Combinations of hormones and local therapies in locally advanced prostate carcinoma

Locally advanced adenocarcinoma of the prostate (American Urological Association stages B2, C; American Joint Committee on Cancer stages T2c, T3) has been difficult to control by either external-beam irradiation or radical prostatectomy. The combination of local therapies with hormonal manipulation is an innovative strategy to combat this entity. Hormonal regimens have evolved to include total androgen suppression, or maximal androgen blockade. In phase III trials, it appears that the combination of irradiation and hormones is superior to the use of radiotherapy alone. Results of phase III trials comparing surgery to combinations of surgery and hormones have been less encouraging. To date, no prospective randomized trial comparing the combination of hormones plus surgery to hormones plus irradiation has been completed.