Adjuvant hormone therapy for localised and locally advanced prostate carcinoma: A systematic review and meta-analysis of randomised trials
Received 23 February 2009; received in revised form 5 May 2009; accepted 6 May 2009. published online 03 June 2009.
Summary
Background
Adjuvant hormone therapy (AHT) following radiotherapy or surgery is a treatment option frequently offered to men with localised or locally advanced prostate cancer. We performed a systematic review of published randomised trials to assess the effectiveness of AHT.
Methods
We searched MEDLINE, EMBASE, the Cochrane library, SCI, LILACS and SIGLE for randomised trials comparing AHT plus primary therapy (radiotherapy or prostatectomy) with primary therapy alone. Data on study design, participants interventions and outcomes were extracted from relevant studies and where possible pooled for meta-analysis.
Findings
AHT following radiotherapy improved overall survival (at 5years OR fixed effect model 1.29, 95% CI 1.07–1.56, p=0.007), disease-specific survival (OR 2.10, 95% CI 1.53–2.88, p<0.00001) and disease-free survival (OR 1.91, 95% CI 1.16–2.23, p<0.00001). A random effect model favoured adjuvant hormone therapy but did not reach significance. After prostatectomy, there was no significant overall survival advantage with AHT, although one study reported a significant improvement in disease-specific survival (HR 4.09, p=0.0004). Disease-free survival was also better with AHT (OR 3.73, 95% CI 2.30–6.03, p<0.00001). AHT-induced toxicities included gynaecomastia, impotence, gastrointestinal and haematological.
Conclusions
There are significant clinical benefits associated with the use of AHT for early prostate cancer. Patients should make an informed decision to accept AHT based on its effectiveness and side-effects.
ABSTRACT