Neoadjuvant hormonal treatment combined with external irradiation in the management of prostate cancer

RTOG and EORTC trials have paved the way of the combination of radiation therapy and androgen suppression. Localized carcinoma with intermediate prognostic factors (cT2b, Gleason 7, or baseline PSA ranging between 10 and 20 ng/mL) may be submitted to a 4-month complete androgene blockade with 2 months before irradiation, unless to include patients in ongoing randomized trials. High risk cancers (cT2c, or Gleason > 7, or PSA > 20 ng/ml) should receive a 4-month or 6-month complete androgen blockade (RTOG trial 86-10), knowing that the results of EORTC trial 22961 are eagerly expected to tell us whether a 3- year androgen suppression is preferable. Very high risk prostate cancers, T3-4 N0 M0 or pelvic lymph node involvement (c or pN1) whatever the UICC T stage, need a long term androgen suppression of 3 years or more.