What is appropriate neoadjuvant/adjuvant androgen deprivation for high-risk/locally advanced prostate cancer?

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The majority of low-risk patients with clinically localized prostate cancer have a high likelihood of disease-free survival, regardless of the treatment option chosen.1 In contrast, patients with high-risk prostate cancer with high Gleason score, elevated prostate-specific antigen level and advanced clinical stage have a high probability of treatment failure after initial management by single-treatment modalities, such as radical prostatectomy (RP), external beam radiation therapy (EBRT) or brachytherapy.2, 3 Therefore, it is extremely important to establish the most effective treatment strategy for patients with high-risk prostate cancer. As high-risk patients may have locally advanced disease with direct extension and/or micrometastases, various combinations of treatments have been developed to augment cancer-specific survival. Neoadjuvant and/or adjuvant androgen deprivation therapy (ADT) offer synergistic enhancement of radiation therapy (RT) or RP due to induction of apoptosis. Moreover, ADT may play a role in elimination of occult systemic disease.4 Whereas many studies have demonstrated benefits of ADT used in conjunction with EBRT to treat locally advanced prostate cancer,5, 6 questions and criticisms remain, including the details of the duration, timing and contents of ADT.

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