Adjuvant hormone therapy for localised and locally advanced prostate carcinoma: A systematic review and meta-analysis of randomised trials

Shelley, M.D.; Kumar, S.; Coles, B.; Wilt, T.; Staffurth, J.; Mason, M.D.

doi:10.1016/j.ctrv.2009.05.001

« Previous Next »Cancer Treatment Reviews
Volume 35, Issue 7 , Pages 540-546, November 2009

Adjuvant hormone therapy for localised and locally advanced prostate carcinoma: A systematic review and meta-analysis of randomised trials

M.D. Shelley
- Cochrane Urological Cancers Unit, Research Department, Velindre NHS Trust, Cardiff CF14 2TL, UK
- Corresponding author. Tel.: +44 029 20 316909; fax: +44 029 20 529625.
S. Kumar
- Department of Oncology, Velindre NHS Trust, Cardiff CF14 2TL, UK
- Tel.: +44 029 20 615888; fax: +44 029 20 316267.
B. Coles
- Cardiff Information Service, Cardiff University, Velindre NHS Trust, Cardiff CF14 2TL, UK
- Tel.: +44 029 20 316291; fax: +44 029 20 521609.
T. Wilt
- Cochrane Prostate Diseases and Urologic Cancers Group, VA Centre for Chronic Disease Outcomes Research, Minneapolis, MN 55417, USA
- Tel.: +1 612 467 2681; fax: +1 612 467 2118.
J. Staffurth
- Cardiff University, School of Medicine, Research Department, Velindre NHS Trust, Cardiff CF14 2TL, UK
- Tel.: +44 029 2061 5888x6353; fax: +44 029 2052 9625.
M.D. Mason
- Cardiff University, School of Medicine, Research Department, Velindre NHS Trust, Cardiff CF14 2TL, UK
- Tel.: +44 029 20 316964; fax: +44 029 20 529625.

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.

Keywords: Adjuvant hormone therapy, Radiotherapy, Prostatectomy, Prostate cancer, Systematic review, Meta-analysis