Neoadjuvant hormonal therapy in men being treated with radiotherapy for localized prostate cancer

Several prospective randomized trials have demonstrated that men with localized prostate cancer benefit from the use of short-term neoadjuvant hormonal therapy (NHT) in combination with external beam radiotherapy (EBRT). Seven randomized trials were summarized in 6 publications including patients treated with NHT in combination with EBRT on 1 or more arms. A total of 17 different arms were compared including radiotherapy alone (n = 3), and NHT and concurrent hormonal therapy (N&CHT) (n = 12) with or without short-term adjuvant hormonal therapy (SAHT) (n = 5) or long-term hormonal therapy (n = 1). Patients treated with EBRT alone had a worse outcome than those treated with NHT. Intermediate-risk patients treated with 2 to 3 months of NHT did as well as those treated with longer neoadjuvant therapy or SAHT. The preponderance of data supports the use of NHT in combination with EBRT in intermediate-risk patients.