Management of locally advanced prostate cancer. 2. Radiotherapy, neoadjuvant endocrine treatment, update 1997-1999

Part 2 of this review identifies the need for effective adjuvant treatment in patients with T3 disease and poor prognostic factors identifiable after surgery. A large volume of information has become available from randomized neoadjuvant and adjuvant studies using endocrine treatment in association with either surgery or radiotherapy. It is well documented that such therapy delays progression in prostate cancer of any stage. This must be taken into account in the interpretation of adjuvant studies of endocrine treatment. Unfortunately, although it leads to volume reduction and downstaging of the primary tumor, neoadjuvant endocrine treatment prior to surgery has not been shown to improve rates of biochemical or clinical progression and/or survival. Neoadjuvant and adjuvant approaches combined with external beam radiotherapy seem to be more effective. Recent data show significant improvements in the time to progression as well as in disease-specific and overall survival following radiotherapy alone as compared with neoadjuvant and/or adjuvant endocrine treatment in addition to radiotherapy. At this time, however, it remains unclear whether endocrine treatment alone might not produce a similar effect. Studies confirming the value of adding radiotherapy to endocrine treatment for T3 disease are urgently needed.