Additional therapy for high-risk prostate cancer treated with surgery: what is the evidence?

Single-modality approaches to the treatment of high-risk prostate cancer, whether radical prostatectomy or external-beam radiotherapy, have yielded disappointing results. Treatment intensification has, thus, been the subject of considerable research activity in recent years. This review will discuss the evidence for neoadjuvant and adjuvant treatment approaches when surgery is chosen as the definitive therapy for high-risk prostate cancer. Particular emphasis will be placed on the randomized trials, both completed and in progress. Trials investigating adjuvant radiotherapy, androgen-deprivation therapy and chemotherapy will each be discussed in turn. Among these, only adjuvant radiotherapy has been shown to prolong survival after surgery, and the recently published evidence for this benefit will be discussed in detail.