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

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 5 years 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. (C) 2009 Elsevier Ltd. All rights reserved.