How the Addition of Hormones Improves Outcome: Hormone Therapy and Surgery

Neoadjuvant hormonal therapy (NHT) prior to radical prostatectomy can result in both downsizing (30-35% after 3 months) and downstaging of the tumour. In localised disease, NHT reduces the incidence of positive margins by about 50%. However, 3 months of NHT has failed to show a benefit in terms of biochemical (PSA) recurrence after surgery. Longer courses of NHT are being investigated and may result in better biochemical outcomes. Patients at high risk of disease progression after radical prostatectomy should be considered for adjuvant hormonal therapy (AHT) or chemotherapy, as some studies suggest that immediate therapy may be superior to deferred treatment in these high-risk groups. In patients with PSA recurrence after radical prostatectomy, PSA kinetics allows us to identify those patients who may benefit most from early hormonal treatment.