Hormone and Radiotherapy versus Hormone or Radiotherapy Alone for Non-metastatic Prostate Cancer: A Systematic Review with Meta-analyses

• Published in: Clinical oncology (Royal College of Radiologists (Great Britain)) 2014-10, Vol.26 (10), p.e21-e46
• Main Authors: Schmidt-Hansen, M, Hoskin, P, Kirkbride, P, Hasler, E, Bromham, N
• Format: Article
• Language: English
• Subjects: Androgen Antagonists - therapeutic use; Chemoradiotherapy; First-line treatment; Hematology, Oncology and Palliative Medicine; hormone therapy; Humans; locally advanced; Male; Prognosis; prostate cancer; prostate neoplasm; Prostatic Neoplasms - drug therapy; Prostatic Neoplasms - radiotherapy; Radiology; Radiotherapy
• ISSN: 0936-6555; 1433-2981
• DOI: 10.1016/j.clon.2014.06.016

Abstract Aims Radiotherapy is standard treatment for localised prostate cancer and is often combined with hormone treatment to prevent androgen stimulation of prostate cancer. Hormone therapy carries significant morbidity and can only be justified in the radical treatment of localised disease if it can be balanced against a significant gain in disease control and survival. Materials and methods We searched Medline, Premedline, Embase, Cochrane Library, Web of Science (SCI & SSCI) and Biomed Central for randomised controlled trials published in English comparing radiotherapy or hormone therapy alone with radiotherapy and hormone therapy in combination as first-line treatment in patients with non-metastatic prostate cancer reporting overall survival, disease-free survival, distant metastases-free survival, biochemical survival, adverse events (including cardiovascular) and/or health-related quality of life. Results Fourteen trials were included and showed that combination therapy was associated with better or similar survival and disease-free outcomes compared with single-modality treatment, and that this may particularly be the case for patients with higher risk disease. The results also suggested that combination therapy is associated with more and worse adverse events and quality of life, although this was not always the case. Some of the results are at risk of reporting bias. Conclusion The published data support the use of combined treatment with androgen deprivation and radiotherapy for intermediate- and high-risk localised and locally advanced prostate cancer. Optimal timing, duration, formulation and the management of side-effects remain important questions for further research.