Neoadjuvant therapy in prostate cancer--is it of any use?

Since 1941, when the androgen dependency of prostatic carcinoma was described first, the question whether neoadjuvant hormone manipulation enhances surgical curability has been of actual importance. With the availability of reversible luteinizing hormone-releasing hormone analogues and non-steroidal antiandrogens, interest in preoperative hormonal manipulation has recently been reinnovated. An overview of the published, sometimes conflicting clinical and pathological studies evaluating the value of neoadjuvant hormone manipulation is given. We conclude that further well-controlled clinical investigations comparing downstaging and downgrading percentages, percentages of local control and survival are needed to prove the benefit of neoadjuvant treatment in patients with locally confined prostatic carcinoma.