Capabilities of the neoadjuvant and adjuvant hormonal therapy in the combination treatment of the prostate cancer

Grickevich A.A., Mishugin S.V., Rusakov I.G.

This article is a review of the last randomized trials, devoted to the assessment and standardization of the neoadjuvant and adjuvant androgen deprivation models in combination with the external radiation therapy. The patients with the low risk of progression are characterized as prognosisperspective independent of the type of the hormonal/radiation therapy. Intermediate and high risk patients are the group, that needs more strict risk stratification. Nowadays we have access to a restricted number of the randomized trials devoted to the combination treatment using neoadjuvant, concomitant and adjuvant therapy. RTOG 8610 study showed the overall survival benefit for the combination of the radiation, neoadjuvant and concomitant therapy when compared to the radiation therapy alone: 43% versus 34%. In case of the high risk prostate cancer short-term androgen blockade before and in course of the radiation therapy tends to increase the overall survival rate, although it seems, according to the EORTC 22961 study, that 3-year long course is more effective. Short-term androgen deprivation before and during the radiation therapy could increase overall survival rate in the patients with T2c-3N0-x and Gleason sum 2-6. The implementation of the neoadjuvant and adjuvant hormonal therapy in the combination with the external-beam radiation therapy showed the decrease of the risk of the biochemical recurrence, metastatic progression, in some studies it showed to be of benefit in terms of overall survival. Nevertheless, the final interpretation of the results derived from different studies was extremely hard, while almost all the studies included the patients of the heterogeneous risk groups (high and intermediate). This warrants the further studies in this area.

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