We performed a systematic review and meta-analysis of randomised trials of neo-adjuvant
hormone therapy (NHT) in localised and locally advanced prostate cancer to assess
the effectiveness of this therapy.
We searched MEDLINE, The Cochrane Library, Science Citation Index, LILACS and SIGLE
for randomised trials comparing NHT plus primary therapy (radiotherapy or prostatectomy)
with primary therapy alone. Data included information on study design, participants,
interventions, and outcomes. Comparable data were extracted from eligible studies
and pooled for meta-analysis with intention to treat principle.
NHT prior to prostatectomy did not improve overall or disease-free survival, but did
significantly reduce positive margin rates (RR 0.49, 95% CI 0.42-0.56, p<0.00001),
organ confinement (RR 1.63, 95% CI 1.37-1.95, p<0.0001) and lymph node invasion (RR
0.49, 95% CI 0.42-0.56, p<0.02). In one study NHT before radiotherapy significantly
improved overall survival for men with Gleason 2-6 (p=0.015). In addition, there was
a significant improvement in both clinical disease-free survival (RR 1.46, 95% CI
1.24-1.71, p<0.00001) and biochemical disease-free survival (RR 1.59, 95% CI 1.00-2.55,
p=0.05). Toxicities included hot flushes, gastrointestinal, hepatic and miscellaneous
adverse events.
NHT is associated with significant clinical benefit when given with radiotherapy and
improves pathological outcome prior to prostatectomy but is of minimal value prior
to radical prostatectomy. The decision to use hormone therapy should be discussed
between the patient, the clinician and policy maker based on the benefits, toxicity
and cost.