Hormonal therapy in the management of prostate cancer: from Huggins to the present

Hormonal therapy has been the mainstay of treatment for advanced forms of prostate cancer. Although early clinical studies suggested that major improvements and even cure could occur, later randomized prospective investigations showed that hormonal treatments were palliative rather than curative. Subsequent studies have suggested, but not conclusively proven, that earlier initiation of hormonal therapy for patients with early forms of metastatic disease may prolong disease-free and overall survival. The choice of hormonal agents, either alone as monotherapy or in combination with agents of differing mechanisms of action, suggests that further improvements in survival can be achieved with combinations of hormonal agents. Many studies have suggested that the use of hormonal therapy with localized forms of prostate cancer may provide pathologic benefit in decreasing the amount of tumor found at the time of radical prostatectomy or treated during radiation therapy. Although short-term outcomes looking at tumor "downstaging" have been positive, longer follow-up will be necessary before definitive conclusions can be made regarding the ultimate utility of preoperative or preradiation therapy hormonal treatments (neoadjuvant hormonal therapy).