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

The rationale for the use of neoadjuvant hormone therapy in combination with radiation therapy is that it reduces tumour volume and therefore the amount of radiation therapy that is needed to treat the tumour. To maximise tumour regression, for the first month of NHT at least it is likely that an antiandrogen would also be needed as part of the treatment regimen. It has been found that 3-4 months of hormonal therapy reduces prostate volume by 25-54%. Intermediate-risk patients treated with NHT and concomitant hormonal therapy have been found to have a 94% freedom from biochemical failure after 4 years, suggesting that this group is the ideal patient population to receive short-term hormonal therapy in combination with brachytherapy. For high-risk patients, the conclusions drawn from recent clinical studies suggest that it is necessary to take multimodal approach using a combination of agents. Long-term studies are necessary with radiation therapy to truly determine which patients are failing and how best to manage them.