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Neoadjuvant androgen ablation in localized carcinoma of the prostate
1Genitourinary Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, MCC-UROPROG, 12902 Magnolia Drive, Tampa, FL 33612, USA. KishJA@moffitt.usf.edu
Background:
An increased awareness of prostate cancer has led to a rise in the detection of this disease at a clinically localized stage at presentation. This article discusses the role of neoadjuvant hormonal ablation at this earlier stage to decrease tumor bulk and thus enhance survival.
Methods:
Outcomes from each primary modality for localized treatment of prostate cancer with and without neoadjuvant androgen deprivation (NAAD) are reviewed.
Results:
Survival benefit using NAAD has not yet been demonstrated from prostatectomy. Long-term hormonal deprivation provides an improved time to progression and has decreased distant metastatic and biochemical failure for poor-risk patients undergoing external-beam radiation. The toxicities of brachytherapy can be decreased with NAAD.
Conclusions:
NAAD with radical prostatectomy is considered to be investigational. The duration of NAAD needs to be delineated for poor-prognosis patients who are treated with external-beam radiation therapy, but the approach improves the local toxicity of brachytherapy.