in high-risk localised and locally advanced PCa. Final results of a phase 3 trial suggest that intermittent hormone therapy improves QoL without a negative effect on overall survival Compared with continuous hormone therapy. Furthermore, the patient-physician dialogue should be enhanced and patients' preferences should be taken into consideration in the decision-making process. Conclusions: Neoadjuvant or adjuvant hormone therapy with radical treatment may improve survival in carefully selected patients with PCa. Intermittent hormone therapy seems to reduce adverse events and improve QoL without a negative effect on survival. The availability of different formulations of a luteinising hormone-releasing hormone agonist offers patients an individualised treatment approach. (C) 2009 European Association of Urology. Published by Elsevier B.V. All rights reserved.