The Emerging Role of Neoadjuvant Hormonal Therapy in the Management of Localized Prostatic Cancer-Reply

Abstract

There has been recent enthusiasm about the emerging role of androgen ablative therapy in conjunction with radiotherapy in the treatment of locally advanced prostatic cancer. For bulky prostatic tumors, high-dose radiotherapy, which is necessary to eradicate locally advanced disease (1), may not be feasible given the relatively large volume of normal tissue structures that lie in close proximity to the target volume. In a previously published article in this journal (2), Forman et al. demonstrated in 20 patients a distinct advantage in the use of neoadjuvant hormonal therapy (NHT) in an effort to reduce the target volume of patients with stage T1-T2 prostate tumors as well as minimizing the volume of normal organs such as the rectum and bladder exposed to the high doss of irradiation prior to a planned course of therapy. In that study, the authors noted a 21% and 23% reduction of the rectal and bladder volumes, respectively, receiving 65 Gy.