Hormones and radiation therapy in locally advanced adenocarcinoma of the prostate

Hormonal dependency of prostate cancer was first described in 1895 by White who showed the initial observation between castration and the treatment of prostatic disease in men with bladder outlet obstruction secondary to benign prostatic hypertrophy. Subsequently, in 1940 Huggins and Hodges demonstrated the association between normal and hyperplastic epithelium of canine prostate glands and adequate levels of circulating androgens. This pioneering work led extensive investigation of the role of androgens in both prostatic growth for benign and malignant disease. The goal of this article is to review the role of hormonal manipulation in prostate cancer in general and more specifically to focus on the role of radiation therapy and hormonal manipulation in locally advanced adenocarcinoma of the prostate. The article is divided into sections that outline the role of different types of hormonal manipulation that are currently available along with the early work combining hormonal manipulation and radiation therapy for prostate cancer. Subsequently, a thorough review of the phase III trials performed to evaluate the potential role of hormonal manipulation in addition to radiation therapy in locally advanced adenocarcinoma of the prostate. Included in that discussion is a section on the potential toxicities of hormonal manipulation. Finally, the current recommendations for the use of hormonal manipulation combined with radiation therapy in locally advanced adenocarcinoma of the prostate is described.